The Use of Evidence in Economic Decision Models A NICE Perspective Dr Carole Longson Director Centre for Health Technology Evaluation National Institute for Health and Clinical Excellence

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

So What’s The Problem……?

What’s in the NICE Methods Guide The Institute has defined a ‘reference case’ The Institute has defined a ‘reference case’ All relevant evidence needs to be assembled systematically and synthesised in a transparent and reproducible manner All relevant evidence needs to be assembled systematically and synthesised in a transparent and reproducible manner It is important for the Appraisal Committee to know about the uncertainty associated with the information It is important for the Appraisal Committee to know about the uncertainty associated with the information

What’s in the NICE Methods Guide Characteristics of the Assessment Report Characteristics of the Assessment Report –The Assessment Report is not an exhaustive review of all the information on a given technology …’ –No preset level of cut-off in the hierarchy of evidence acceptable… –Type of evidence pragmatically determined by the quantity and quality of the evidence available…

So What’s the Problem? ResourceTime Requirements

The NICE Environment ConsistencyTransparency Scrutiny

Thoughts for Discussion We need understand the requirements of our decision makers We need understand the requirements of our decision makers We need to develop solutions that work in the ‘NICE’ environment We need to develop solutions that work in the ‘NICE’ environment The solutions are not straightforward The solutions are not straightforward We will need to make difficult trade- offs We will need to make difficult trade- offs

…Who shall tempt with wandering feet The dark unbottomed infinite abyss And through the palpable obscure find out His uncouth way… …Long is the way And hard, that out of hell leads up to light Milton Paradise Lost 1667