Balancing cost-effe ctiveness with other values: the NICE experience. Stirling Bryan Department of Health Economics. Overview. Introduction to the National Institute for Health & Clinical Excellence (NICE) Cost-effectiveness analysis as a key driver of NICE decisions
Department of Health Economics
2st Committee meeting
Number of Committee members (per branch)
Medical (e.g. GP, physician, surgeon)
Other clinical (e.g. nurse, pharmacist)
Methodologists (e.g. health economist, statistician)
2 (7%)NICE Appraisal Committee membership (n=28)
Guidance: “Anakinra should not normally be used as a treatment for rheumatoid arthritis. It should only be given to people who are taking part in a study on how well it works in the long term.”
but the number of health economists needed to prove its value may cause dizziness and nausea
Britain Stirs Outcry by Weighing Benefits of Drugs Versus Price
Millions of patients around the world have taken drugs introduced over the past decade to delay the worsening of Alzheimer's disease. …
But this year, an arm of Britain's government health-care system, relying on some economists' number-crunching, said the benefit isn't worth the cost. It issued a preliminary ruling calling on doctors to stop prescribing the drugs.
THE WALL STREET JOURNAL November 22, 2005; Page A1
There is a feeling when we get beyond £30,000 per QALY we’re running into trouble.
I do sometimes have reservations about the figure of £30,000 per QALY. Where does the figure come from? Who determines where the cut-off point should be?
My biggest criticism … is basically we are funding things at a level that actually the NHS cannot afford – that the [cost per] QALY figure is far too high, it should be much lower.
Bryan et al (2007)
“The efficiency of adopting the new intervention depends crucially on where the additional resources required to support the new intervention are to be taken from and at what opportunity cost.”
The ‘workings’ of
Concepts & processes
relating to economic
They really do allow us to begin to compare hearing aids to insulin pumps to MS drugs. Now there are a lot of problems with them … but without that it becomes very difficult to do anything meaningful in terms of decision making.
When people with MND are looking forward over that really quite dire prospect, … having a few weeks or a few months of better quality of life … might be valued much more highly than just assigning a QALY weight.
I think there’s a sort of recognition at the moment, that we have no basis for doing the weighting.
At the end of each of these discussions people say, ‘well we have no basis for doing this so let’s just treat a QALY as a QALY regardless’. But where that isn’t true, I think, is in relation to children … although people don’t necessarily explicitly state it, I think everybody tends to give it more weight.
“While we recognise that there are aspects of NICE’s methods that could stand building, on balance we think that UK health economists should sleep more soundly at night for its presence …
Gold & Bryan (2007)