Value, Affordability, and Decision Making

The Value in Health May issue includes the paper “How Should the World Pay for a Coronavirus Disease (COVID-19) Vaccine?”. Finalised in December 2020, it includes: an overview of COVID-19 vaccine development; a proposal for a benefit-based advance market commitment (BBAMC) to get the vaccines needed; and proposals for future pandemic preparedness. In this blog, the authors update their thinking to take account of the events of the last 6 months.

Our new paper explores the evidence currently being used to allocate budgets between public sector activities in the UK and its limitations. We argue that there is much that can and should be done to improve the evidence base to inform the allocation of public sector budgets across portfolios. We propose a pragmatic approach to measure and value disparate public sector outputs in a commensurate manner.

In a recently published report, we explore the financial sustainability of gene therapies and highlight the factors that are likely to influence the financial sustainability of this important medical technology.

Berdud, M., Jofre-Bonet, M., Rodes-Sanchez, M., Towse, A. 

Consulting Report
May 2021

After the shock caused by the first wave of COVID-19, discovering vaccines against the virus and administering them quickly to the population became the utmost priority worldwide, especially once subsequent waves of COVID-19 were inevitable. Not only incentivising the research on vaccines and authorising them quickly, but managing optimally the portfolio of vaccine candidates and establishing an efficient distribution plan became paramount to the success of this instrument.

A team at the University of York recently published a study in which they sought to generate more reliable evidence to inform the estimation of marginal productivity in the NHS. In our response, published in Medical Decision Making, we suggest that, unfortunately, the estimates provided by the ‘experts’ in the study are of little practical use.

In this blog, we reflect on some of the key learnings from the recent pull and push strategies to develop COVID-19 vaccines in the UK, the US, and the European Union. We use our recent work on portfolio management, pricing, and procurement of COVID-19 vaccines (forthcoming as an OHE report) to organise the review.

A new paper explores the equivalence of Multi-Criteria Decision Analysis and Augmented Cost-Effectiveness Analysis in adding elements of value to QALY-based cost-effectiveness decision making. It finds that they are equivalent methods under reasonable assumptions when elements of value can be aggregated into two separate top-level groups: health and financial.

In the contentious debate around US drug prices, less well understood is: if the price of a drug is a fair, value-based, price, how we assess if insurance coverage provides patients with ‘fair access’ to that drug? This paper from ICER and OHE authors seeks to define fair access. It proposes Ethical Goals for Access and Fair Design Criteria for cost-sharing and prior authorisation protocols.

A new Editorial reviews three solutions to the price and value challenge to reimbursing combination products. Higher thresholds are not justifiable. Evidence to support use of shorter regimens will take time to develop. Multi-use pricing is the best option to explore.

This blog summarises an initiative taken by more than 300 health economists and experts in support of the creation of an independent health technology assessment agency in Spain.


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