Intended for healthcare professionals


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

BMJ 2005; 330 doi: (Published 06 January 2005) Cite this as: BMJ 2005;330:65
  1. A H Miners, visiting research fellow (Alec.Miners{at},
  2. Martina Garau, MSc student2,
  3. Dogan Fidan, honorary research fellow3,
  4. A J Fischer, senior lecturer4
  1. 1Health Economics Research Group, Brunel University, Uxbridge UB8 3PH
  2. 2Economics Department, University of York, Heslington, York YO1 5DD
  3. 3Health Policy Unit, Department of Public Health and Policy, London School of Health and Tropical Medicine, London WC1E 7HT
  4. 4Department of Community Health Sciences, St George's Hospital Medical School, London SW17 0RE
  1. Correspondence to: A H Miners
  • Accepted 18 October 2004


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.


  • Contributors The study was conceived by AJF. AJF and DF presented a forerunner of this paper at an international health economics association conference. AHM and AJF were primarily responsible for further developing the study design. MG collected the data and performed the statistical analyses. AHM, AJF, and DF double checked all abstracted information. All authors contributed to the writing of the final manuscript. AHM is the guarantor.

  • Funding None.

  • Competing interests AHM and AJF are members of NICE's appraisals team. DF was a member of the appraisals team when this study was undertaken.

  • Ethical approval Not required.

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