Cole, A., Cubi-Molla, P., Elliott, R., Feast, A., Hocking, L., Lorgelly, P., Payne, K., Peek, N., Sim, D., Sussex, J., Zhang, K and Steuten, L.
Outcome based payment (OBP) is a flexible payment mechanism that links the price the NHS pays for a medicine to the outcomes it achieves in practice for NHS patients. In 2019 we published the results of a research study which described that OBP could help to accelerate patient access to some new medicines, ensure close monitoring of real-world patient benefit, promote value for money in NHS spending and support innovation.
Cubi-Molla, P., Mott, D., Henderson, N., Zamora, B., Grobler, M. & Garau, M.
OHE explores the values of life that are used in analyses by the governmental departments of health, social care, environment, and transport, for a range of countries: Australia, Canada, Japan, New Zealand, South Korea, The Netherlands, and the UK. In most of the countries explored in this report, there is evidence that the criteria for resource allocation used by government or its agencies in the health sector values life significantly lower than the other non-health departments. The authors present a theoretical model which suggests that the existence of different values of life across departments is not inconsistent with the idea of optimal resource allocation (in a static model) but only if perfectly counterbalanced by non-health attributes. Notably, some form of reconciliation is needed to correct the potential imbalance in the value of the same attribute (life) across public sectors. Reconciliation could range from reallocation of budgets, transfers of benefit, to adjustments of benchmarking thresholds.
By convention, values for generic ‘preference-based’ measures, such as the EQ-5D, are anchored at 1 = full health and 0 = dead. This paper challenges the assumption that anchoring health state values at ‘dead = 0’ is a necessary condition for values to be used in quality-adjusted life year (QALY) estimation. The authors consider five propositions, using narrative review of the literature and conceptual explication of the problem:
Pearson, S., Lowe, M., Towse, A., K., Segel, C. and Henshall, C.
In the focus on US drug prices, ICER has contributed thinking on determining when price aligns with patient benefits. Less debated is whether insurance coverage provides patients with fair access to a drug with a fair, value-based, price. But how do we define fair access? This paper from ICER and OHE authors develops a fair access framework, proposing Ethical Goals for Access and Fair Design Criteria for cost sharing and prior authorization protocols.
Vaccines are widely regarded as one of the most important public health achievements of the last century. Health economists, however, have long highlighted the gaps between what policymakers typically count as vaccine benefits and the full benefits that vaccines confer. Failure to consider substantial portions of vaccines' full benefits, referred to as their ‘broader value’, can lead to undervaluing vaccines. This, in turn, may lead to suboptimal vaccine development, recommendation, and reimbursement decisions.
Shah, K.K., Ramos-Goñi, J.M., Kreimeier, S. and Devlin, N.J.
To date there have been no value sets to support the use of the EQ-5D-Y in cost-utility analysis. Discrete choice experiments (DCEs) can be used to obtain values on a latent scale, but these values require anchoring at 0 = dead to meet the conventions of quality-adjusted life year (QALY) estimation. This Research Paper describes a study in which four stated preference methods for anchoring EQ-5D-Y values were compared: visual analogue scale, DCE (with a duration attribute), lag-time TTO and the recently developed ‘location-of-dead’ (LOD) element of the personal utility function approach.
Antimicrobial resistance (AMR) is a growing public health threat, limiting the ability of health care systems to prevent and treat infections and save lives. In parallel, global antibiotic development pipelines are weak. Various R&D incentives have been proposed to address the challenges associated to low economic returns from investment in antibiotics. Value assessment methods recognising the value of new antibiotics to the whole health system are needed to help match the size of the required monetary incentives to the value that they offer.
Berdud, M., Wallin-Bernhardsson, N., Zamora, B., Lindgren, P., and Towse, A.
The present work aims to assess the life-cycle value of innovative medicines based on the example of Second-Generation Antipsychotics (SGA). Assessing the entire life-cycle of SGA, the study explores how much additional value has been delivered through additional approved indications for SGAs, generic competition or new and clinically superior formulations launched. Using risperidone as representative of the SGA class and comparing it to haloperidol – its counterpart from the First-Generation Antipsychotics (FGA) – this research estimates the life-cycle cost-effectiveness of the SGA class against FGA class in incremental terms. It also estimates the absolute social value added, measured by the sum of the consumer and producer surpluses. Study results aim to quantify the nature of value added by pharmaceutical innovation over the long-run to support consideration as to how access decisions can be informed by these life cycle effects.
Mott, D.J., Shah, K.K., Ramos-Goñi, J.M., Devlin, N.J. and Rivero-Arias, O.
This Research Paper describes a study examining adolescent and adult responses to a discrete choice experiment (DCE) containing EQ-5D-Y health states in order to determine whether the two groups exhibit different preferences.
The aim of this paper is to provide an overview of the issues that might limit comparability of PRO data and to highlight some of the evidence that exists on these issues. We note some of the implications for the development and use of PRO instruments, for their application in multi-country clinical trials, and for employing evidence from them in regulatory and reimbursement decisions. Although much progress has been made in this area, there is still scope for further research and improvement. Numerous factors can affect the comparability of PRO data across (and potentially within) countries and cultures. Failure to recognise and account for these differences could lead to incorrect conclusions about the effectiveness and cost effectiveness of new medicines and other health care interventions. We suggest areas where further research and enhanced guidelines for users of PRO instruments and data would be useful.