A Stated Preference Binary Choice Experiment to Explore NICE Decision Making

Objective: To explore whether the National Institute for Health and Clinical Excellence (NICE) takes account of concerns other than just incremental cost effectiveness in commissioning healthcare services. Method: A stated preference binary choice experiment was used to explore the preferences of members of NICE's Appraisal Committees for incremental cost effectiveness, the degree of uncertainty surrounding incremental costs and health outcomes, the age of beneficiaries, baseline health-related quality of life (HR-QOL) and the availability of alternative therapies when considering whether to recommend health technologies. Results: A logit modelling analysis of Committee members' stated preferences suggested that increases in the incremental cost-effectiveness ratio and economic uncertainty, and the availability of other therapies was associated with statistically significant reductions in the odds of a positive recommendation (p < 0.01). The transition from a very low to a comparatively high level of baseline HR-QOL was also associated with a statistically significant reduction in the odds of a positive recommendation (p = 0.003). The age of beneficiaries did not significantly affect decisions concerning whether to recommend technologies. Conclusion: The results of the choice experiment support the notion of a probabilistic adoption/rejection approach rather than the operation of a single cost-effectiveness threshold.