Seminar

Review of NICE appraisals of cancer drugs – Martina Garau, OHE
Martina Garau presented the main findings of a review of NICE Technology Appraisals Guidance on cancer interventions focusing on cost-effectiveness of cancer treatments and other factors which have informed NICE's decision-making processes. Overall, cancer medicines have been found to offer good value for money on the basis of cost per life year or quality adjusted life year (QALY) gained. They are also expected to have a relatively modest cost impact on the NHS. The main non-economic factor that has influenced NICE recommendations on cancer treatments has been a concern to permit patients a choice of treatment.

NICE’s cost-effectiveness threshold – Nancy Devlin, City University
Professor Nancy Devlin reported on ongoing work being conducted by colleagues at City University and Abacus International to model NICE decisions as a function of cost-effectiveness and other variables.The work extends and updates previous analysis to estimate the impact of the cost per QALY ratio and uncertainty around it, of the existence or otherwise of other effective treatments for the condition under investigation, of budget impact estimates, patient group submissions and other factors on the probability of a positive or partially positive recommendation.They can thus indicate how NICE's acceptable level of cost per QALY alters as other factors vary. Issues around extraction of data from NICE appraisals and classification of NICE decisions were also discussed.

Industry versus Assessment Group estimates of cost-effectiveness – Deven Chauhan, OHE
Deven Chauhan reported on work undertaken with colleagues at NICE to investigate whether differences in the incremental cost-effectiveness ratios submitted to NICE appraisals by manufacturers and sponsors as opposed to the Assessment Groups are accompanied by systematic differences in estimates of incremental costs and benefits.The work also explored data inputs and analytical procedures such as duration of benefits used within the models in greater detail to pinpoint specific reasons for differences. It was found that incremental effects (difference in effects between the medicine under investigation and the comparator) were greater, and incremental costs smaller, in the sponsor's submission than in the Assessment Group’s analysis, in more than 50% of cases, but the results were statistically significant only for incremental effects.

OHE survey on post-launch data collection – Adrian Towse, OHE and Tony Whitehead, Sanofi-Aventis and NICE’s R&D Advisory Committee
Tony Whitehead introduced the session by explaining the role of NICE's R&D Advisory Committee in addressing whether and how the research recommendations made by NICE could be mandated or encouraged. Needed research could take the form of post-launch clinical trials but might also include observational and database studies, with data sources available for undertaking the latter having improved considerably over the last 25 years. Against this background,Adrian Towse reported preliminary results from a survey on post-launch data collection being conducted jointly with Mike Drummond and Anne Mason at York University.The survey asks pharmaceutical industry heads of pharmacoeconomics and outcomes research globally and UK heads of clinical/health outcomes research about reasons for and obstacles to undertaking post-launch studies, and types of studies undertaken. All respondents to the global survey agreed that a commitment by authorities/payers to revise their decisions based on the results of post-launch health economics/outcomes research studies would increase the likelihood of these studies being undertaken.

Update from the National Health Technology Assessment/Clinical Guidelines (NHTA/CG) User Group and Methodology sub-group – Martin Price, Janssen-Cilag
Martin Price reported on the role of the recently formed methodology sub-group of the ABPI's NHTA/CG User Group in addressing methodological issues which arise as part of health technology assessments undertaken by NICE and other bodies in the UK.The functions of the sub-group are to provide a mechanism for responding to consultations on HTA methods and processes, to assess the importance of new methodological developments, and to provide a forum for engagement with academics and academic groups undertaking technology assessments for NICE on issues of methodological controversy.