OHE presents an overview on the use of cost-effectiveness thresholds (CETs) in a number of selected countries in their decision-making process for health technology assessments. In addition to the different levels of CETs in these countries, this review examines whether an explicit or implicit CET is used, and the additional considerations (here termed ‘modifiers’) that are incorporated when funding and reimbursement decisions are made.
Although the science underlying drug development has evolved, there has been little change in how we pay for them. As more and more medicines come to market with multiple indications (or even more importantly the unrealised potentialto treat multiple indications), the way we pay for those medicines becomes critical in making sure we can benefit from them. “Indication-based pricing” (IBP) permits price to vary according to indication and has been proposed to tackle this issue.
Hernandez-Villafuerte, K., Shah, K., Herdman, M., and Lorgelly, P.
Meningococcal disease is a life-threatening infection and can result in severe sequelae. Recent scientific and technical advances have led to the discovery and implementation of novel meningococcal vaccines which have resulted in a substantial reduction in the burden of disease worldwide, representing a major public health achievement (Crum-Cianflone and Sullivan, 2016).
Cubi-Molla, P., Errea, M., Zhang, K. and Garau, M.
Cost-Effectiveness Thresholds (CETs) are used in a selected number of countries as tool in decision-making on funding and reimbursements for new healthcare technologies. In this white paper, OHE presents an analysis of the relative merits and shortfalls of current approaches to defining, estimating and applying CETs in Health Technology Assessments. The paper also puts forward a number of policy recommendations to help guide decision makers in ensuring CETs are used to achieve improved health outcomes in the future.
Henderson N., Errea M., Skedgel C. and Jofre-Bonet, M.
In light of concerns that not all medicines for ultra-rare (also known as ultra-orphan) conditions are appraised under the same NICE process, a new OHE Consulting Report discusses the distinct ethical and economic challenges faced by medicines for ultra-rare conditions, with particular reference to the challenges of HTA in the UK. A failure to consistently consider all ultra-rare disease medicines under the HST process could lead to inequalities in access and health outcomes for patients with ultra-rare conditions.
Yasunaga, H., Yamana, H., Rodes Sanchez, M. and Towse, A.
In 2015, OHE Consulting published a report on data governance arrangements for real-world evidence (RWE) covering the specifics under which RWE was used in eight different countries: Australia, France, Germany, Italy, Sweden, the Netherlands, the UK and the US1. Two years later, Lilly commissioned a second report based on the South Korean setting, following the same method and structure as the original2.
In England, an estimated 378,427 people receive palliative care each year in a range of specialised and generalised services. Overall, the quality of palliative care in England and the wider UK is widely regarded as excellent. However, despite the generally high level of care, many patients receiving palliative care die in pain every year. Yet, to date, there is little evidence of the scale of this problem. This study estimates that currently there are approximately 125,971 end-of-life patients receiving, or in need of, palliative care suffering from unrelieved pain.
Whether or not society values curative therapies more highly (or less highly) than the sum of the iterative improvements that might come from conventional therapy has been highlighted as an important area for research. The aim of this research was thus to explore society’s preferences across curative and non-curative therapies and large and small health gains, via a discrete choice experiment.
The proliferation of health data in our ever more digitalised world of health care creates opportunities for better research around – and delivery of – pharmaceutical innovation. However, these opportunities may be constrained around the legal barriers to the use of health data for these purposes, which are poorly understood, particularly in relation to the new General Data Protection Regulation (GDPR).
This OHE Consulting Report reviews “Measurement of Medicines Expenditure in the Context of the 2014-18 PPRS.” The project was funded by the ABPI.
For the year 2015/16, the Treasury reported growth in Government funded healthcare expenditure in the UK of 4.0% whilst NHS Digital reported medicines expenditure growth for the English National Health Service (NHS) for the same period at 8.0%. However, NHS Digital reported much reduced medicines expenditure growth for England of 3.5% for 2016/17, suggesting a complex underlying picture. NHS Digital growth rates are at list price as NHS Digital is not able to take account of rates of discount obtained by the NHS, which our analysis suggests are increasing, or of the rebate payments for branded drugs under the 2014-18 Pharmaceutical Price Regulation Scheme (PPRS).
It is important to stress that we are analysing data to understand trends since 2014. This work does not allow us to make any predictions about future trends.