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.
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.