Avoiding opportunity cost neglect in cost-effectiveness analysis for health technology assessment

Despite being a fundamental tenet of economic analysis, there is a lack of clarity regarding the relevance of opportunity costs to cost-effectiveness analysis for health technology assessment. We argue that this is in part due to the importance of the decision context in understanding the nature of opportunity costs. Taking the example of the National Institute of Health and Care Excellence (NICE) on behalf of the NHS in England and Wales, we explore the implications of existing discrepancies between policy thresholds and emerging empirical evidence for analysts presenting results of cost-effectiveness analysis. A number of conceptually related, but distinct, issues are discussed and clarified.