The response of the government to the House of Common’s health committee’s report on the National Institute for Health and Clinical Excellence (NICE) has provided clarification both on value based pricing and NICE.

The committee’s report, published in January 2013, expressed concern that arrangements for value based pricing due to be introduced in January 2014 had not been clarified, urging the Department of Health to clarify before end of March 2013. more…

This blog reports on the third workshop held by the Department of Health on the methods being planned for value based pricing, due to start in January 2014. Previous workshops on wider social benefits (WSBs) and quality adjusted life year (QALY) weights were reported in previous blogs. This workshop extended the work reported previously, with quantitative analysis of the effects of WSBs and qualitative analysis of QALY weights. more…

This blog reports on a workshop held by the Department of Health on 28 November 2012 under Chatham House rules, that is the discussion can be reported but not attributed.

This workshop aimed to provide a framework for “a part of the government exploring use of QALY weights” in value based pricing (VBP), specifically:

• Burden of illness: does the social value of a QALY vary by size of unmet need (“QALYs lost per patient with current best practice treatment”)?
• Therapeutic innovation and improvement: does social value vary with “magnitude of QALY gain provided by a treatment?”
• End of life (EOL): does social value vary by “patients life expectancy with current best practice treatment?” (quotes are from the Department of Health briefing papers). more…

With the introduction of value based pricing scheduled to apply to new drugs when the current prescription pricing regulation system expires in 2014, the Department of Health has been working on the details of how it might apply. This blog reports on an invited workshop held by NICE on how the cost impact of health technologies might be extended to reflect a societal (termed “wider social benefits”) as opposed to the (current NICE) NHS and personal social care perspective. Chatham House rules applied (the discussion can be reported but not attributed). more…

The publication of a summary of the benefits and harms of breast cancer screening in the Lancet, with the full report to follow, raises the question of whether referring this to NICE would have made any difference. The most obvious difference is that NICE would have gone on to appraise cost effectiveness. The final sentence of the review states: “ The panel also believes that the overall cost effectiveness of the UK breast cancer screening programmes needs to be reassessed in view of this report.” more…

The trends on obesity are shocking. UK data on the prevalence of obesity in adults and children are provided by the National Obesity Observatory, which also shows the social gradient in obesity.

NICE’s guideline on obesity emphasised prevention, but recommended medical and surgical treatment. Bariatric surgery was an option for those with a body mass index (BMI) >40 or >35 with comorbidies with a cost per quality adjusted life year (£/QALY) of around £10k. Orlistat was also an option, plausibly between £20k and £30k per QALY. Incorporating these treatments into the clinical guideline made them less mandatory. Big geographical variations persist for bariatric surgery. Neither the restrictions on bariatric surgery nor on orlistat were formally estimated. The models used were simple and took minimal account of the impact of surgery on mortality or diabetes. more…

The decision by the National Institute for Health and Clinical Excellence (NICE) in May, after a provisional refusal in February, to recommend abaritarone acetate for metastatic castration resistant prostate cancer in adult men whose disease has progressed on or after a docetaxel-based chemotherapy regimen has been hailed by most of the news media as a defeat for NICE. Was it? What went on?

Prostate cancer growth is stimulated by androgens (male sex hormones, such as testosterone). In England and Wales, there were over 33,000 men newly diagnosed with prostate cancer and over 9,100 deaths from prostate cancer in 2008. more…

The publication of the Government response to the value based pricing consultation provides some further insight into current thinking. 188 responses are summarised to the 20 questions posed in the consultation, along with the Department of Health response to each. Of the 20 questions, seven asked yes/no questions along the lines of do you agree that X is best. Given that such questions will have been crafted with mandarin nuance, one might be surprised if some gave the wrong answers. Several did. more…

A recent breakfast meeting at the Kings Fund discussed the issue of an NHS top-up policy in relation to multifocal lenses in cataract surgery. My contribution from the commissioner perspective involved six points:

i) the lenses were dear, adding several hundred pounds to the around £800 NHS cost of a cataract procedure,
ii) that they were highly unlikely to be cost effective as the main gains appeared to have to do with some patients not requiring glasses,
iii) that within NHS budgets, the bigger issue had to do with lucentis versus avastin,
iv) that commissioners would consequently and rightly say no to funding multifocal lenses,
v) that top-ups for such lenses were worth considering, and
vi) that were I faced with the choice of top-up I would want more information to do with longer term follow up. more…

A useful update was provided at a meeting this week sponsored by the Royal National Institute for the Blind (RNIB) and Patients Involved in NICE (the National Institute for Health and Clinical Excellence). As the proceedings are to be written up and published, I focus here on the key points that emerged for me. more…