---
title: "NICE Submission Workflow"
output: rmarkdown::html_vignette
vignette: >
  %\VignetteIndexEntry{NICE Submission Workflow}
  %\VignetteEngine{knitr::rmarkdown}
  %\VignetteEncoding{UTF-8}
---

```{r setup, include = FALSE}
knitr::opts_chunk$set(collapse = TRUE, comment = "#>")
library(dceasimR)
```

## NICE 2025 requirements

NICE (2025) Methods Support Document (PMG36) on health inequalities requires
manufacturers to submit DCEA as supplementary evidence when:

- The intervention targets a condition with documented SES gradients.
- The ICER is above £20,000/QALY and equity may affect the decision.
- The committee requests equity evidence.

## Step-by-step NICE workflow

### 1. Determine method

Use **aggregate DCEA** unless subgroup-specific evidence is available.

```{r step1}
# Check whether disease has SES gradient
# Use disease_icd to auto-lookup HES utilisation
result <- run_aggregate_dcea(
  icer            = 28000,
  inc_qaly        = 0.45,
  inc_cost        = 12600,
  population_size = 12000,
  disease_icd     = "C34",
  wtp             = 20000,
  opportunity_cost_threshold = 13000
)
```

### 2. Sensitivity analysis

NICE expects sensitivity over key parameters, especially η.

```{r step2}
sa <- run_dcea_sensitivity(result, params_to_vary = c("eta", "wtp", "occ_threshold"))
sa$eta_profile
```

### 3. Generate submission table

```{r step3}
tbl <- generate_nice_table(result, format = "tibble")
knitr::kable(tbl, caption = "DCEA Summary Table (NICE format)")
```

### 4. Export to Excel

```{r step4, eval = FALSE}
export_dcea_excel(result, "dcea_submission.xlsx")
```

### 5. Present impact plane

```{r step5, fig.width = 6, fig.height = 5}
plot_equity_impact_plane(result)
```

## NICE compliance checklist

- [ ] Aggregate DCEA conducted using England IMD quintile baseline
- [ ] Opportunity cost threshold set to £13,000/QALY
- [ ] Sensitivity analysis over η range 0-10
- [ ] Equity-efficiency impact plane included
- [ ] SII, RII, and Atkinson index reported pre and post
- [ ] NICE submission table generated
- [ ] Results presented as supplementary to base-case CEA

## References

NICE (2025). *Technology Evaluation Methods: Health Inequalities* (PMG36).
National Institute for Health and Care Excellence.