# 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.