As York Health Economics Consortium (YHEC) celebrate four decades of innovation and growth during our 40th anniversary year, we look back on one of the partnerships that made this milestone possible. In this blog post, we take a closer look at our longstanding collaboration with the National Institute for Health and Care Excellence (NICE).
YHEC’s relationship with NICE stretches back decades. Over that time, the organisation has supported everything from public health guidance and MedTech evaluations to methodological research and international training.
To explore how that work has evolved, and why it matters, we spoke with Matthew Taylor and Hayden Holmes about some of the most challenging, controversial and rewarding projects they’ve worked on with NICE.
“We’ve worked across almost every part of NICE”
YHEC’s formal work with NICE spans multiple programmes and advisory roles. Between 2015 and 2022, the team led NICE’s Economic and Methodological Unit (EMU), developing economic reviews and models for public health guidance while also undertaking methodological research in a role similar to a Decision Support Unit.
Alongside this, YHEC has been part of NICE’s External Assessment Group (EAG) programme since 2010, initially subcontracted through Newcastle upon Tyne Hospitals NHS Foundation Trust before becoming an EAG in its own right.
But the relationship goes even further back. “We’d actually been doing ad hoc work with NICE before any of the formal contracts,” Matthew explains. “That included modelling work in smoking cessation and obesity.”
Over the years, YHEC staff have also contributed directly to NICE committees and policy development. Stuart Mealing serves on NICE’s Rare Diseases Committee (formerly known as the Highly Specialised Technologies Evaluation Committee), while Matthew previously sat on the Public Health Advisory Committee. Other colleagues contributed to Medical Innovation Briefings, the Evidence Standards Framework, and the National Collaborating Centre for Indicator Development.
“It’s become a really strong relationship,” Hayden reflects. “We’ve had staff seconded into NICE as Technical Advisors, we’ve trained NICE staff directly, and we’ve built a level of trust over many years.”
From tightly defined models to open-ended public health questions
One of the biggest shifts in YHEC’s NICE work has been the nature of the questions being asked. “In pharmaceuticals, you’re often looking at a very specific treatment in a clearly defined population, with very specific outcomes,” Hayden says. “Public health is much messier.”
Matthew agrees. “One thing we learnt quickly was that the modelling approach depends entirely on the question you’re trying to answer — and the evidence available to answer it.”
Some NICE questions were straightforward and tightly scoped: ‘Is intervention X cost effective for population Y?’ Others were far broader. “We once got asked to explore what pharmacies could do to improve health while still being cost effective”, Matthew recalls. “We asked whether they meant things like pharmacist training or posters on the wall, and the answer was basically: ‘Yes. Things like that.”
That led the team to distinguish between what Matthew calls “specific” and “generalised” models. Specific models tackle narrowly defined decisions. Generalised models, by contrast, are designed for broader policy questions where evidence is uncertain and interventions are difficult to isolate. “With something like pamphlets in pharmacies, you can’t realistically calculate a precise cost per quality-adjusted life year (QALY),” he says. “The effectiveness depends on the content, who reads it, what condition it relates to, and whether behaviour changes.”
Instead, the team often worked backwards from the intervention cost. “We’d estimate how many QALYs would need to be generated to justify the spend, then describe the sort of real-world scenario that would achieve that. The committee could then combine that with the available evidence and their own expertise to judge whether those benefits seemed plausible.”
“Some of the most interesting projects were the hardest to model”
For Hayden, some of the most memorable NICE projects involved public health interventions around sexual health and alcohol misuse. “Work around sexually transmitted infections (STIs) and Pre-Exposure Prophylaxis (PrEP) was particularly interesting because of the complexity of the populations and the evidence challenges,” he says. “Public health interventions often don’t have a single clean outcome measure.”
School-based alcohol interventions became another major challenge. “You might observe reduced alcohol consumption,” Hayden explains, “but then you have to ask what that actually translates into. Does it reduce hospital admissions? Crime? Social harms? And how do you connect all those outcomes together?”
Sometimes the evidence raised uncomfortable policy questions. Hayden explained, “There was a Dutch study where the intervention that was most effective at reducing alcohol consumption also increased marijuana use”. “That immediately led to questions from committee members about what level of marijuana use was acceptable to gain bigger reductions in alcohol use, which was politically impossible to answer.”
Matthew saw similar debates elsewhere. “With e-cigarettes, there were questions around what level of vaping might be acceptable if smoking rates fell overall,” he says. “And with financial incentives for smoking cessation during pregnancy, the intervention was highly effective but also highly controversial. All very difficult to quantify because it comes down to ethics and politics too.” Another project involved modelling the cost effectiveness of teaching toothbrushing in schools. “The analysis suggested it was cost effective,” Matthew adds. “But some people fundamentally felt that schools simply shouldn’t be responsible for that kind of intervention.”
The challenge of costs beyond healthcare
A recurring difficulty in public health modelling is that many costs and benefits fall outside the healthcare system entirely. “NICE has an established cost-per-QALY threshold,” Hayden explains. “But that doesn’t necessarily work when you’re looking at interventions in schools or wider society.” For example, a school-based intervention may improve long-term health outcomes but require time and resources from the education sector. “So what’s the opportunity cost for schools?” Hayden asks. “Educational attainment? Teacher time? We know broadly how society values health gains, but we don’t have the same clear thresholds for education or social outcomes.”
These projects also exposed broader societal attitudes around responsibility and behaviour. “There can be a lot of victim blaming in public health discussions,” Hayden adds “With sexual health interventions, people may focus on risk-taking behaviour. With obesity or Type 2 diabetes, there are assumptions around personal responsibility.” Those debates often become just as important as the technical modelling itself.
NICE as a foundation for international work
The experience gained through NICE projects has also shaped YHEC’s work internationally. “Our NICE work gave us the grounding to support the Danish Medicines Council when they adopted the QALY framework,” Hayden says. “We delivered training over several years as they developed their centralised decision-making processes.”
Matthew adds that YHEC has also delivered training for health technology assessment bodies in countries including Norway, Sweden, Lithuania and China. “It’s been rewarding to see how methods developed through NICE work can influence decision making internationally.”
Measuring impact is difficult — but sometimes the impact is enormous
When asked where YHEC’s NICE work has had the greatest impact, both Matthew and Hayden point to the evolution of MedTech evaluations and public health policy. Hayden highlights the increasing sophistication of NICE’s MedTech assessments. “There’s now much more focus on evidence generation and identifying what matters most to the NHS,” he says. “Over time, that has the potential to become a much stronger mechanism for assessing value and negotiating pricing based on evidence rather than marketing arguments.”
Matthew points to smoking cessation guidance as a particularly powerful example. “When we built our first smoking cessation model for NICE, smoking prevalence in the UK was around 27%,” he says. “Now it’s closer to 10%.” He is careful not to overstate YHEC’s contribution, but the scale of the public health impact remains striking. “If those reductions translate into millions of people living longer, healthier lives, the societal value is enormous. Even making a very small contribution to that kind of change is hugely meaningful.”
“We shouldn’t let imperfect evidence stop us”
For both Matthew and Hayden, one of the most rewarding aspects of NICE work has been tackling problems that initially appear impossible. “I’ve always enjoyed the methods work,” Matthew says. “It influences multiple therapy areas at once and helps shape broader NICE policy.” That has included work on cross-sector costs and benefits, environmental sustainability, clinical equivalence, loss of exclusivity and living models.
Hayden, meanwhile, enjoys the challenge of finding pragmatic solutions where evidence is incomplete. “With some of the school-based alcohol work, people said it simply couldn’t be modelled,” he says. “But we felt there was still value in trying to produce something useful.” His view is that health economists should not wait for perfect evidence before informing decision making. “If you can help a committee make a better-informed decision, even with uncertainty, that’s worthwhile.”
A fast-paced environment with lasting relationships
Beyond the technical work, both Matthew and Hayden describe NICE projects as highly rewarding environments for staff development. “There’s a pace to NICE work that people really enjoy,” Hayden says. “Deadlines are fixed around committee meetings, and there’s a very direct connection between the work you do and national policy decisions.”
Matthew also reflects on the relationships built over the years. “We’ve worked with a huge number of brilliant people,” he says. “Many professional relationships have become personal friendships.”
Several former YHEC staff have gone on to work at NICE. “That’s something we’re really proud of,” Matthew adds. “It reflects the trust NICE places in the quality of our colleagues.”
Contact us
Contact the YHEC team to find out more about how we can support your health economics needs. If you want to learn more about our work with NICE, visit our website for further information.