Techniques for eliciting societal preferences for “severity” for use in health technology assessments

Background

In the recent methods guide, the National Institute for Health and Care Excellence (NICE) introduced a ‘severity modifier’ that places additional weight on health gains in the most severe conditions. While the severity modifier has been introduced as a pragmatic solution, NICE has recognised the limitations in the evidence available to date and has committed to further research on societal value of severity of condition to inform future update to health technology assessment (HTA) methods. Aim and objectives The aim of this research is to make broad recommendations to NICE about commissioning future research to elicit severity weights from a UK population for use in HTA. The objectives are twofold:

a.to critically review the range of elicitation techniques that have been used for generating societal values that could be used to generate severity weights as defined by NICE for use as severity weights in HTA presented as a briefing report to be used to inform the discussion during a meeting of experts.

b.to provide an overview of expert opinion on the suitability of different elicitation techniques identified above.

Method

A literature review was conducted to produce a narrative report of elicitation techniques that have been used to estimate societal preferences that can be used to generate severity weights as defined by NICE. An existing systematic literature formed the basis of this report, with further techniques and key papers for the various techniques identified from a forward and backward citation search carried out in January 2023, starting from four additional core papers identified by the research team. This review henceforth referred to as briefing report based was circulated in advance to a group of experts who were invited to an online meeting for a discussion of the elicitation techniques. The meeting began with a presentation by the research team, followed by discussions in small groups where each group discussed pre-prepared questions classified into the following three headings: completeness of the briefing report, discussion of the elicitation techniques and future research. The notes from the discussions at the meeting were written up and circulated to experts to check for accuracy.