Towse, A., Lothgren, M., Steuten, L. and Bruce, A.
Using medicines in combination can deliver better outcomes for patients across different tumour types and disease stages. Yet many HTA agencies do not find that the expected additional benefits from adding a new medicine to a currently reimbursed medicine represents value for money to the health system. In markets that utilise cost-per-QALY approaches for assessing value, a clinically effective medicine might even be found to be “not cost-effective at zero price” when used as part of a regimen that increases treatment duration.
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:
Determining and defining value in health care is a persistent challenge in every country. To some extent, what constitutes value depends on perspective, e.g. a pharmaceutical company may view value somewhat differently than a doctor or a hospital administrator.
Errea, M., Skedgel, C., Zamora, B., G, Hampson., R, Althin., Hofmarcher, T., Lindgren, P., & Cookson, G.
Substantial economic resources are devoted to healthcare across Europe, but there is evidence that a large proportion of these resources are of limited benefit to patients and society. Around 10% of European Gross Domestic Product (GDP) is spent on healthcare and estimates suggest that as much as one-fifth of this amount (2% of GDP) is spent on interventions that make no meaningful contribution to health outcomes. In economic terms, these resources are used inefficiently.
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.
Histology independent therapies, a new class of medicines that target cancer based on specific genomic or molecular alterations of cancer cells rather than tissue of origin, face significant methodological and policy hurdles related to evidence development and acceptance, value assessment and reimbursement pathways, and diagnostic infrastructure availability.
The issue of rising prescription drug prices is a concern in every country. Dozens of policy initiatives and hundreds of research projects over last the fifty years have attempted to find solutions to pricing that provide an appropriate balance between the cost to health care systems and incentives for R&D. To name but a few, these include reference pricing, managed entry agreements, price-volume agreements, rebates, and risk sharing. The ultimate solution, however, remains elusive.
Most value assessments of vaccination programs are carried out by taking the perspective of the health system. To stimulate the debate concerning the broader value of vaccination beyond this perspective, this report quantifies the related return on investment to the UK government.