Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-15T03:35:59.718Z Has data issue: false hasContentIssue false
  • English
  • Français

On the margins of health economics: a response to ‘resolving NICE’S nasty dilemma’

Published online by Cambridge University Press:  09 January 2015

Stephen Birch  and
Amiram Gafni
Stephen Birch*
Affiliation:
Centre for Health Economics and Policy Analysis, McMaster University, Canada & Centre for Health Economics, University of Manchester, UK
Amiram Gafni
Affiliation:
Centre for Health Economics and Policy Analysis, McMaster University, Canada
*
*Correspondence to: Stephen Birch, Centre for Health Economics and Policy Analysis and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario L8S 4K1, Canada. Email: stephen.birch@manchester.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

In a 2011 article published in this journal, Baker et al. set out to resolve a nasty dilemma for NICE by reconciling two approaches for determining whether adopting a new intervention would increase total health gains produced from available resources and hence increase system efficiency. In this response we show how the proposed reconciliation, as well as the two approaches on which it is based, fail to inform decision makers about the efficiency of a new intervention. We show how this arises from the misuse of incremental costs and effects of between-intervention comparisons as measures of changes in costs and effects associated with marginal adjustments to the scale of an intervention. Ironically, incremental data represent the choices faced by decision makers and we illustrate a method for determining unambiguously whether a new intervention represents an improvement in efficiency.

Type
Response
Information
Health Economics, Policy and Law , Volume 10 , Issue 2 , April 2015 , pp. 183 - 193
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Baker, R., Chilton, S., Donaldson, C., Jones-Lee, M., Lancsar, E., Mason, H., Metcalf, H., Pennington, M. and Wildman, J. (2011), ‘Searchers vs surveyors in estimating the monetary value of a QALY: resolving a nasty dilemma for NICE’, Health Economics, Policy and Law, 6: 435–447.Google Scholar
Birch, S. and Donaldson, C. (1987), ‘Applications of cost-benefit analysis to health care: departures from welfare economic theory’, Journal of Health Economics, 6: 211–225.Google Scholar
Birch, S. and Gafni, A. (1992), ‘Cost-effectiveness/utility analyses: do current decision rules lead us to where we want to be?’, Journal of Health Economics, 11: 279–296.Google Scholar
Birch, S. and Gafni, A. (2007), ‘Economists’ dream or nightmare? Maximising health gains from available resources using the NICE guidelines’, Health Economics, Policy and Law, 2: 193–202.Google Scholar
Chen, M. and Bush, J. (1976), ‘Maximising health system output with political and administrative constraints using mathematical programming’, Inquiry, 13: 215–227.Google Scholar
Cleary, S., Mooney, G. and McIntyre, D. (2010), ‘Equity and efficiency in HIV treatment in South Africa: the contribution of mathematical programming to priority setting’, Health Economics, 19: 1166–1180.Google Scholar
Culyer, A., McCabe, C., Briggs, A., Claxton, K., Buxton, M., Akehurst, R., Sculpher, M. and Brazier, J. (2007), ‘Searching for a threshold, not setting one; the role of the National Institute for Health and Clinical Excellence’, Journal of Health Services Research and Policy, 12: 56–58.Google Scholar
Donaldson, C. and Farrar, S. (1993), ‘Needs assessment: developing an economic approach’, Health Policy, 25: 95–108.Google Scholar
Donaldson, C., Bate, A., Mitton, C., Dionne, F. and Ruta, D. (2010), ‘Rational disinvestment’, Quarterly Journal of Medicine, 103: 801–807.Google Scholar
Drummond, M. (1980), Principles of Economic Appraisal in Health Care, Oxford: Oxford University Press.Google Scholar
Drummond, M. (2012), Twenty years of using economic evaluations for reimbursement decisions: what have we achieved? Centre for Health Economics Research Paper 75, University of York, York, UK.Google Scholar
Gafni, A. and Birch, S. (2006), ‘Incremental cost-effectiveness ratios (ICERs): the silence of the lambda’, Social Science and Medicine, 62: 2091–2100.Google Scholar
Gafni, A., Walter, S. and Birch, S. (2013), ‘Uncertainty and the decision maker: assessing and managing the risk of undesirable outcomes’, Health Economics, 22: 1287–1294.Google Scholar
McCabe, C. (2007), The Cost Effectiveness Threshold, Briefing Paper for the Methods Working Party, London: The National Institute for Health and Clinical Excellence.Google Scholar
Mitton, C. and Donaldson, C. (2004), Priority Setting Toolkit: A Guide to the Use of Economics in Health Care Decision-Making, London: BMJ Books.Google Scholar
Mooney, G. (2003), Economics, Medicine and Health Care, 3rd edn, Harlow, UK: Pearson Education Limited.Google Scholar
Neumann, P., Cohen, J. and Weinstein, M. (2014), ‘Updating cost-effectiveness analysis – the curious resilience of the $50,000 per QALY threshold’, New England Journal of Medicine, 371: 796–797.Google Scholar
Sendi, P., Gafni, A. and Birch, S. (2002), ‘Opportunity costs and uncertainty in the economic evaluation of health care interventions’, Health Economics, 11: 23–31.Google Scholar
Tianawit, S., Chongsuvivatwong, V. and Birch, S. (2009), ‘Optimizing the mix of basic dental services for Southern Thai school children based on resource consumption, service needs and parental preference’, Community Dentistry and Oral Epidemiology, 37: 372–380.Google Scholar
Torrance, G., Thomas, W. and Sackett, D. (1972), ‘A utility maximization model for evaluation of health care programmes’, Health Services Research, 7: 118–133.Google Scholar
Weinstein, M. (2012), ‘Decision rules for incremental cost effectiveness analysis’, in A. Jones (ed.), The Elgar Companion to Health Economics, 2nd edn, Cheltenham: Edward Elgar.Google Scholar