NICE Submission Workflow

NICE 2025 requirements

NICE (2025) Methods Support Document (PMG36) on health inequalities requires manufacturers to submit DCEA as supplementary evidence when:

The intervention targets a condition with documented SES gradients.
The ICER is above £20,000/QALY and equity may affect the decision.
The committee requests equity evidence.

Step-by-step NICE workflow

1. Determine method

Use aggregate DCEA unless subgroup-specific evidence is available.

# Check whether disease has SES gradient
# Use disease_icd to auto-lookup HES utilisation
result <- run_aggregate_dcea(
  icer            = 28000,
  inc_qaly        = 0.45,
  inc_cost        = 12600,
  population_size = 12000,
  disease_icd     = "C34",
  wtp             = 20000,
  opportunity_cost_threshold = 13000
)

2. Sensitivity analysis

NICE expects sensitivity over key parameters, especially η.

sa <- run_dcea_sensitivity(result, params_to_vary = c("eta", "wtp", "occ_threshold"))
sa$eta_profile
#> # A tibble: 11 × 5
#>      eta equity_weight_q1 equity_weight_q5 equity_weighted_nhb delta_ede
#>    <int>            <dbl>            <dbl>               <dbl>     <dbl>
#>  1     0             1               1                  -1246.    -0.104
#>  2     1             1.14            0.886              -1265.    -0.106
#>  3     2             1.28            0.779              -1284.    -0.108
#>  4     3             1.43            0.680              -1303.    -0.110
#>  5     4             1.59            0.589              -1322.    -0.112
#>  6     5             1.75            0.506              -1340.    -0.114
#>  7     6             1.92            0.432              -1358.    -0.116
#>  8     7             2.09            0.366              -1374.    -0.118
#>  9     8             2.25            0.308              -1390.    -0.119
#> 10     9             2.42            0.258              -1405.    -0.121
#> 11    10             2.58            0.215              -1419.    -0.122

3. Generate submission table

tbl <- generate_nice_table(result, format = "tibble")
knitr::kable(tbl, caption = "DCEA Summary Table (NICE format)")

DCEA Summary Table (NICE format)
Equity subgroup	Baseline HALE (years)	Post-intervention HALE (years)	Change in HALE (years)	Net Health Benefit (QALYs)	Population share
Q1 (most deprived)	52.1	51.97	-0.1298	-1557.69	0
Q2	56.3	56.18	-0.1168	-1401.92	0
Q3	59.8	59.70	-0.1038	-1246.15	0
Q4	63.2	63.11	-0.0909	-1090.38	0
Q5 (least deprived)	66.8	66.72	-0.0779	-934.62	0
Total / Summary	NA	NA	NA	-6230.77	1.000

4. Export to Excel

export_dcea_excel(result, "dcea_submission.xlsx")

5. Present impact plane

plot_equity_impact_plane(result)

NICE compliance checklist

Aggregate DCEA conducted using England IMD quintile baseline
Opportunity cost threshold set to £13,000/QALY
Sensitivity analysis over η range 0-10
Equity-efficiency impact plane included
SII, RII, and Atkinson index reported pre and post
NICE submission table generated
Results presented as supplementary to base-case CEA

References

NICE (2025). Technology Evaluation Methods: Health Inequalities (PMG36). National Institute for Health and Care Excellence.

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