Author: Almudena González Domínguez
The economic evaluation of health interventions consists of transforming clinical evidence and cost data into structured information that serves as a basis for funding decisions.
The way in which the disease is modelled—structure, comparators, time horizon, assumptions, or data sources—affects the results. Each evaluation is usually constructed using a different model, even within the same pathology, which generates variability and a lack of methodological comparability.
In response, the document Use of disease-specific reference models in economic evaluations: NICE position statement (ECD18), published by the National Institute for Health and Care Excellence (NICE) in September 2025, proposes a methodological change: developing disease-specific reference models and extensions that serve as a common framework for economic evaluations (1,2).
What is NICE proposing?
NICE starts from a familiar observation for anyone working in economic evaluation: even though there is a shared reference case, each assessment uses different modelling structures. To reduce this variability, the position statement proposes (1,2):
- Disease-specific reference case extensions, which adapt the general methodology to the characteristics of each therapeutic area. They define populations, comparators, outcomes, and data sources as well as a conceptual model of a disease.
- Disease-specific reference models, which are complete, executable, and validated structures based on the best available evidence, and which can be used as a common basis for evaluating different interventions in that condition.
The aim is to ensure consistency, transparency, and efficiency, so that differences between evaluations are based on evidence rather than on the structural decisions of the modeler.
Benefits and challenges
The benefits and challenges are clear (1,2):
- Methodological consistency: allows comparison of results across technologies.
- Efficiency: reduces duplication and modelling and review times.
- Transparency: makes assumptions and parameters traceable and auditable.
- Predictability for the pharmaceutical industry and consultancies: acceptable standards are defined in advance.
- onsistency between guidelines and assessments.
NICE recognises, however, that these models require resources, continuous maintenance and validation with real evidence. It also highlights the need for clear governance and for prioritising areas where standardisation brings the most value (1,2).
Next steps
In 2026, NICE will launch its first extension of the reference case on obesity and comorbidities, and between 2026 and 2027 it will adapt the conceptual model for MASH (metabolic liver disease) (1,2).
The scoping processes and evidence submission templates will be adjusted so that companies can explain how their models align with these specific guidelines, and a governance framework will be created to ensure their maintenance and review (1,2).
In addition, NICE will explore the use of real-world data, artificial intelligence, and international collaboration to keep models up to date and extend this approach to other therapeutic areas (1,2).
Conclusion
With this position statement, NICE reinforces its leadership in the methodological standardisation of economic evaluation. The proposal to develop disease-specific reference case extensions and reference models is a decisive step towards more coherent, transparent, and reproducible assessments (1,2).
This approach is not only about improving the technical quality of models. It also aims to build trust and enhance comparability across evaluations of different technologies and in different contexts. In doing so, NICE points towards a new stage in economic evaluation, one in which models cease to be isolated tools and become shared knowledge infrastructures that support more consistent and efficient health-care decisions (1,2).
With Spain’s Royal Decree on Health Technology Assessment on the horizon and NICE’s experience as a benchmark, there is a clear opportunity to move towards a more robust, integrated, and sustainable framework for economic evaluation in Spain (1,2).
References
1. National Institute for Health and Care Excellence (NICE). Use of disease-specific reference models in economic evaluations: NICE position statement [Internet]. 2025 [citado 6 de noviembre de 2025]. Disponible en: https://www.nice.org.uk/corporate/ecd18/resources/use-of-diseasespecific-reference-models-in-economic-evaluations-nice-position-statement-pdf-40464280701637
2. National Institute for Health and Care Excellence (NICE). Use of disease-specific reference models in economic evaluations: NICE position statement [Internet]. NICE; 2025 [citado 19 de noviembre de 2025]. Disponible en: https://www.nice.org.uk/corporate/ecd18/
