Nermina Ferizovic | Health Economics Expert

The National Institute for Health and Care Excellence (NICE) are currently undertaking a review of the methods they employ for the evaluation of health technologies in order to ensure that they remain “cutting-edge” and “support the needs of the health and life sciences ecosystem”. Five key areas are being examined: valuing the benefits of health technologies; understanding and improving the evidence base; structured decision making; challenging technologies, conditions and evaluations; and aligning methods across programmes. These areas cover the elements of health technology appraisals and include academic input to ensure that changes to the methods are in line with the latest research and theoretically sound. From a health economics perspective, the latter is fundamental: supporting the needs of the health and life sciences ecosystems must be in line with economic theory and understanding with pragmatic consideration given to any proposed changes and their implications. With this in mind, several of the proposed changes may impact negatively on reimbursement decisions and the field as a whole. 

An example is that of the discounting rate used to value costs and benefits*. Whilst 1.5% is the Treasury’s preferred approach, the implications of reverting to 1.5% from the current 3.5% are potentially wide-reaching. For instance, there would be a very strong argument for the re-assessment of all appraisals conducted to date with possible changes to past reimbursement decisions. Not only would this be an administrative burden on NICE and other agencies, but it could impact on patient access to health interventions. A further example is that of the assessment of uncertainty. Although this is an essential part of economic evaluations, the proposed changes create an unrealistic analytic burden on agencies with relatively small returns and minimal impact on decision making. A final example is that of disease severity modifiers intended to take into account the impact of the disease on patients and their families. In principle, these should provide a fairer assessment of interventions, in particular for rare diseases, but may be prone to double counting especially where vignettes are used for utility generation. 

As such, these, and other elements of the NICE methods review, need to be carefully considered by NICE and its academic partners to ensure that the changes to the methods are not only “cutting edge” but also pragmatic.

* Although not part of the current workstream, will be examined in a subsequent workstream.