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A Stated Preference Binary Choice Experiment to Explore NICE Decision Making

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Abstract

Objective: To explore whether the National Institute for Health and Clinical Excellence (NICE) takes account of concerns other than just incremental cost effectiveness in commissioning healthcare services.

Method: A stated preference binary choice experiment was used to explore the preferences of members of NICE’s Appraisal Committees for incremental cost effectiveness, the degree of uncertainty surrounding incremental costs and health outcomes, the age of beneficiaries, baseline health-related quality of life (HR-QOL) and the availability of alternative therapies when considering whether to recommend health technologies.

Results: A logit modelling analysis of Committee members’ stated preferences suggested that increases in the incremental cost-effectiveness ratio and economic uncertainty, and the availability of other therapies was associated with statistically significant reductions in the odds of a positive recommendation (p < 0.01). The transition from a very low to a comparatively high level of baseline HR-QOL was also associated with a statistically significant reduction in the odds of a positive recommendation (p = 0.003). The age of beneficiaries did not significantly affect decisions concerning whether to recommend technologies.

Conclusion: The results of the choice experiment support the notion of a probabilistic adoption/rejection approach rather than the operation of a single cost-effectiveness threshold.

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Acknowledgements

This study was undertaken without external funding. None of the authors have any conflicts of interest to declare. We thank Dr Carole Longson, Prof. David Barnett, Ms Emily Marschke, Prof. Andrew Stevens and Prof. Jeremy Wyatt at NICE for making this study possible. The study team would also like to thank all the members of NICE’s Appraisal Committees who kindly participated in the choice experiment. Finally, we would like to acknowledge the advice of Dr Stephen Walters from the HEDS Section within ScHARR.

P. Tappenden initiated the research. P. Tappenden, J. Brazier, J. Chilcott and J. Ratcliffe designed the study and the choice questionnaire. P. Tappenden collated all response data and undertook the statistical analysis. P. Tappenden will act as guarantor for the paper, accepts full responsibility for the conduct of the study, had access to the data and controlled the decision to publish.

Ethical approval for this study was obtained from the Sheffield University Research Ethics Committee (UREC). Permission to distribute the choice questionnaire was kindly granted by Prof. David Barnett (Chair of Appraisal Committee, NICE, London), Prof. Andrew Stevens (Chair of Appraisal Committee, NICE, London) and Dr Carole Longson (Appraisals Programme Director, NICE, London).

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Authors and Affiliations

  1. School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, England

    Paul Tappenden, John Brazier, Julie Ratcliffe & James Chilcott

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  1. Paul Tappenden
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  2. John Brazier
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  3. Julie Ratcliffe
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  4. James Chilcott
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Correspondence to Paul Tappenden.

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Tappenden, P., Brazier, J., Ratcliffe, J. et al. A Stated Preference Binary Choice Experiment to Explore NICE Decision Making. Pharmacoeconomics 25, 685–693 (2007). https://doi.org/10.2165/00019053-200725080-00006

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  • DOI: https://doi.org/10.2165/00019053-200725080-00006

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