Methods to estimate the NICE cost-effectiveness threshold

在决定是否批准一项卫生技术在国民保健制度中使用时，需要评估预期使用该技术获得的健康是否超过预期在其他地方放弃的健康，因为国民保健制度的其他活动被削减，以适应额外的费用。NICE使用明确的方法来估计预期从使用技术中获得的健康以及NHS的预期额外成本。然而，它？对可能放弃的成本效益阈值的评估没有那么有根据。像NICE这样的机构不能也不一定需要知道哪些特定的服务和治疗将在特定的地方被取代，或者谁将实际放弃健康。然而，所需要的是对整个国民保健制度平均可能放弃的健康状况进行评估。这项研究的目的是开发分析方法，可以应用于NHS已经收集的数据（或在不久的将来收集的数据），以提供一个阈值的估计，这将是适合NICE的决策类型。这项研究将建立在已经完成的工作的基础上，该工作检查了已经收集的关于23个广泛护理方案中当地NHS支出的数据。这项工作着眼于特定类型的护理和健康结果的地方支出之间的关系。需要开展更多的工作，对所有这些方案进行综合分析，并确定特定类型的支出如何随总体预算而变化，以及总体支出与总体成果之间的关系。这项工作可能会允许阈值随时间的变化被确定，以及可能对NHS预算产生重大影响的决定的影响。衡量健康结果的改善需要反映生命长度和质量的提高。需要开展更多的工作，以确定和使用其他证据来源，这些证据来源是在NHS中公布或定期收集的，可用于估计不同护理方案中的生活质量收益。此外，还需要做更多的工作，以更好地了解在支出变化时增加或削减哪些服务和治疗。因此，我们将与当地NHS组织合作，确定和使用其他常规数据，并设计新的数据收集，这将更详细地了解关键护理方案的变化。

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.