Published May 17, 2013

Toronto, ON, Canada - The National Institute for Health and Care Excellence (NICE) is highly regarded for the rigorous methods it adopts for the economic appraisal of health care technologies. A recent amendment to these appraisal methods, however, raises a number of concerns. The amendment recommends the application of differential discounting of costs and health effects (at annual rates of 3.5% and 1.5% respectively) to interventions which satisfy specific criteria, with common discounting of costs and health effects (at a rate of 3.5%) recommended for other interventions. A recent article, “NICE’s Selective Application of Differential Discounting: Ambiguous, Inconsistent, and Unjustified,” by James O’Mahony (Trinity College Dublin) and Mike Paulden (University of Toronto), explains why NICE’s selective application of differential discounting for specific interventions is out of step with the Institute’s usual commitment to methodological excellence. The authors demonstrate that NICE’s amended appraisal methods give rise to a number of methodological inconsistencies, including the potential for age discrimination. The differential discount rates recommended by NICE ignore important recent theoretical research, and the criteria for their adoption are ambiguous and unjustified. NICE’s apparent motivation for the amendment was to achieve a favourable cost-effectiveness ratio for an expensive paediatric oncology drug. Rejecting the drug would have been politically controversial. However, NICE’s attempt to avoid this controversy through a seemingly ad-hoc and theoretically unjustified amendment to its appraisal methods undermines its scientific credibility. “We think it's important that NICE's recent amendment to their methods guidance does not pass without comment,” said Mike Paulden, a co-author on the paper. “This appears to be an attempt by NICE to avoid a politically controversial rejection of a childhood cancer treatment through a crude adjustment to their appraisal methods, without due consideration as to the possible consequences."

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