A review of public health economic modelling in the National Institute for Health and Care Excellence (NICE)

Abstract

Background: The National Institute for Health and Care Excellence (NICE) use economic modelling to inform judgements whenever further insight is required for decision-making. Doing so for public health guidance poses several challenges. The study’s objective was to investigate the level of heterogeneity in NICE’s public health economic models with regards to economic evaluation techniques, perspectives on outcomes and the measurement of non-health benefits. Methods: A review of all economic modelling reports published by NICE’s Centre for Public Health (CPH) as part of their guidance. Results: The review identified 56 eligible pieces of public health over the relevant period. Of these, 43 used economic modelling and 13 used no formal economic model. In total 61 economic models were used. Though the CPH specifies a reference case, in practice there is a large amount of variability from one model to the next. The most common perspective used for evaluations was that of the National Health Service (NHS); the most common economic evaluation approach was cost-utility analysis (CUA). 23 of the 56 topics used other combinations of perspective and technique, which allowed them to incorporate non-health effects, such as productivity, the effect on taxes raised and benefits spending, costs to the criminal justice sector, the effect on educational attainment and general wellbeing. Conclusions: NICE regularly updates its reference case, and non-CUA evaluation techniques have become more prominent in recent years. The results highlight the genuine advantages of having a variety of economic evaluation techniques available, which can be matched with the given topic. While it is always necessary to be wary of the possibility of gamesmanship and cherry picking, there is a surprising alignment between many approaches in certain circumstances.