Reference Case

A ‘reference case’ is a formal framework used by health technology assessment (HTA) bodies to provide standardized guidance for preparing and evaluating reimbursement submissions. The reference case outlines the accepted methods and assumptions that underpin economic analyses, ensuring consistency and comparability between different submissions and assessments.

Key aspects of a reference case include:

– Purpose: The main objective is to standardize the methodology and assumptions used in economic evaluations to facilitate consistent and transparent decision-making.

– Guidance Components: The reference case typically includes detailed statements on:

– Defining the Decision Problem: Clearly specifying the health intervention, target population, and the health outcomes of interest.

– Choice of Comparator: Identifying appropriate alternative interventions for comparison.

– Perspective: Stating the viewpoint of the analysis, such as the healthcare system or societal perspective.

– Time Horizon: Defining the period over which costs and benefits are considered.

– Discounting: Providing guidelines on how future costs and benefits should be discounted to present values.

– Sources of Data: Recommending preferred data sources for clinical effectiveness, costs, and health outcomes.

– Type of Economic Evaluation: Specifying the preferred methods of economic evaluation, such as cost-effectiveness analysis (CEA) or cost-utility analysis (CUA).

– Flexibility: While adherence to the reference case is expected, non-reference case methods and analyses are permitted if a clear justification for deviation is provided. This allows for the incorporation of innovative methods or unique aspects of specific interventions.

Example – UK NICE Reference Case:

– The National Institute for Health and Care Excellence (NICE) in the UK uses a reference case for technology appraisals. This includes specific guidelines on the elements mentioned above, ensuring that submissions are consistent and comparable.

By adhering to a reference case, HTA bodies can maintain a high standard of methodological rigor and transparency, facilitating fair and evidence-based decision-making for the reimbursement of health technologies.

Click HEOR TERMINOLOGY