Methods to estimate the NICE cost-effectiveness threshold

批准一项健康技术在NHS使用的决定需要评估使用该技术预计获得的健康是否超过预计将在其他地方放弃的健康，因为NHS的其他活动被削减以适应额外的成本。NICE使用明确的方法来估计使用一项技术预计获得的健康，以及预计NHS的额外成本。然而，它？S对可能被放弃的成本效益门槛的评估没有那么充分的依据。像NICE这样的机构不能也不一定需要知道在特定地区将被取代的具体服务和治疗，或者谁实际上将放弃健康。然而，需要的是对整个NHS平均而言可能被放弃的健康状况的评估。这项研究的目的是开发可以应用于NHS已经收集(或可能在不久的将来收集)的数据的分析方法，以提供适合NICE做出的决定类型的门槛估计。这项研究将建立在已经完成的工作的基础上，这些工作检查了已经在23个广泛的医疗保健计划中收集的关于地方NHS支出的数据。这项工作着眼于地方在特定类型的护理上的支出与健康结果之间的关系。还需要开展更多的工作来综合分析所有这些方案，并确定特定类型的支出如何随总体预算变化，以及总体支出与总体成果之间的关系。这项工作可以确定门槛随时间的变化，以及可能对国民保健制度预算产生重大影响的决定的影响。健康结果改善的衡量标准需要考虑到生活长度和质量的增加。还需要开展更多的工作，以确定和使用NHS公布的或常规收集的其他证据来源，这些证据可用于评估不同护理方案内生活质量的提高。此外，还需要进行额外的工作，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，识别和使用其他常规数据，并设计新的数据收集，以更详细地描述关键护理计划内的变化。

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.