Evidence map›Paper›PMID 25145802›Full record

ArticlePharmacoEconomics2014

Some inconsistencies in NICE's consideration of social values.

Mike Paulden, James F O'Mahony, Anthony J Culyer, Christopher McCabe

Abstract read
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In one paragraph

Article in PharmacoEconomics, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
31citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

31 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
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  4. Review
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  10. Framework for developing cost-effectiveness analysis threshold: the case of Egypt.The Journal of the Egyptian Public Health Association · 2024
    Article
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  14. Cost-effectiveness thresholds or decision-making threshold: a novel perspective.Cost effectiveness and resource allocation : C/E · 2023
    Article
  15. Article
  16. Discounting health gain: a different view.Journal of market access & health policy · 2023
    Article
  17. Justice, Transparency and the Guiding Principles of the UK's National Institute for Health and Care Excellence.Health care analysis : HCA : journal of health philosophy and policy · 2022
    Article
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors.

Mike PauldenDepartment of Emergency Medicine, University of Alberta, 736 University Terrace, 8303 112 St, Edmonton, AB, T6G 2T4, Canada, paulden@ualberta.ca.
James F O'Mahony
Anthony J Culyer
Christopher McCabe

Funding

Canadian Institutes of Health Research
6 · The paper itself

Abstract

The UK's National Institute for Health and Care Excellence (NICE) recently proposed amendments to its methods for the appraisal of health technologies. Previous amendments in 2009 and 2011 placed a greater value on the health of patients at the "end of life" and in cases where "treatment effects are both substantial in restoring health and sustained over a very long period". Drawing lessons from these previous amendments, we critically appraise NICE's proposals. The proposals repeal "end of life" considerations but add consideration of the "proportional" and "absolute" quality-adjusted life-year (QALY) loss from illness. NICE's cost-effectiveness threshold may increase from £20,000 to £50,000 per QALY on the basis of these and four other considerations: the "certainty of the ICER [incremental cost-effectiveness ratio]"; whether health-related quality of life is "inadequately captured"; the "innovative nature" of the technology; and "non-health objectives of the NHS". We demonstrate that NICE's previous amendments are flawed; they contain logical inconsistencies which can result in different values being placed on health gains for identical patients, and they do not apply value weights to patients bearing the opportunity cost of NICE's recommendations. The proposals retain both flaws and are also poorly justified. Applying value weights to patients bearing the opportunity cost would lower NICE's threshold, in some cases to below £20,000 per QALY. Furthermore, this baseline threshold is higher than current estimates of the opportunity cost. NICE's proposed threshold range is too high, for empirical and methodological reasons. NICE's proposals will harm the health of unidentifiable patients, whilst privileging the identifiable beneficiaries of new health technologies.

Indexed as

Social ValuesCost-Benefit AnalysisHumansQuality-Adjusted Life YearsTechnology Assessment, BiomedicalUnited Kingdom

Identifiers

PMID25145802

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.