ICERs for diagnostics and factors impacting NICE decisions
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ICERs for diagnostics and factors impacting NICE decisions Diagnostics Assessment Programme (DAP) decisions made by the UK National Institute for Health and Care Excellence (NICE) are generally based on whether incremental cost-effectiveness ratios (ICERs) are below a willingness-to-pay (WTP) threshold of £20 000 per QALY gained, as recommended in the DAP manual, but in some cases may be impacted by decision-modifying factors, according to findings of a review published in Value in Health. All NICE Diagnostics Guidance documents published up to February 2018, and their associated diagnostics assessment reports, were reviewed to assess whether ICERs used in evaluations were consistent with WTP thresholds given in the DAP manual, and to investigate decision-modifying factors. Eight out of 30 Diagnostics Guidance documents were excluded because the Diagnostics Advisory Committee (DAC) concluded that the evidence was insufficient for decision making. In total, 91 decision problems were identified for further analysis in the other 22 Diagnostics Guidance documents and received guidance of recommended (n=52), not recommended (15) or "not recommended–only in research" (24). ICERs for decision problems were below £20 000 per QALY gained in 80.8% of those recommended, 33.3% of those not recommended and 37.5% of those not recommended–only in research. Overall, 73.6% of decisions were consistent with the WTP threshold of £20 000 per QALY gained. Diagnostic interventions with ICERs below the threshold which were not recommended had more decision-modifying factors favouring comparators than interventions which were recommended. However, diagnostic interventions with ICERs exceeding the threshold of £20 000 per QALY gained had similar numbers of decision-modifying factors whether they were recommended or not recommended. "Overall, this analysis suggests that an ICER threshold of £20 000/QALY is generally followed by the NICE DAC, with patient-centric decision-modifying factors, healthcare-centric decision-modifying factors, and uncertainty likely contributing to the final decision," concluded the authors. "Our research provides insightful examples of situations, in which positive decision-modifying factors contributed to a recommended decision, despite an ICER greater than £20 000/QALY," they added. Chen G, et al. Evaluation of the National Institute for Health and Care Excellence Diagnostics Assessment Program Decisions: Incremental Cost-Effectiveness Ratio Thresholds and Decision-Modifying Factors. Value in Health : 18 Aug 2020. Available from: URL: https://doi.org/10.1016/j.jval.2020.04.1835
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PharmacoEconomics & Outcomes News 5 Sep 2020 No. 861
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