PNS70 Societal Cost Savings Are Often Not Considered in NICE Decision Making

Abstract

Broader societal cost savings offered by new technologies, for example from reduced absenteeism and increased productivity at work, less caregiver time or reduced costs associated with travelling to a hospital to receive treatment, are not typically considered by the National Institute for Health and Care Excellence (NICE) when making recommendations for funding. Instead, NICE refers to ‘exceptional cases’ where these may be accepted. The research presented here explores NICE and evidence review group (ERG) critiques of societal cost-saving analyses in submission documents, to understand how these are currently evaluated and their impact on recommendations. We reviewed all technology appraisals (TAs) and highly specialised technology (HST) assessments published between April 2013, when the current NICE methods guidance was issued, and July 2020. Manufacturers included societal cost considerations within economic models in 6% (19/331) of NICE TAs and HST assessments. Societal cost-saving analyses were presented for a range of (mostly chronic) conditions, most commonly neurological conditions or rare diseases. In only two of the 19 appraisals (11%), the inclusion was agreed with NICE in scoping materials. In 84% (16/19), the societal cost-saving analyses were incorporated into scenario analyses; only three submissions considered different elements of societal costs in their base case. NICE commented on societal costs in only 26% of appraisals (5/19; 2/5 included analyses in the base case), while the ERG commented on 47%. NICE accepted the analyses in only two of the five appraisals (HST3 and TA325). In appraisals of new treatments where NICE did not comment on the submitted societal cost analyses, these are unlikely to have contributed heavily to the final funding decision. Given the low acceptance rate of societal cost savings by NICE, funding decisions may not reflect those that would most benefit society.