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James Raftery’s NICE blogs

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.”


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…

James Raftery: NICE, obesity, and bariatric surgery

13 Jul, 12 | by BMJ

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…

James Raftery: Abaritarone for metastatic castration resistant prostate cancer—whose victory?

29 May, 12 | by BMJ

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…

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