The Issue
Commonwealth Fund–supported researchers sought to understand how the United Kingdom’s National Institute for Health and Clinical Excellence (NICE) uses findings from cost-effectiveness analyses (CEA) of medical technologies, including both drugs and devices, to inform coverage decisions for the National Health Service. To do so, the researchers followed the approval process for seven topics through interviews with members of the Technology Appraisal Committee and by sitting in on meetings and reviewing supporting documents.
What the Study Found
The authors found that cost-effectiveness analyses are central to NICE’s decision-making process. Some committee members found such analyses too complex, while others reported that members had developed a “high understanding of health economics” over time. One common concern was that the available data for economic analyses were poor and members might not interpret them with due caution. Most agreed that “quality-adjusted life years” are a useful way to measure the potential benefit of medical technology, though some said they failed to capture different kinds of benefits.
Conclusions
To be most acceptable to NICE committee members, cost-effectiveness analyses, the authors say, should provide information that: 1) is relevant to users; 2) is appropriate to the decisions being faced, taking into account budgets and other contexts; and 3) can inform complex decision-making processes that involve experts as well as patient and manufacturer representatives.