Question to the Department of Health and Social Care:

To ask Her Majesty's Government what assessment has been made by NICE of the suitability of applying the 1.5 per cent non-reference discount rate for one time gene therapies that offer long-term health benefits.

The National Institute for Health and Care Excellence (NICE) is considering discounting in its ongoing methods review for both technology appraisals and highly specialised technologies. This includes consideration of different discount rates, including reference-case and non-reference-case, and the circumstances in which they might be considered.

As of May 2019, nine pieces of technology appraisal (TA) guidance and three pieces of highly specialised technologies (HST) guidance include discussions about discounting, specifically the appropriateness of using non-reference-case discount rates.

Non-reference-case rates were considered appropriate in one TA (TA538) and partially in one HST evaluation (HST7). Where non-reference-case discounting was not accepted, the committee’s considerations varied according to the circumstances of the individual appraisals; common themes included whether the technology aligned with the intention of the non-reference-case discounting criteria, uncertainties about long-term health effects, and whether the treatment would restore patients to ‘full or near full health’.

The discount rates applied by NICE in its health technology assessments are specified in its methods guides. These specify that the reference case discount rate is 3.5% per year for costs and health effects; a non-reference-case discount rate of 1.5% per year for costs and health effects may be considered in specific circumstances.

Sensitivity analyses using rates of 1.5% for both costs and health effects may be presented alongside the reference-case analysis. In certain cases, cost-effectiveness analyses are very sensitive to the discount rate used, and in these circumstances a non-reference-case discount rate for costs and outcomes may be considered.

NICE is considering whether there is a case for change in discounting in its ongoing methods review for both technology appraisals and highly specialised technologies.