Skip to main content

Advertisement

SpringerLink
Log in

Methodological issues in undertaking independent cost-effectiveness analysis for NICE: the case of therapies for ADHD

  • Original paper
  • Published:
The European Journal of Health Economics Aims and scope Submit manuscript

Abstract

This paper outlines methodological challenges encountered in producing an independent economic evaluation for the National Institute for Health and Clinical Excellence (NICE) to inform its technology appraisal process. The analysis used to highlight these challenges is a recent evaluation of pharmacological treatments for attention deficit hyperactivity disorder (ADHD). The NICE reference case for economic evaluation is compared with the methods necessary to complete an evaluation given the evidence base for ADHD. The primary analysis deviated from NICE methods guidelines most noticeably in the time horizon. Identifying appropriate utility data was challenging, and the results were sensitive to the values used. Issues found in this evaluation are common to many technology appraisals. Although challenging to undertake, economic evaluation in disease areas such as ADHD has great potential to add value, making the limitations of the data explicit, combining available evidence in a systematic and transparent framework and identifying future research needs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. The base-case represents the main analysis that includes the “first-choice” assumptions.

References

  1. Drummond M.F., Sculpher M.J., TorranceG.W., O’Brien B.J., Stoddart G.L.: Methods for the economic evaluation of health care programmes, 3rd edn. Oxford University Press, Oxford (2005)

  2. NICE. National Institute for Health and Clinical Excellence: Guide to the Technology Appraisal Process. London (2004)

  3. Canadian Coordinating Office for Health Technology Assessment (CCOHTA): Guidelines for Authors of CCOHTA Health Technology Assessment Reports, Ottawa (2003)

  4. Pharmaceutical Management Agency Ltd (PHARMAC): A Prescription for Pharmacoeconomic Analysis. Wellington: Pharmaceutical Management Agency; Report No.: Version 1.1 (2004)

  5. NICE National Institute for Health and Clinical Excellence: Guide to the methods of technology appraisal. London (2004)

  6. King, S., Griffin, S., Hodges, Z., Weatherly, H., Asseburg, C., Richardson, G., et al.: Methylphenidate, dexamfetamine and atomoxetine for the treatment of attention deficit hyperactivity disorder in children. Health Technol Assess 10(23):1–162 (2006)

    Google Scholar 

  7. Gold, M. R., Siegel, J. E., Russell, L. B., Weinstein, M. C.: Cost-effectiveness in health and medicine. Oxford University Press, Oxford (1996)

    Google Scholar 

  8. NICE. Methylphenidate, atomoxetine and dexamfetamine for attention deficit hyperactivity disorder (ADHD) in children and adolescents including review of existing guidance number 13 (Guidance on the use of methylphenidate [Ritalin, Equasym] for Attention Deficit/Hyperactivity Disorder [ADHD] in childhood): Scope. London: National Institute for Health and Clinical Excellence (2003)

  9. Hawkins, N., Epstein, D., Drummond, M., Wilby, J., Kainth, A., Chadwick, D., et al.: Assessing the cost-effectiveness of new pharmaceuticals in epilepsy in adults: The results of a probabilistic decision model. Med Decis Making 25(5):493–511 (2005)

    Article  Google Scholar 

  10. Ades, A. E., Cliffe, S.: Markov Chain Monte Carlo estimation of a multi-parameter decision model: consistency of evidence and the accurate assessment of uncertainty. Med Decis Making 22:359–371 (2002)

    Article  Google Scholar 

  11. Higgins, J. P. T., Whitehead, A.: Borrowing strength from external trials in a meta-analysis. Stats in Med 15:2733–2749 (1996)

    Article  Google Scholar 

  12. Ades, A. E., Sculpher, M., Sutton, A., Abrams, K., Cooper, N., Welton, N., et al.: Bayesian methods for evidence synthesis in cost-effectiveness analysis Pharmacoeconomics 24(1):1–19 (2006)

    Article  Google Scholar 

  13. Caldwell, D. M., Ades, A. E., Higgins, J. P. T.: Simultaneous comparison of multiple treatments: combining direct and indirect evidence. Biol Med 97–900 (2005)

  14. Janssen-Cilag Ltd. For Health Technology Appraisal: Methylphenidate, atomoxetine and dexamphetamine for attention-deficit/hyperactivity disorder in children and adolescents, including review of existing guidance number 13. A submission to the National Institute for Clinical Excellence. Bucks: Janssen-Cilag (2004)

  15. Coghill, D., Spender, Q., BArton, J., Hollis, C., Yuen, C., Cleemput, I.: Measuring quality of life in children with attention-deficit-hyperactivity-disorder in the United Kingdom. In: 16th World Congress of the International Association of Child and Adolescent Psychiatry and Allied Professions (IACAPAP); 2004; Germany (2004)

  16. Eli Lilly and Company Ltd. Atomoxetine for the treatment of ADHD. A submission to the National Institute for Clinical Excellence. Hampshire: Eli Lilly and Company (2004)

  17. Secnik, K., Cottrell, S., Matza, L. S., Edgell, E., Aristides, M., Tilden, D.: Assessment of health state utilities for attention-deficit/hyperactivity disorder in children using parent-based standard gamble scores. In: 9th Annual International Meeting of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR); 2004; Arlington (2004)

Download references

Author information

Authors and Affiliations

  1. Centre for Health Economics, University of York, Alcuin A Block Heslington, York, YO10 5DD, UK

    Susan C. Griffin, Helen L. A. Weatherly, Gerry A. Richardson & Mike F. Drummond

Authors
  1. Susan C. Griffin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Helen L. A. Weatherly
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gerry A. Richardson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mike F. Drummond
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Susan C. Griffin.

Additional information

This paper is based on work funded by the Health Technology Assessment Programme (project number 03/33/01) and commissioned on behalf of NICE. The views expressed are those of the authors and do not necessarily reflect those of the Department of Health.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Griffin, S.C., Weatherly, H.L.A., Richardson, G.A. et al. Methodological issues in undertaking independent cost-effectiveness analysis for NICE: the case of therapies for ADHD. Eur J Health Econ 9, 137–145 (2008). https://doi.org/10.1007/s10198-007-0052-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10198-007-0052-7

Keywords

Search

Navigation