• Biosimilars
  • Drug Development/R&D
  • All Topics
OHE OHE
Newsletter SignupSubscribe

News & Insights
  • News
  • Events
  • Insights
  • Bulletin
  • News
  • Events
  • Insights
  • Bulletin

News & Insights

  • News
  • Events
  • Insights
  • Bulletin
Newsletter SignupSubscribe
  • News
  • Events
  • Insights
  • Bulletin

Close
OHE OHE
  • Research & Publications
  • News & Insights
  • Education
  • Innovation Policy Prize
  • Events
  • About Us
  • OHE Experts
  • Contact Us
Newsletter SignupSubscribe

Research & Publications

All Publications

Filter by:
  • Antimicrobial Resistance (AMR)
  • Biosimilars
  • Cell and Gene Therapies
  • Chronic Diseases
  • Combination Therapies
  • COVID-19 Research
  • Digital Health
  • Drug Development/R&D
  • Emerging Markets
  • EQ-5D and PROMs
  • Health Care Systems
  • Health Data and Statistics
  • Health Technology Assessment
  • Precision Medicine
  • Real World Evidence
  • Use of Medicines
  • Value-Based Pricing
  • Vaccine Research
  • Economics of Innovation
  • Measuring and Valuing Outcomes
  • Policy, Organisation and Incentives in Health Systems
  • Value, Affordability and Decision Making

News & Insights

  • News
  • Events
  • Insights
  • Bulletin

Education

  • Education Hub
  • OHE Graduate School
  • EVIA Programme

Innovation Policy Prize

  • The Prize Fund
  • 2022 Prize Fund

Latest Research & Publications

Proposal for a General Outcome-based Value Attribution Framework for Combination Therapies

CombTher_Adobe_photoguns_portrait
Read more
© photoguns
  • Digital Health

Navigating the Landscape of Digital Health – United Kingdom

Healthcare_Adobe_elenabsl
Read more

2021 OHE Annual Report to the Charity Commission

charityreport_lina-trochez-unsplash_landscape
Read more
© Lina Trochez/Unsplash

Supporting the Era of Green Pharmaceuticals in the UK

Sustainability_AdobeStock_270582392_landscape
Read more

Quality of life and wellbeing in individuals with experience of fertility problems and assisted reproductive techniques

Quality of life assisted reproduction Cover
Read more
  • Cell and Gene Therapies
  • Value, Affordability, and…

Health Technology Assessment of Gene Therapies: Are Our Methods Fit for Purpose?

gene_therapies_national-cancer-institute-unsplash_landscape
Read more
© NCI/Unsplash
  • Drug Development/R&D
  • Economics of Innovation
  • Health Policy and Regulation

Limitations of CBO’s Simulation Model of New Drug Development as a Tool for Policymakers

CBO-US_mayer-tawfik-K4Ckc0AxgDI-unsplash_landscape
Read more
© Mayer Tawfik/Unsplash
  • Measuring and Valuing Outcomes

When Generic Measures Fail to Reflect What Matters to Patients: Three Case Studies

PROMS_unsplash_National Cancer Institute_landscape
Read more
© NCI/Unsplash
Close
OHE
  • All Publications

    Filter by:
    • Antimicrobial Resistance (AMR)
    • Biosimilars
    • Cell and Gene Therapies
    • Chronic Diseases
    • Combination Therapies
    • COVID-19 Research
    • Digital Health
    • Drug Development/R&D
    • Emerging Markets
    • EQ-5D and PROMs
    • Health Care Systems
    • Health Data and Statistics
    • Health Technology Assessment
    • Precision Medicine
    • Real World Evidence
    • Use of Medicines
    • Value-Based Pricing
    • Vaccine Research
    • Economics of Innovation
    • Measuring and Valuing Outcomes
    • Policy, Organisation and Incentives in Health Systems
    • Value, Affordability and Decision Making
    • News
    • Events
    • Insights
    • Bulletin
    • Education Hub
    • OHE Graduate School
    • EVIA Programme
    • The Prize Fund
    • 2022 Prize Fund
  • Events
  • About Us
  • OHE Experts
  • Contact Us
Newsletter SignupSubscribe
Back
  • News
11 min read 2nd December 2013

Critique of Research Proposing to Lower NICE’s Cost-per-QALY Threshold to £12,936

This paper counters recent research that recommended NICE lower its threshold from the current official £20,000-£30,000. Critique of CHE Research Paper 81: Methods for the Estimation of the NICE Cost Effectiveness Threshold The OHE has just published an Occasional Paper…

Share:
  •  Twitter
  •  LinkedIn
  •  Facebook
  • has-icon Email

This paper counters recent research that recommended NICE lower its threshold from the current official £20,000-£30,000.

Critique of CHE Research Paper 81: Methods for the Estimation of the NICE Cost Effectiveness Threshold

The OHE has just published an Occasional Paper by Barnsley et al that counters the recently-published recommendation by Claxton et all that NICE should lower its cost-per-QALY threshold from the current £20,000–£30,000 official range to £12,936. The Claxton et al paper is an excellent attempt at answering a difficult question, based on a detailed analysis of differences in spending and mortality across Primary Care Trusts (PCTs) throughout England during the 2008–09 financial year.

The OHE has just published an Occasional Paper[1] by Barnsley et al that counters the recently-published recommendation by Claxton et al[2]  that NICE should lower its cost-per-QALY threshold from the current £20,000–£30,000 official range to £12,936.

The Claxton et al paper is an excellent attempt at answering a difficult question, based on a detailed analysis of differences in spending and mortality across Primary Care Trusts (PCTs) throughout England during the 2008–09 financial year. Claxton et al argue that these differences imply that a decrease in PCT spending of £12,936, as a result of NICE approving a new medicine, will lead to the loss of one quality-adjusted life-year (QALY). Therefore, they conclude, NICE should not approve medicines with a cost-per-QALY greater than this threshold.

The critique by OHE’s Barnsley et al accepts the premise that NICE’s cost-effectiveness threshold should be set equal to the budget decrease that would cause the NHS to produce one less QALY. However, it argues that the £12,936 estimate has two serious difficulties: (1) important data are unavailable and therefore assumptions have to be made and (2) the result is very sensitive to those assumptions, several of which Barnsley et al challenge.

The first serious difficulty is with the type of data available. Claxton et al take a snapshot of differences between PCTs and use that to predict changes in spending and mortality within individual PCTs. But this approach would not be justified if PCTs systematically differ in their decision making, e.g. for historical reasons. Furthermore, no data are available on how health spending improves patients’ quality of life. There are only mortality data and those are available only for some areas of spending. As a result,  Claxton et al have to estimate quality-adjusted life-years, which they do based on an uncertain and possibly incorrect assumption about the relative skill of PCTs in improving quality of life versus reducing mortality.

The second critical difficulty noted in the critique by Barnsley et al is in the additional assumptions made by Claxton et al. These include, first, assuming that patients whose lives are saved will live as long as healthy people of the same age and, second, that these patients will enjoy better quality of life than the average patient with the same disease. If these assumptions do not hold, then Claxton et al overestimate the success of PCTs in improving health and consequently underestimate the NICE threshold.



[1] Download Barnsley, P., Towse, A., Schaffer, S.K. and Sussex, J. (2013) Critique of CHE Research Paper 81: Methods for the Estimation of the NICE Cost Effectiveness Threshold. Occasional Paper 13/01. London: Office of Health Economics.
 
[2] Claxton, K., Martin, S., Soares, M., Rice, N., Spackman, E., Hinde, S., Devlin, N., Smith, P.C. and Sculpher, M. (2013) Methods for the estimation of the NICE cost effectiveness threshold. CHE Research Paper 81. Revised report following referees’ comments. York: Centre for Health Economics, University of York.

 

  • Value, Affordability, and…
  • NICE

Related News

  • News
  • September 2020

Assessing the Productivity Value of Vaccines in Health Technology Assessment: Worth a Shot?

Read more
  • News
  • August 2020

Are Discount Rates Used in UK Vaccine Economic Evaluations Jeopardising Investment in Immunisation Programmes?

Read more
  • News
  • July 2020

NICE ‘Optimised’ Recommendations: What Do They Mean for Patient Access?

Read more
  • News
  • January 2020

Ethical and Economic Issues in the Appraisal of Medicines for Ultra-rare (or Ultra-orphan) Conditions

Read more
footer_ohe_logo

Leading intellectual authority on global health economics

Sign Up for the OHE News Bulletin

Newsletter SignupStart Sign Up

Research & Publications

News & Insights

Innovation Policy Prize

Education

Events

About Us

OHE Experts

Contact Us

Sign Up for the OHE News Bulletin

Newsletter SignupStart Sign Up

The Office of Health Economics (OHE) is a company limited by guarantee registered in England and Wales (registered number 09848965) and its registered office is at 2nd Floor Goldings House, Hay’s Galleria, 2 Hay’s Lane, London, SE1 2HB.

Terms & Conditions

Privacy Policy

Cookies Policy

© 2023 Website Design

An error has occurred, please try again later.An error has occurred, please try again later.

We are using cookies to give you the best experience on our website.

You can find out more about which cookies we are using or switch them off in settings.

 Twitter
 Facebook
 LinkedIn
 Copy
 Email
Powered by  GDPR Cookie Compliance
Privacy Overview

This website uses cookies so that we can provide you with the best user experience possible. Cookie information is stored in your browser and performs functions such as recognising you when you return to our website and helping our team to understand which sections of the website you find most interesting and useful.

Strictly Necessary Cookies

Strictly Necessary Cookie should be enabled at all times so that we can save your preferences for cookie settings.

If you disable this cookie, we will not be able to save your preferences. This means that every time you visit this website you will need to enable or disable cookies again.

3rd Party Cookies

This website uses Google Analytics to collect anonymous information such as the number of visitors to the site, and the most popular pages.

Keeping this cookie enabled helps us to improve our website.

Please enable Strictly Necessary Cookies first so that we can save your preferences!