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PharmacoEconomics

, Volume 37, Issue 11, pp 1383–1390 | Cite as

NICE, in Confidence: An Assessment of Redaction to Obscure Confidential Information in Single Technology Appraisals by the National Institute for Health and Care Excellence

  • Ash Bullement
  • Matthew Taylor
  • Sam Thomas McMordie
  • Errol Waters
  • Anthony James HatswellEmail author
Original Research Article

Abstract

Introduction

Health technology assessment (HTA) aims to provide a transparent framework within which normative judgements can be applied for decision making. Such transparency enables the public to understand the rationale for decision making, but conflicts with companies being able to offer commercially sensitive discounts. We investigated how to balance these conflicting ideals.

Methods

National Institute for Health and Care Excellence (NICE) submissions were reviewed for products with an approved, simple Patient Access Scheme (PAS) discount. The approach to censoring was noted (e.g. total cost and clinical outcomes redacted). Submissions were then assessed for transparency (i.e. whether the decision appeared justifiable given the available information) and confidentiality (i.e. whether the PAS discount could be ‘back calculated’).

Results

One hundred and eighteen products have an approved commercial arrangement, of which 110 have simple PAS discounts considered within the NICE Single Technology Appraisal programme. A definitive incremental cost-effectiveness ratio was presented within final NICE guidance in only 20 appraisals. Documentation for seven appraisals allowed for the straightforward ‘back calculation’ of PAS discounts. Furthermore, a large amount of information was censored as academic-in-confidence and remains so many years later.

Conclusion

Appropriate redaction ensures discounts remain confidential, yet maintains the transparency of the HTA decisions made. Complete redaction does not allow for transparent, justifiable decision making. However, redacting ‘enough’ information to preclude direct estimation of discounts provides a means of maintaining both transparency and confidentiality. This study demonstrates a lack of consensus regarding presentation of results, and the importance of appropriate redaction.

Notes

Author Contributions

AH and MT conceived the paper. AB, SM and EW carried out data extraction and data analysis. The paper was drafted by AB, AH and MT. All authors contributed to the draft of the paper and addressed comments from the reviewers.

Compliance with Ethical Standards

Funding

No funding was received for this manuscript.

Conflict of interest

AB, MT, STM, EW and AJH declare that they have no conflicts of interest.

Data Availability

All data were taken from the website of the National Institute for Health and Care Excellence (NICE), and are in the public domain.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Delta HatNottinghamUK
  2. 2.York Health Economics Consortium, University of YorkYorkUK
  3. 3.University College LondonLondonUK

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