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Related Experiment Video

Updated: Jun 26, 2026

Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
06:16

Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease

Published on: August 9, 2024

Searching for cost effectiveness thresholds in the NHS.

John Appleby1, Nancy Devlin, David Parkin

  • 1King's Fund, 11-13 Cavendish Square, London W1G 0AN, United Kingdom. j.appleby@kingsfund.org.uk

Health Policy (Amsterdam, Netherlands)
|January 27, 2009
PubMed
Summary

Investigating National Health Service (NHS) decision-making revealed it is possible to estimate cost-effectiveness thresholds. However, a definitive comparison with the National Institute for Health and Clinical Excellence (NICE) explicit threshold requires more extensive data and deeper insight into local processes.

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Last Updated: Jun 26, 2026

Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
06:16

Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease

Published on: August 9, 2024

Area of Science:

  • Health Economics
  • Health Services Research
  • Public Health Policy

Background:

  • The National Institute for Health and Clinical Excellence (NICE) uses an explicit cost-effectiveness threshold for National Health Service (NHS) service provision.
  • Evidence supporting the specific level of NICE's explicit threshold is limited.
  • This study explores local NHS decision-making to assess the feasibility of gathering evidence on implicit cost-effectiveness thresholds.

Purpose of the Study:

  • To develop a conceptual model linking NICE's explicit thresholds with implicit local NHS thresholds.
  • To evaluate the feasibility of identifying implicit local cost-effectiveness thresholds.
  • To assess the utility of these local thresholds in evaluating NICE's explicit threshold.

Main Methods:

  • Conducted structured interviews with senior staff in six NHS purchasers and 18 providers.
  • Collected financial and public health data.
  • Identified and examined healthcare services introduced or discontinued in 2006/7 for cost-effectiveness ratio estimation.

Main Results:

  • Identified decisions and estimated cost-effectiveness for some services, not exclusively marginal ones.
  • Encountered challenges including dominated services, decisions on service delivery methods, lack of local cost-effectiveness evidence, and non-cost-effectiveness considerations.
  • Demonstrated feasibility in identifying decisions and estimating cost-effectiveness for certain services.

Conclusions:

  • Confirming consistency between NICE and NHS cost-effectiveness thresholds necessitates observing numerous decisions.
  • A comprehensive understanding of local decision-making processes is crucial for definitive findings.
  • Further research with extensive data is required to validate NICE's explicit threshold against local NHS practices.