The Use of The Use of Evidence in Evidence in

Economic Decision Economic Decision ModelsModels

A NICE PerspectiveA NICE Perspective

Dr Carole LongsonDr Carole LongsonDirectorDirectorCentre for Health TechnologyCentre for Health Technology EvaluationEvaluationNational Institute for Health and Clinical ExcellenceNational Institute for Health and Clinical Excellence

NICE Technology AppraisalsNICE Technology Appraisals

‘…. a well deserved reputation for innovation and methodological developments that represent an important model for technology appraisal internationally’

WHO report 2003

Setting the standard……..Setting the standard……..

• …’…’NICE methodology is well respected NICE methodology is well respected internationally. The consistency of NICE internationally. The consistency of NICE appraisal techniques, their transparency appraisal techniques, their transparency and rigorousness would be beneficial and rigorousness would be beneficial attributes to apply more widely to other attributes to apply more widely to other interventions, such as in the area of public interventions, such as in the area of public health.’health.’

Derek WanlessDerek Wanless

Securing Good Health for the Whole PopulationSecuring Good Health for the Whole Population

So What’s The So What’s The Problem……?Problem……?

What’s in the NICE Methods What’s in the NICE Methods GuideGuide

• The Institute has defined a ‘reference The Institute has defined a ‘reference case’case’

• All relevant evidence needs to be All relevant evidence needs to be assembled systematically and assembled systematically and synthesised in a transparent and synthesised in a transparent and reproducible mannerreproducible manner

• It is important for the Appraisal It is important for the Appraisal Committee to know about the Committee to know about the uncertainty associated with the uncertainty associated with the informationinformation

What’s in the NICE Methods What’s in the NICE Methods GuideGuide

• Characteristics of the Assessment Characteristics of the Assessment ReportReport– The Assessment Report is not an The Assessment Report is not an

exhaustive review of all the information exhaustive review of all the information on a given technology …’on a given technology …’

– No preset level of cut-off in the hierarchy No preset level of cut-off in the hierarchy of evidence acceptable…of evidence acceptable…

– Type of evidence pragmatically Type of evidence pragmatically determined by the quantity and quality of determined by the quantity and quality of the evidence available…the evidence available…

So What’s the Problem?So What’s the Problem?

Resource Time

Requirements

The NICE EnvironmentThe NICE Environment

Consistency Transparency

Scrutiny

Thoughts for DiscussionThoughts for Discussion

•We need understand the We need understand the requirements of our decision makers requirements of our decision makers

•We need to develop solutions that We need to develop solutions that work in the ‘NICE’ environmentwork in the ‘NICE’ environment

•The solutions are not straightforwardThe solutions are not straightforward

•We will need to make difficult trade-We will need to make difficult trade-offsoffs

…Who shall tempt with wandering feetThe dark unbottomed infinite abyssAnd through the palpable obscure find outHis uncouth way…

…Long is the wayAnd hard, that out of hell leads up to light

MiltonParadise Lost 1667