BMJ, doi: 10.1136/bmj.38285.482350.82, (Published 15 December 2004)

PAPERS

Comparing estimates of cost effectiveness submitted to the National Institute for Clinical Excellence (NICE) by different organisations: retrospective study

A H Miners ¹, Martina Garau ², Dogan Fidan ³, A J Fischer ⁴

¹ Health Economics Research Group, Brunel University, Uxbridge UB8 3PH
² Economics Department, University of York, Heslington, York YO1 5DD
³ Health Policy Unit, Department of Public Health and Policy, London School of Health and Tropical Medicine, London WC1E 7HT
⁴ Department of Community Health Sciences, St George's Hospital Medical School, London SW17 0RE

Objective To assess the association between different types of organisation and the results from economic evaluations.

Design Retrospective pairwise comparison of evidence submitted to the technology appraisal programme of the National Institute for Clinical Excellence (NICE) by manufacturers of the relevant healthcare technologies and by contracted university based assessment groups.

Data sources Data from the first 62 appraisals.

Main outcome measure Incremental cost effectiveness ratios.

Results Data from 27 of the 62 appraisals could be compared. The analysis of 54 pairwise comparisons showed that manufacturers' estimates of incremental cost effectiveness ratios were lower (suggesting a more cost effective use of resources) than those produced by the assessment groups (25 were lower, 29 were the same, none were higher, P<0.01). Restriction of this dataset to include only one pairwise comparison per appraisal (27 pairs) produced a similar result (21 were lower, two were the same, four were higher, P<0.001).

Conclusions The estimated incremental cost effectiveness ratios submitted by manufacturers were on average significantly lower than those submitted by the assessment groups. These results show that an important role of NICE's appraisal committee, and of decision makers in general, is to determine which economic evaluations, or parts of evaluations, should be given more credence.

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(Accepted 18 October 2004)
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