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Decision making by NICE: examining the influences of evidence, process and context

  • Karin H. Cerri (a1), Martin Knapp (a2) and Jose-Luis Fernandez (a3)
Abstract
Abstract

The National Institute for Health and Clinical Excellence (NICE) provides guidance to the National Health Service (NHS) in England and Wales on funding and use of new technologies. This study examined the impact of evidence, process and context factors on NICE decisions in 2004–2009. A data set of NICE decisions pertaining to pharmaceutical technologies was created, including 32 variables extracted from published information. A three-category outcome variable was used, defined as the decision to ‘recommend’, ‘restrict’ or ‘not recommend’ a technology. With multinomial logistic regression, the relative contribution of explanatory variables on NICE decisions was assessed. A total of 65 technology appraisals (118 technologies) were analysed. Of the technologies, 27% were recommended, 58% were restricted and 14% were not recommended by NICE for NHS funding. The multinomial model showed significant associations (p ⩽ 0.10) between NICE outcome and four variables: (i) demonstration of statistical superiority of the primary endpoint in clinical trials by the appraised technology; (ii) the incremental cost-effectiveness ratio (ICER); (iii) the number of pharmaceuticals appraised within the same appraisal; and (iv) the appraisal year. Results confirm the value of a comprehensive and multivariate approach to understanding NICE decision making. New factors affecting NICE decision making were identified, including the effect of clinical superiority, and the effect of process and socio-economic factors.

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Copyright
The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution licence http://creativecommons.org/licenses/by/3.0/
Corresponding author
*Correspondence to: Dr Karin H. Cerri, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK. Email: k.h.cerri@lse.ac.uk
References
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Al M. J., Feenstra T. Brouwer W. B. (2004), ‘Decision makers’ views on health care objectives and budget constraints: results from a pilot study’, Health Policy, 70(1): 3348.
Association of the British Pharmaceutical Industry (ABPI) (2010), ‘Facts & Statistics from the Pharmaceutical Industry – Medicines and the NHS’. www.abpi.org.uk/statistics/section.asp?sect=4#15 [29 January 2010].
Barbieri M., Hawkins N. Sculpher M. (2009), ‘Who does the numbers? The role of third-party technology assessment to inform health systems’ decision-making about the funding of health technologies’, Value Health, 12(2): 193201.
BBC (2005), ‘2005: Historic third term for Labor’, http://news.bbc.co.uk/2/hi/uk_news/politics/vote_2005/6994476.stm [22 December 2010].
Bryan S., Williams I. McIver S. (2007), ‘Seeing the NICE side of cost-effectiveness analysis: a qualitative investigation of the use of CEA in NICE technology appraisals’, Health Economics, 16(2): 179193.
Buxton M. J. (2005), ‘How much are health-care systems prepared to pay to produce a QALY?’, European Journal of Health Economics, 6: 285287.
Chalkidou K. (2009), ‘Comparative effectiveness review within the U.K.'s National Institute for Health and Clinical Excellence’, The Commonwealth Fund Issue Brief, 59: 112.
Clement F. M., Harris A., Li J. J., Yong K., Lee K. M. Manns B. J. (2009), ‘Using effectiveness and cost-effectiveness to make drug coverage decisions: a comparison of Britain, Australia, and Canada’, JAMA, 302(13): 14371443.
Dakin H. A., Devlin N. J. Odeyemi I. A. O. (2006), ‘“Yes”, “No” or “Yes, but”? Multinomial modelling of NICE decision-making’, Health Policy, 77: 352367.
Department of Health (2002), Improvement, Expansion and Reform: The Next Three Years Priorities and Planning Framework 2003–2006 London: Department of Health (Crown Copyright).
Department of Health (2006a), The NHS in England: The Operating Framework for 2006/7, London: Crown Copyright.
Department of Health (2006b), The NHS in England: The Operating Framework for 2007/08, London: Crown Copyright.
Department of Health (2007), The NHS in England: The Operating Framework for 2008/09, London: Crown Copyright.
Devlin N. Parkin D. (2004), ‘Does NICE have a cost-effectiveness threshold and what other factors influence its decisions? A binary choice analysis’, Health Economics, 13(5): 437452.
EUnetHTA (2011), ‘HTA definition’ 2011, http://www.eunethta.net/Public/AboutEUnetHTA/HTA/ [2 February 2011].
European Medicines Agency (2011), ‘European Public Assessment Reports’, www.ema.europa.eu/ema [30 March 2011].
Henshall C., Oortwijn W., Stevens A., Granados A. Banta D. (1997), ‘Priority setting for health technology assessment – theoretical considerations and practical approaches – a paper produced by the priority setting subgroup of the EUR ASSESS project’, International Journal of Technology Assessment in Health Care, 13(2): 144185.
Joint Formulary Committee (2010), British National Formulary, 60 ed, London: British Medical Association and Royal Pharmaceutical Society.
Kanavos P., Nicod E., van den Aardweg S. Pomedli S. (2010), ‘The impact of health technology assessments: an international comparison’, Euro Observer 12(4): 17.
Littlejohns P., Garner S., Doyle N., Macbeth F., Barnett D. Longson C. (2009), ‘10 years of NICE: still growing and still controversial’, Lancet Oncology, 10(4): 417424.
Mason A. R. Drummond M. F. (2009), ‘Public funding of new cancer drugs: Is NICE getting nastier?’, European Journal of Cancer, 45(7): 11881192.
Menon D., Stafinski T. Stuart G. (2005), ‘Access to drugs for cancer: Does where you live matter?’, Canadian Journal of Public Health, 96(6): 454458.
National Office for Statistics (2009), Key demographic and health indicators, 1976 onwards: Population Trends. ONS 1976-2008 data.
NICE (2008a), Guide to the methods of technology appraisal, NICE. http://www.nice.org.uk/media/B52/A7/TAMethodsGuideUpdatedJune2008.pdf [15 May 2009].
NICE (2008b), Social Value Judgements – Principles for the Development of NICE guidance. Second edition, NICE http://www.nice.org.uk/media/C18/30/SVJ2PUBLICATION2008.pdf [15 May 2009].
NICE (2009), Threshold Workshop Report. NICE.
O'Neill P. Devlin N. J. (2010), ‘An analysis of NICE's ‘restricted’ (or ‘optimized’) decisions’, Pharmacoeconomics, 28(11): 987993.
OECD ed. (2005), Health Technologies and Decision Making, The OECD Health Project, OECD Publishing. Printed in France.
Owens D. K. (1998), ‘Interpretation of cost-effectiveness analyses’, JGIM, 13: 716717.
Packer C., Simpson S. Stevens A., EuroScan: the European Information Network on New and Changing Health Technologies. (2006), ‘International diffusion of new health technologies: a ten-country analysis of six health technologies’, International Journal of Technology Assessment in Health Care, 22(4): 419428.
Raftery J. (2006), ‘Review of NICE's recommendations, 1999–2005’, BMJ, 332(7552): 12661268.
Ross J. (1995), ‘The use of economic evaluation in health care: Australian decision makers’ perceptions’, Health Policy, 31(2): 103110.
Sorenson C., Drummond M., Kanavos P. (2008). Ensuring value for Money in Health Care: the role of HTA in the European Union. Cornwall: World Health Organisation, on behalf of the European Observatory on Health Systems and Policies.
Summerhayes M. Catchpole P. (2006), ‘Has NICE been nice to cancer?’, European Journal of Cancer, 42(17): 28812886.
Velasco Garrido M. Busse R. (2005), Health Technology Assessment – An Introduction on Objectives, Role of Evidence, and Structure in Europe, Brussels: European Observatory on Health Systems and Policies.
Vuorenkoski L., Toiviainen H. Hemminki E. (2008), ‘Decision-making in priority setting for medicines – a review of empirical studies’, Health Policy, 86(1): 19.
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Health Economics, Policy and Law
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