In 2018, the NHS turns 70. This OHE Consulting Report demonstrates the contribution and impact of medicines to the health economy in the UK throughout the history of the NHS. Through interviews with experts we identified a shortlist of the most important medicines to have been brought to market, and from a review of the literature and evidence base we attempt to quantify the benefits of these key medicines in terms of health and economic outcomes.
Cubi-Molla, P., Mott, D., Shah, K., Herdman, M., Summers, Y. and Devlin, N.
Cancer survival rates have improved dramatically in recent decades due in part to pharmaceutical advances, with a growing range of increasingly effective and targeted medicines being developed, such as immunotherapies. In the economic modelling of such treatments, the question arises of which utilities should be assigned to patients who show a long-term, durable response.
In recent critiques of economic models in this area by the National Institute for Health and Care Excellence (NICE), the idea that long-term cancer survivors (LTCS) who have received such treatments could report quality of life (QoL) scores which are similar to, or higher than, those of equivalent general population samples has not been viewed as credible. This literature review examines whether there is evidence to support the assumption that the QoL of LTCS can be similar to that of age/sex-matched population samples.
This OHE Consulting Report reviews “Estimated costs of production and potential prices of medicines for the World Health Organization Essential Medicines List” (Hill et al., 2018) in which the authors argue for “greater transparency in drug pricing” and propose generating estimates of the cost of manufacturing essential medicines to inform negotiations on drug pricing.
The notion that the price of a medicine should be linked in some way to value it generates for patients and the health system is generally accepted. Yet, how can this be achieved, when increasingly medicines are being developed that derive patient benefit across many different indications? Indication-based pricing (IBP) has been proposed as a way to tackle this issue, permitting price to vary according to indication and – critically – according to value.
The report addresses the implications of NICE appraising treatments for very rare diseases using a cost-per-QALY gained decision rule of the type used by NICE in its Technology Appraisal Programme to appraise therapies for more common conditions.
Cole, A., O'Neill, P., Sampson, C., and Lorgelly, P.
Surgical practice has and continues to develop at a tremendous pace, reflecting the evolving technological landscape as well as the expanding skillset of the surgical workforce. Minimal access surgery (MAS) can offer improved recovery prospects for patients, but uptake in the UK is variable across both procedures and hospitals.
The CRA Report has an underlying assumption that the EU is as globally competitive in generics and biosimilars as it is in innovative products. There is no evidence to support this. The correct industrial strategy for the EU may well be to focus on the development, manufacture and export of innovative products, rather than on lower value generics where EU global competitiveness appears to be weaker.
Maignen, F., Berdud, M., Hampson, G., and Lorgelly, P.
This report explores the consequences of the exit of the United Kingdom (UK) from the European Union (EU) on public health in the UK and in the EU. It also provides an estimate of the economic impact for pharmaceutical companies.
The centralised procedure was created in 1995 to facilitate access to innovative medicines across the European Union. Since then the scope of authorisation via the centralised procedure has been broadened and made mandatory for orphan and oncology medicines.
We analysed routine funding in the NHS for new medicines recently authorised via the centralised procedure with a particular focus on oncology and orphan medicines. We utilised a database of outcomes of health technology assessment (HTA) evaluations conducted in the UK by NICE, AWMSG and SMC: OHE’s Medicines Tracker. We considered centrally authorised products (CAP) approved between 1 January 2011 and 31 December 2016.
We find that a substantial number of products that received an EU authorisation between 2011 and 2016 were not referred for a HTA evaluation in the UK. We also show that there is both variation across agencies and variation across therapeutic classes in terms of adoption decisions and access across England, Scotland and Wales.
Lee, E.K., Park, J.A., Cole, A., and Mestre-Ferrandiz, J.
In 2015, OHE published a report which set out the core principles that should govern how Real-World Data (RWD) is accessed or generated, and used credibly to generate Real-World Evidence (RWE), thereby working toward a set of “international standards”. The analysis was based on a study of governance arrangements in eight key markets: the UK, France, Italy, Sweden, Germany, the Netherlands, Australia and the U.S.
In recognition of the expanding market for health care data in South Korea, the authors partnered with collaborators from SungKyunKwan University to extend this assessment to South Korea. In this report, the authors outline the current arrangements for the collection, sharing and use of RWD in South Korea, and assess how these compare with an “ideal”, facilitative framework for data governance.