Some Inconsistencies in NICE’s Consideration of Social Values

Paulden, Mike; O’Mahony, James F.; Culyer, Anthony J.; McCabe, Christopher

doi:10.1007/s40273-014-0204-4

Cited by 54 publications

(48 citation statements)

References 11 publications

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“…objetivos não relacionados à saúde, como geração de emprego. Atualmente, o NICE ainda concede um aumento do limiar para £50.000/QALY para a geração de benefícios no fim da vida, fornecendo maior peso aos QALY ganhos em pacientes com doenças terminais (Paulden, 2014).…”

Section: Icer =unclassified

Limiar de custo-efetividade: uma necessidade para o Brasil?

Pinto¹,

Santos²,

Trajman³

2016

JBES

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RESUMOEste artigo teve como objetivo discutir a adoção de um limiar em avaliações econômicas em saúde. Um debate crucial nos sistemas de saúde é a definição de um limiar de custo-efetividade abaixo de um valor em que os tomadores de decisão e a sociedade estejam dispostos a pagar. Neste artigo trazemos este debate a partir das vantagens e limitações da adoção de um limiar e as diferentes possibilidades de estimá-lo a partir de experiências de outros países. Na América Latina, incluindo o Brasil, a maioria dos países ainda não adotou um limiar de custo-efetividade. ABSTRACTThis paper aims to discuss the adoption of a threshold in economic analysis. A crucial debate in health systems is the cost-effectiveness threshold below which public health stakeholders, decision makers and the society are willing to pay. We here debate the advantages and caveats of adopting a threshold and the different ways to calculate this threshold based on the experience of other countries. In Latin America, including Brazil, cost-effectiveness threshold was not adopted by the majority of countries. IntroduçãoO cenário de recursos finitos, potencializado por uma expressiva oferta de novas tecnologias para os sistemas de saúde em geral e, em particular para o Sistema Único de Saú-de (SUS), requer que o gestor tome decisões de incorporação com base em múltiplos critérios, dentre eles, as avaliações econômicas. As avaliações econômicas completas, destacadamente as análises de custo-efetividade (ACE) e de custo-utilidade (ACU), comparam duas ou mais tecnologias em termos de custos e benefícios. Essas ferramentas têm sido utilizadas desde a década de setenta em diversos países (Elixhauser et al., 1998) com vistas a apoiar as decisões de incorporação e a garantir tanto a eficiência técnica quanto a alocativa.A ACE e a ACU geram resultados que se traduzem através de uma medida denominada razão de custo-efetividade incremental (ICER, do inglês incremental cost-effectiveness ratio), expressa em custo adicional por um desfecho de saúde ganho, em geral, anos de vida ajustados por qualidade (QALY, do inglês quality-adjusted life years) ou anos de vida salvos Keywords:cost-effectiveness analysis, technology assessment, health systems.

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Section: Icer =unclassified

Limiar de custo-efetividade: uma necessidade para o Brasil?

Pinto¹,

Santos²,

Trajman³

2016

JBES

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“…The use of Health Technology Assessment (HTA) and costeffectiveness analyses increases the time to reimbursement as well as the degree of restrictions on access and use [25,40,44]. Changes in appraisal methods of National Institute of Clinical Excellence (NICE) in 2006 led to the presumption of a higher cost-effectiveness threshold for end-of-life medicines, which limited access to HCMs within the NHS between years 2006 and 2008 [45] until further changes that favoured end-of-life medicines between 2009 and 2011 [66]. In Australia the incremental costeffectiveness ratio is an important criterion for funding decisions made by the Pharmaceutical Benefits Advisory Committee [27].…”

Section: Search Resultsmentioning

confidence: 99%

Barriers to access and use of high cost medicines: A review

Wahlster

Scahill

et al. 2015

Health Policy and Technology

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“…The initial CDF imposed opportunity costs fell on different groups of cancer patients according to the criteria used in the CDF prioritisation tool, whereas the principle of a "QALY is a QALY is a QALY" that NICE applies (with exceptions) reflects the notion that each QALY has an equal value for different individuals (55). Arguments that the "hopeful outcomes" (56) of the CDF offered a bridge between cost-effectiveness analysis of bodies such as NICE and the views of patients are incomplete unless the opportunity costs of decisions so made are confronted.…”

Section: Discussionmentioning

confidence: 99%

Did It Matter That the Cancer Drugs Fund Was Not NICE? A Retrospective Review

2016

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms October 2010 and the introduction of reforms to its structure and operations in July 2016. There has been much more debate about the existence of the fund than about how it spent its substantial budget. It is important to undertake a retrospective examination of "where the money went" in light of the substantial reforms that will be introduced in 2016.Objective: We review the means by which the CDF made recent funding decisions for cancer drugs in order to provide an assessment of the merits of the CDF "model" as a basis for allocation decisions. We assess the extent to which proposed reforms could overcome defects in the original CDF model of prioritisation, and lessons for other countries. Methods:We provide a narrative commentary on the CDF's methods and processes since 2014. We evaluate methods against best practice in cost-effectiveness analysis, and processes against the "accountability for reasonableness" framework.We comment on reforms to the fund.Results: There are no grounds for concluding that the opportunity costs imposed on cancer patients were well evidenced, or the product of legitimate deliberative processes. We note that some of these issues will be addressed in the proposed next incarnation of the fund, but the rationale for the fund's existence remains unconvincing.

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Some Inconsistencies in NICE’s Consideration of Social Values

Cited by 54 publications

References 11 publications

Limiar de custo-efetividade: uma necessidade para o Brasil?

Limiar de custo-efetividade: uma necessidade para o Brasil?

Barriers to access and use of high cost medicines: A review

Did It Matter That the Cancer Drugs Fund Was Not NICE? A Retrospective Review

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