Methods to estimate the NICE cost-effectiveness threshold

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The decision to approve a health technology for use in the NHS requires an assessment of whether the heath that is expected to be gained from its use exceeds the health that is expected to be forgone elsewhere as other NHS activities are curtailed to accommodate the additional costs. NICE uses explicit methods to estimate the health expected to be gained from use of a technology and the expected additional costs to the NHS. However, it?s assessment of what might be forgone, the cost effectiveness threshold, is less well founded. A body like NICE cannot and does not necessarily need to know what specific services and treatments will be displaced in particular localities or who will actually forgo health. What is required, however, is an assessment of the health that is likely to be forgone on average across the NHS. The aim of this research is to develop methods of analysis that can be applied to data the NHS already collects (or could collected in the near future) to provide an estimate of the threshold which would be suitable for the type of decisions NICE makes. The research will build on work that has already be done, which examines data already collected about local NHS spending in 23 broad programmes of care. This work looks at the relationship between local spending on particular types of care and health outcomes. Additional work is needed to analyse all these programmes together and establish how particular types of spending changes with overall budget and how overall spending is related to overall outcomes. This work may allow changes in the threshold over time to be identified as well as the effects of decisions which could have a large impact on the NHS budget. Measures of improvements in health outcome need to capture increases in the length and quality of life. Additional work is needed to identify and use other sources of evidence which are published or routinely collected in the NHS that can be used to estimate the quality of life gains within the different programmes of care. Also, additional work is needed to better understand which services and treatments are added or cut back when spending changes. Therefore, we will work with local NHS organisations to identify and use other routine data and design new data collection which will give a more detailed picture of changes within key programmes of care.