Notes from the East: Examining NICE's digital health guidelines
Rebekah Fong Soe Khioe, consultant health economist at Health Enterprise East, examines NICE’s guidelines on digital health.
The number of digital healthcare technologies (DHTs) entering the NHS is growing at a rapid rate. With mounting pressures from budget constraints and limited resources within the health system, it has become more important than ever for innovators to demonstrate the clear economic impact of their technologies if these innovations are to stand a chance of being purchased and adopted by the NHS.
NICE evidence-based guidance
Gaining a clear understanding of the economic value of an innovation, and communicating this evidence to commissioners are two substantial challenges which rely heavily on intricate economic methodology. To support both innovators and commissioners, the National Institute for Health and Care Excellence (NICE) recently published an “Evidence Standards Framework for Digital Health Technologies”, describing the evidence required to demonstrate effectiveness and value in the UK healthcare system. Its aims were to provide digital health innovators with an understanding of the NHS procurement process and the standard evidence required, whilst at the same time helping NHS commissioners hone in on the most critical evidence necessary for making informed decision-making.
One size fits all?
The three priority evidence areas as set out by NICE comprise: economic information/data, economic analysis and economic reporting standards.
The guidelines helpfully include a handy data checklist for innovators and specify the economic information required when making a value-driven case to commissioners. However, it remains up to innovators to weigh up the relative value of specific data selected for use in economic modelling. This could be problematic as inexperienced innovators often leave out relevant data, simply due to lack of understanding of which elements are most significant.
The guidance also provides insight into the nature of the economic analysis that should be undertaken. NICE specifies the type of analysis in terms of levels of financial commitment, which may help an innovator pick out an analysis model that is in line with the funds available, from the outset.
Once the model has been selected, NICE guidelines reference a number of case reporting standards that innovators should consider when designing the economic model and interpreting and analysing the results. However, whilst the level and type of economic modelling are defined by NICE, the explicit details of each model are not provided. All that innovators are given is a general overview, and it is left to their own interpretation to select the best economic analysis model.
The “gold standard” approach
All healthcare technologies and DHTs need to demonstrate the value of their innovations based upon transparent and robust economic modelling. The NICE economic impact standards provide innovators and commissioners with a good general overview of the necessary data and modelling required. The evidence guide does, however, appear to lack detailed explanation to support the innovator in deciding which type of economic modelling would be most suitable.
A cost-utility analysis or economic evaluation alongside a clinical trial is often the “gold standard” approach. For early stage developments of innovations, an understanding of the budgetary impact is essential. More explicit advice is needed to ensure that innovators clearly understand the need for early economic modelling, such as a budget impact model complemented by more robust cost-utility analyses. This combination would provide innovators with a robust evidence-based assessment of the economic value and financial impact for each stage of development of their DHT. In turn, this puts them in the strongest position of convincing NHS procurement teams of the true benefits of their new technologies.