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Study finds that NICE breast cancer treatment guidance does not consistently follow NICE methodological guidelines for measuring health-related quality of life

Published: 5 January 2016
Quality of life measurement must be consistent across disease areas for appropriate decision-making

Micah Rose from SHTAC will present the results of the study in a poster at the Health Economics Study Group (HESG) winter 2016 conference in Manchester, January 6th to 8th 2016.

In England guidance on the use of health technologies in the health service is produced by the National Institute for Health and Care Excellence (NICE). Since 2006 the primary process used for assessing the clinical effectiveness and cost effectiveness of health technologies to inform guidance has been the Single Technology Assessment (STA) programme. NICE uses methodological guidelines (including the ‘NICE Reference Case’) to define appropriate methods for conducting technology appraisals. How to measure health-related quality of life is an important element of these guidelines. Health-related quality of life is represented by numbers called utility scores. Ideally, patients define how well they feel, and the general public assigns preference-based values to different states of wellness. NICE prefers that the EuroQol 5-Dimensions (EQ-5D) questionnaire is used for utility score measurement. Different methods produce different results, so it is important to have consistent methods to ensure that health care funding decisions are made on a ‘like for like’ basis. The study therefore investigated whether the utility score methods and measurements used in NICE’s guidance on treatments for breast cancer has been consistent and has followed methodological guidelines.

NICE’s STAs of breast cancer drugs were reviewed as a case study. All documents associated with utility scores were acquired and data was extracted. Comparison of the methods used in STAs with preferred methods as stated in NICE methodological guidance found that almost all utility scores used in STAs of breast cancer were inconsistent with NICE’s preferred methods. This means that health-related quality of life measurements in breast cancer guidance may not be directly comparable to those used in other disease areas. This can potentially cause inefficient allocation of resources, with corresponding potential losses in health-related quality of life borne by society. Future technology appraisals should ensure that methodological guidelines are followed for health-related quality of life measurement. The study presents a flowchart designed to aid better compliance.

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