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The NICE cost-effectiveness threshold: what it is and what that means
Christopher McCabe1, Karl Claxton, Anthony J Culyer
1Academic Unit of Health Economics and NICE Decision Support Unit, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK. c.mccabe@leeds.ac.uk
Pharmacoeconomics
|September 5, 2008
Summary
The National Institute for Health and Clinical Excellence (NICE) should adopt a single cost-effectiveness threshold. This threshold should account for budgetary impact and be regularly reviewed to ensure efficient health service resource allocation.
Area of Science:
- Health Economics
- Health Technology Assessment
Background:
- The National Institute for Health and Clinical Excellence (NICE) has utilized a cost-effectiveness threshold range for over seven years.
- Discussions persist regarding the representation, appropriate level, and consideration of other factors for NICE's cost-effectiveness threshold.
Purpose of the Study:
- To critically assess NICE's use of the incremental cost-effectiveness ratio (ICER) threshold.
- To suggest improvements for NICE's ICER threshold utilization to enhance health service resource efficiency.
Main Methods:
- Review of NICE's current cost-effectiveness threshold practices.
- Critical analysis of ICER threshold application in NICE guidance.
- Development of recommendations for optimizing ICER threshold use.
Main Results:
- A single, explicit threshold is feasible and desirable over the current range.
- The threshold should integrate 'other' criteria beyond ICER, considering budgetary impact.
- Regular re-evaluation of the threshold value is necessary to reflect efficiency and budget changes.
Conclusions:
- NICE should consider a single, explicit cost-effectiveness threshold, integrating broader criteria.
- Interventions with significant budgetary impact may require a lower threshold.
- Caution is advised regarding equity weights and uncertainty when ICER exceeds the threshold; disinvestment guidance is recommended.
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