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Health Opportunity Costs (Estimating health opportunity costs in the NHS and other health care systems)

Methods for estimation of the NICE cost-effectiveness threshold

• Funder: Medical Research Council Methodology Research Programme
• Karl Claxton, Steve Martin, Marta Soares, Nigel Rice, Eldon Spackman, Sebastian Hinde, Nancy Devlin (Office of Health Economics), Peter C Smith(Imperial College), Mark Sculpher

Study summary:

Cost-effectiveness analysis used by NICE is essentially an assessment of whether the health expected to be gained from the use of a new medical technology exceeds the health likely to be forgone as other NHS activities are displaced to accommodate the additional costs of the new technology. The cost-effectiveness threshold represents an estimate of the health forgone as services are displaced. Currently the threshold used by NICE has little empirical basis. The aim of this new research project is to develop and to demonstrate methods for threshold estimation which make best use of routinely available NHS data, allowing scrutiny by a range of stakeholders, improving accountability and predictability. This research will focus on complementary methods which can make best use of those data that are already available, where there are already plans to make data available or where additional data could feasibly be made available at reasonable cost.

Final report:

• NICE Threshold Press release 19 February 2015 (PDF , 298kb)
• Media activities as of 13/04/2015 (PDF , 658kb)
• Presentation at Science Media Centre press briefing 17/2/15 (PDF , 426kb)
• Methods for the estimation of the NICE cost effectiveness threshold. Claxton K, Martin S, Soares M, Rice N, Spackman E, Hinde S, Devlin N, Smith PC, Sculpher M. Health Technology Assessment 2015;19(14):doi10.3310/hta19140. Available on the NIHR Journals Library website.
• CHE Research Paper 81 (PDF , 3,781kb)  November 2013
• Opportunity cost calculator‌ How much and what type of health is lost (MS Excel , 268kb) 
• Why is the central estimate of the cost per QALY threshold lower? (PDF , 426kb)

International thresholds:

• Ochalek, JM, Lomas, J & Claxton, KP 2015 'Cost per DALY averted thresholds for low- and middle-income countries: evidence from cross country data' CHE Research Paper, no. 122, Centre for Health Economics, University of York, York, UK, pp. 1-50‌ 
• Calculating cost per DALY averted thresholds for LMICs (MS Excel , 788kb)
• Cost per DALY averted thresholds for LMICs (MS Excel , 239kb)
• Health opportunity cost calculator for LMICs (MS Excel , 33kb)
• Woods, B, Revill, P, Sculpher, M & Claxton, KP 2015 'Country-level cost-effectiveness thresholds: initial estimates and the need for further research.' CHE Research Paper, no. 109, Centre for Health Economics, University of York, York, UK, pp. 1-24.
• Revill, P, Walker, S, Madan, J, Ciaranello, A, Mwase, T, Gibb, DM, Claxton, K & Sculpher, MJ 2014 'Using cost-effectiveness thresholds to determine value for money in low- and middle-income country healthcare systems: Are current international norms fit for purpose?' CHE Research Paper, no 98. Centre for Health Economics, University of York, York, UK. pp. 1-9.

Previous versions of report:

• CHE Research Paper 81 (June 2013) (PDF , 7,618kb)
• CHE Research Paper 81 (Jan 2013) (PDF , 4,518kb)
• Press release 24th January 2013‌
• Draft final report submitted to HTA 7^th January 2013 Draft Final Report (PDF , 6,392kb)
• Resubmission to HTA taking into account peer review and editors comments 10^th June 2013 Resubmitted Report (PDF , 6,795kb)

Further project details:

• Forum on Medical Innovation, the London School of Economics and Political Science and Imperial College London, 14 October 2015. For discussion of the threshold see 37:10, 1:29:30, 1:32:04, 1:34:00 and 1:39:30.
• Seminar, Health Economics and Policy Analysis, NUI Galway, 6^th March 2015
• 2014 Oslo Seminar: Full Programme, Threshold presentation, slides Making decisions about health care: methods for estimating the benefits from inv (PDF , 448kb) and Methods for the Estimation of the NICE Cost Effectiveness Threshold (PDF , 990kb)
• 2013 CADTH Symposium: Video and slides International trends in drug assessment: ‘The’ critical issue (PDF , 493kb)
• Further details of project Threshold project - case for support (PDF , 128kb) and details of the funding call from the MRC
• Slide deck for the final threshold report (PDF , 757kb)‌
• NICE technical forum September 2013 (PDF , 765kb)‌
• A web cast of a presentation of this research can be found on our Seminars page
• Session at the International Health Economics Association meeting, Toronto, 13^th July 2011. Further details
• Workshop held at Imperial College London 9^th May 2011. Further details

Additional material:

• Claxton K, Sculpher M, Palmer S, Culyer AJ. Causes for concern: is NICE failing to uphold its responsibilities to all NHS patients? Health Economics 2015;24(1):1–7. Download from Wiley
• Appendix A (PDF , 223kb) (Displacement by ICD Code)
• Appendix B (PDF , 2,067kb) (Methods to estimate wider social benefits)
• Appendix A (Displacement by ICD code) (MS Excel , 1,930kb)
• The UK's Cancer Drugs Fund does more harm than good - Article in the NewScientist by Karl Claxton

The OHE critique of CHE Research paper 81:

• Response to the OHE critique (PDF , 487kb) of CHE Research Paper 81