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James Raftery’s NICE blogs

James Raftery: NICE: “inconsistent,” “in large part arbitrary and opaque,” according to friends

29 Aug, 14 | by BMJ

A strong critique just published points to logical inconsistencies in NICE’s consideration of social values, specifically in how it handles quality adjusted life years (QALYs). Since these are key to many of the most controversial decisions made by NICE’s appraisal committees, this matters. It matters all the more that the authors include Tony Culyer, who was “the founding vice chair of the National Institute for Health and Clinical Excellence and is a member of the NICE Citizens Council Committee and the NICE International Advisory Committee.” Besides being a leading health economist, he pioneered NICE’s approach to economic evaluation. Chris McCabe, another prominent health economist, has long advised NICE, notably through its decision support unit, which specialises in difficult cases. more…

James Raftery: Sofosbuvir for hepatitis C—moving to country specific prices

20 Aug, 14 | by BMJ

The National Institute for Health and Care Excellence (NICE) has provisionally approved sofosbuvir (brand name Sovaldi) for the treatment of hepatitis C, a decision that has surprised some commentators given its high price. The drug’s price in the United States of $84k for a 12 week course would be £54.6k at the current exchange rate of $/£0.65. But Gilead has priced sofosbuvir at £34 983 for England, which is 36% less than the US price. This is the price used in the NICE appraisal.

Pharmaceutical companies have tended to charge a single global price, but it is based on the US market, which accounts for over half of all branded pharmaceutical sales. This might be termed the Apple strategy, in that an iPhone costs more or less the same in all countries. While this can ensure enormous profits, its application to effective drugs is often seen as unethical. more…

James Raftery: Should the NHS use the new meningitis B vaccine?

28 Mar, 14 | by BMJ

The argument over whether the NHS should fund Bexsero, the new meningitis B vaccine from Novartis, raises a global issue about the price of the new vaccine, as well as questions about the role of cost effectiveness analysis in setting prices for vaccines, and the processes of the Joint Committee on Vaccinations and Immunisation (JCVI), which acts as the NICE of vaccines and immunisations.

The good news is that Bexsero is a new, apparently effective, vaccine for meningitis B. The bad news is its price: £75 per dose. Modelling of cost effectiveness estimated that it cost over £100k per quality adjusted life year (QALY.) The price at which it would meet NICE’s threshold for cost effectiveness was put at £9 per vaccine dose. more…

James Raftery: NICE proposes alternative for value based pricing

25 Feb, 14 | by BMJ

Recent headlines have indicated NICE’s displeasure at how it has been asked to implement value based pricing. The stories are based on a paper, “Value based assessment of health technologies,” which was considered by the NICE board on 22 January.

The paper proposed two main changes:

a) an alternative approach to the Wider Social Benefit proposed by the Department of Health, based on “the shortfall in the ability of people to contribute to society as a result of their disease or condition.”
b) incorporation of burden of illness based also on the “shortfall.” more…

James Raftery: Value based pricing—terms of reference given by the Department of Health to NICE

28 Jun, 13 | by BMJ

On 20 June the Department of Health announced that: “Expert body given responsibility to look at the benefits medicines bring to wider society.” The terms of reference are not on either the Department of Health’s nor NICE’s websites, but I requested and got a copy. Here is what they say:

“ The methods for value assessment of branded medicines under value based pricing should:

  • be applied to medicines within the scope of the value based pricing system, and incorporated into the methods for other categories of guidance at NICE’s discretion;
  • adopt the same benefit perspective for all technologies falling within the scope of value based pricing, and for displaced treatments;
  • be as transparent and predictable as possible;
  • be informed by the best available evidence;
  • include a simple system of weighting for burden of illness that appropriately reflects the differential value of treatments for the most serious conditions;
  • encompass the differential valuation of “End of Life” treatments in the current approach within the system of Burden of Illness weights;
  • include a proportionate system for taking account of Wider Societal Benefits;
  • not include a further weighting for Therapeutic Innovation and Improvement;
  • produce guidance for patients and the NHS which describes the clinical and cost effectiveness of the technology and its position in clinical practice.”

more…

James Raftery: Value based pricing—NICE to have key role

10 Apr, 13 | by BMJ

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…

James Raftery: Value based pricing—equality effects and ways forward

14 Feb, 13 | by BMJ

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…

James Raftery: QALYs and value based pricing

21 Dec, 12 | by BMJ

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…

James Raftery: Moving to value based pricing—adjusting costs

20 Nov, 12 | by BMJ

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…

James Raftery: Breast cancer screening review—would NICE have done it differently?

9 Nov, 12 | by BMJ

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…

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