NHS and personal and social services costs NHS and personal and social services costs
5.5.1 For the reference case, costs should relate to resources that are under the control of the NHS and personal and social services. These resources should be valued using the prices relevant to the NHS and personal and social services.
Evidence should be presented to demonstrate that resource use and cost data have been identified systematically.
5.5.2 The public list prices for technologies (for example, pharmaceuticals or medical devices) should be used in the reference-case analysis. When there are
nationally available price reductions, for example for medicines procured for use in secondary care through contracts negotiated by the NHS Commercial Medicines Unit, then the reduced price should be used in the reference-case analysis to best reflect the price relevant to the NHS. The Commercial
Medicines Unit publishes information on the prices paid for some generic drugs by NHS trusts through its Electronic Marketing Information Tool (eMIT);
focusing on medicines in the National Generics Programme Framework for England. Analyses based on price reductions for the NHS will only be considered when the reduced prices are transparent and consistently available across the NHS, and if the period for which the specified price is available is guaranteed.
When a reduced price is available through a patient access scheme that has been agreed with the Department of Health, the base-case analysis should include the costs associated with the scheme. The review date for the appraisal will be informed by the period of time over which the manufacturer or sponsor can guarantee any such pricing agreements.
5.5.3 For medicines that are predominantly prescribed in primary care, prices should be based on the Drug Tariff.
5.5.4 In the absence of a published list price and price agreed by a national institution (as may be the case for some devices), the price submitted by the manufacturer may be used, provided that it is nationally and publicly available.
5.5.5 Healthcare resource groups (HRGs)are a valuable source of information for estimating resource use. HRGs are standard groupings of clinically similar treatments that use common levels of healthcare resources. The national average unit cost of an HRG is reported as part of the annual mandatory collection of reference costs from all NHS organisations in England. The use of these costs can reduce the need for local micro-costing (costing of each
individual component of care related to the use of a technology). Care must be taken to ensure that all relevant HRGs have been taken into account. For example, the cost of hospital admission for a serious condition may not account for time spent in critical care, which is captured and costed as a separate HRG.
5.5.6 Data based on HRGs may not be appropriate in all circumstances (for example, when the new technology and the comparator both fall under the same HRG, or when the mean cost does not reflect resource use in relation to the new
technology under appraisal). In such cases, other sources of evidence, such as micro-costing studies, may be more appropriate. When cost data are taken from literature, the methods used to identify the sources should be defined. When several alternative sources are available, a justification for the costs chosen should be provided and discrepancies between the sources explained. When appropriate, sensitivity analysis should be used to assess the implications for results of using alternative data sources.
5.5.7 Costs related to the condition of interest and incurred in additional years of life gained as a result of treatment should be included in the reference-case
analysis. Costs that are considered to be unrelated to the condition or technology of interest should be excluded.
5.5.8 If introduction of the technology requires changes in infrastructure, costs or savings should be included in the analysis.
5.5.9 When a group of related technologies is being appraised as part of a 'class' of treatments, an analysis using the individual unit costs specific to each
technology should normally be presented in the reference case. Exceptionally, if there is a very wide range of technologies and costs to be considered, then analyses using the weighted mean cost and the highest and lowest cost estimates should be presented.
5.5.10 Value added tax (VAT) should be excluded from all economic evaluations, but included in calculation of the budgetary impact when the resources in question are liable for this tax.
Non-NHS and non-personal and social services costs Non-NHS and non-personal and social services costs
5.5.11 Some technologies may have a substantial impact on the costs (or cost savings) to government bodies other than the NHS. Exceptionally, these costs may be included if specifically agreed with the Department of Health, usually before referral of the topic. When non-reference-case analyses include these broader costs, explicit methods of valuation are required. In all cases, these costs should be reported separately from NHS and personal social services costs, and not included in the ICER.
5.5.12 Costs borne by patients may be included when they are reimbursed by the NHS or personal social services. When the rate of reimbursement varies between patients or geographical regions, such costs should be averaged across all patients. Where there are costs borne by patients that are not reimbursed by the NHS and personal social services, these may be presented separately.
Productivity costs should be excluded.
5.5.13 When care by family members, friends or a partner might otherwise have been provided by the NHS or personal social services it may be appropriate to
consider the cost of the time of providing this care, even when adopting a NHS or personal social services perspective. All analyses including the time spent by family members of providing care should be presented separately. A range of valuation methods exists to cost this type of care. Methods chosen should be clearly described and sensitivity analyses using other methods should be presented. Personal social service savings should also be incorporated.