This document summarizes a presentation given by Professor Adrian Towse on reflections on value based pricing and assessment. The presentation covered several topics: definitions of value based pricing versus value based assessment; preferences elicitation research on weighting QALY gains; approaches to aggregating multiple criteria in decision making; issues around setting cost effectiveness thresholds; and reforms to the Cancer Drugs Fund in the UK. The conclusion was that further work is still needed to better define and measure broader concepts of value, but that value based assessment rather than pricing is a better approach going forward.
In this presentation, OHE's Shah explains what a QALY is, how NICE has used QALYs in its decisions, whether and when other factors might take priority -- e.g. in end-of-life situations, and the importance of systematically gathering and analysing public preferences about such exceptions.
In this presentation, OHE's Mestre-Ferrandiz summarizes what is known about innovation, both challenges and incentives, and applies this to efforts to encourage the development of new antibiotics.
Are Wider Societal Effects Considered in Healthcare Decision-making? An over...Office of Health Economics
Presentation at ISPOR Italy - 12.04.16 - Are Wider Societal Effects Considered in Healthcare Decision-making? An overview from other countries by Martina Garau, OHE
HTA Value Based Pricing Versus WHO Fair Pricing: Which Delivers Universal Hea...Office of Health Economics
Slides from a presentation Adrian gave as part of an issue panel on the topic of HTA value-based pricing versus WHO fair pricing at the 2018 ISPOR Europe conference in Barcelona.
In this presentation, OHE's Shah explains what a QALY is, how NICE has used QALYs in its decisions, whether and when other factors might take priority -- e.g. in end-of-life situations, and the importance of systematically gathering and analysing public preferences about such exceptions.
In this presentation, OHE's Mestre-Ferrandiz summarizes what is known about innovation, both challenges and incentives, and applies this to efforts to encourage the development of new antibiotics.
Are Wider Societal Effects Considered in Healthcare Decision-making? An over...Office of Health Economics
Presentation at ISPOR Italy - 12.04.16 - Are Wider Societal Effects Considered in Healthcare Decision-making? An overview from other countries by Martina Garau, OHE
HTA Value Based Pricing Versus WHO Fair Pricing: Which Delivers Universal Hea...Office of Health Economics
Slides from a presentation Adrian gave as part of an issue panel on the topic of HTA value-based pricing versus WHO fair pricing at the 2018 ISPOR Europe conference in Barcelona.
This project explored whether an aligned, forward-looking health technology assessment (HTA) process exists, or can be established. The areas of interest for modern HTA systems were identified and explored in terms of ‘future directions’, namely the HTA good practice principles that are debated or that pose implementation challenges. Based on conversations with HTA experts from high- and middle-income countries, we concluded that an aligned, modern, forward-looking HTA is not feasible but further research initiatives would be valuable to stimulate debate and provide clarity in these topic areas.
Author(s) and affiliation(s): Margherita Neri, the Office of Health Economics, Grace Hampson, the Office of Health Economics and Adrian Towse, the Office of Health Economics
Conference/meeting: ISPOR Europe 2018
Event location: Barcelona, Spain
Date: 13 November 2018
Slides from the presentation Adrian gave on payment mechanisms and handling uncertainty as part of a forum held at the 2018 ISPOR Europe conference on the topic of triangulating developers, regulators, and payors to reap rewards and address challenges with curative therapies.
Incorporating Life-cycle Price Modelling into Pharmaceutical Cost-effectivene...Office of Health Economics
In this presentation, OHE's Pistollato explains why it is important to consider price changes after marketing in CEA analysis and presents an approach for doing so.
Slides from a presentation Adrian gave on the subject of indication-based pricing at the 2018 ISPOR Europe conference in Barcelona, Spain on November 12th.
OHE Lunchtime Seminar with Associate Professor Paula Lorgelly, Deputy Director, Office of Health Economics
From the Antipodes to the Motherland: reflections on HTA decision makers as budget takers and budget makers
Should Drug Prices Differ by Indication? Outlining the debate on indication-b...Office of Health Economics
The notion that the price of a medicine should be linked in some way to the value it generates for patients and the health system is generally accepted. Yet, how can this be achieved when, increasingly, medicines are being developed that derive patient across many different indications? We summarise the current state-of-play for indication-based pricing (IBP), both in theory as described in the key literature, and in practice by investigating its use in the US and five major European countries.
Author(s) and affiliations(s): Amanda Cole, OHE Bernarda Zamora, OHE Adrian Towse, OHE
Conference/meeting: ISPOR Europe
Event location: ISPOR Europe
Date: 13/11/2018
Rising Importance of Health Economics & Outcomes ResearchCitiusTech
Health Economics & Outcomes Research (HE&OR) guides stakeholders to make informed decisions regarding patient access to drugs and services. This document highlights specific use cases for healthcare information technology that add value to HE&OR.
Sponsored Webinar: Bringing Price Transparency to HealthcareModern Healthcare
Sponsored Webinar: Bringing Price Transparency to Healthcare
http://www.modernhealthcare.com/article/20140729/SPONSORED/307299924
About the Webinar
More consumers are finally asking for price transparency in healthcare, but most providers are still engrained in the pricing and billing practices they've always used. How can organizations take the lead on providing price transparency that will benefit all the stakeholders in healthcare?
By attending this webinar, you will learn:
Key steps in transitioning healthcare to a more price transparent model
How price transparency reduces the cost of care
The benefits of price transparent organizations
This project explored whether an aligned, forward-looking health technology assessment (HTA) process exists, or can be established. The areas of interest for modern HTA systems were identified and explored in terms of ‘future directions’, namely the HTA good practice principles that are debated or that pose implementation challenges. Based on conversations with HTA experts from high- and middle-income countries, we concluded that an aligned, modern, forward-looking HTA is not feasible but further research initiatives would be valuable to stimulate debate and provide clarity in these topic areas.
Author(s) and affiliation(s): Margherita Neri, the Office of Health Economics, Grace Hampson, the Office of Health Economics and Adrian Towse, the Office of Health Economics
Conference/meeting: ISPOR Europe 2018
Event location: Barcelona, Spain
Date: 13 November 2018
Slides from the presentation Adrian gave on payment mechanisms and handling uncertainty as part of a forum held at the 2018 ISPOR Europe conference on the topic of triangulating developers, regulators, and payors to reap rewards and address challenges with curative therapies.
Incorporating Life-cycle Price Modelling into Pharmaceutical Cost-effectivene...Office of Health Economics
In this presentation, OHE's Pistollato explains why it is important to consider price changes after marketing in CEA analysis and presents an approach for doing so.
Slides from a presentation Adrian gave on the subject of indication-based pricing at the 2018 ISPOR Europe conference in Barcelona, Spain on November 12th.
OHE Lunchtime Seminar with Associate Professor Paula Lorgelly, Deputy Director, Office of Health Economics
From the Antipodes to the Motherland: reflections on HTA decision makers as budget takers and budget makers
Should Drug Prices Differ by Indication? Outlining the debate on indication-b...Office of Health Economics
The notion that the price of a medicine should be linked in some way to the value it generates for patients and the health system is generally accepted. Yet, how can this be achieved when, increasingly, medicines are being developed that derive patient across many different indications? We summarise the current state-of-play for indication-based pricing (IBP), both in theory as described in the key literature, and in practice by investigating its use in the US and five major European countries.
Author(s) and affiliations(s): Amanda Cole, OHE Bernarda Zamora, OHE Adrian Towse, OHE
Conference/meeting: ISPOR Europe
Event location: ISPOR Europe
Date: 13/11/2018
Rising Importance of Health Economics & Outcomes ResearchCitiusTech
Health Economics & Outcomes Research (HE&OR) guides stakeholders to make informed decisions regarding patient access to drugs and services. This document highlights specific use cases for healthcare information technology that add value to HE&OR.
Sponsored Webinar: Bringing Price Transparency to HealthcareModern Healthcare
Sponsored Webinar: Bringing Price Transparency to Healthcare
http://www.modernhealthcare.com/article/20140729/SPONSORED/307299924
About the Webinar
More consumers are finally asking for price transparency in healthcare, but most providers are still engrained in the pricing and billing practices they've always used. How can organizations take the lead on providing price transparency that will benefit all the stakeholders in healthcare?
By attending this webinar, you will learn:
Key steps in transitioning healthcare to a more price transparent model
How price transparency reduces the cost of care
The benefits of price transparent organizations
Health System Efficiency and Sustainability in Australia, Canada, France, Ger...Office of Health Economics
OHE Consulting was commissioned by Eli Lilly and Company’s Global Public Policy department to identify and analyse inefficiencies and bottlenecks that undermine health care system sustainability and potential policy solutions to address them. We focused on Australia, Canada, France, Germany, Italy, Spain and UK.
We found that the focus of health care policy thinking is on: removing perverse incentives; filling gaps in information to payers, health care professionals and patients; more/better chronic disease management and better coordination of care, especially between primary and secondary care; and better compliance with good practice guidelines.
Our results confirm and reinforce some of the key inefficiencies that have been discussed in the literature. Some differences across countries emerge but there is considerable consensus, with a major focus on better integrated care, especially for chronic diseases. The findings imply a clear, high level health care policy agenda for tackling health system inefficiency.
Our main findings were presented as a poster at the 9th HTAi Annual Meeting, Bilbao, 25-27 June 2012. We have reproduced that poster here as a slide presentation.
Rethinking Value Based Healthcare
Around the world healthcare providers are busy exploring how value-based healthcare can both improve the efficiency and effectiveness of healthcare delivery and seed new opportunities for innovation. Continuing our collaboration with Denmark, we are very pleased to release a new perspective on how VBHC can have greater impact in practice. Based on insights from a recent event hosted by DTU Executive Business Education and undertaken in partnership with Rethink Value, this point of view looks at the key issues for patients, physicals, providers and payers.
It explores some of the associated implications for healthcare systems worldwide, highlights several leading early examples of VBHC in practice and looks at how it can have impact at scale. Recommendations focus on the structure of care, key metrics, moving beyond pilots, changes in reimbursement models and the need for greater insight sharing and deeper collaboration.
For related Future Agenda research see www.futureofpatientdata.org
Pharmacoeconomic Assessment through Market Approval and Beyond: Theory and Op...Medpace
Pharmacoeconomic assessment of a drug, medical device, or other healthcare product can take on many forms and occur at multiple points in the development cycle. Cost-effectiveness analysis, a major component of pharmacoeconomic assessment, has traditionally occurred in the later phases of product development—either as a piggy-back to a phase III or pivotal clinical trial, or peri-authorization.
This timely presentation addresses the changes that are proposed under NICE's new value-based assessment (VBA) approach to assessing health technologies. It reviews NICE's current approach and decisions to date for all technologies and separately for orphan and cancer drugs. VBA's proposed calculations for burden of illness and societal impact use estimates of 'shortfall' are illustrated in the presentation. Also discussed are changes in QALY thresholds.
On 31 October 2019, Adrian Towse and Chris Henshall from the Office of Health Economics (OHE) presented at the G20 meeting on antimicrobial drugs R&D in Paris organised by the Wellcome Trust. The topic of their presentation was HTA and payment mechanisms for new drugs to tackle antimicrobial resistance.
This presentation looks at ways in which governments can set prices, including “cost plus”, value, and the external referencing of prices elsewhere. It looks at the role that competition can play in keeping down prices. In that context it briefly discusses pricing proposals being considered in Malaysia. It makes the case for using HTA to inform pricing decisions.
Adrian Towse
% GDP spending in UK, G5 countries and OECD upper middle income countries. W...Office of Health Economics
This presentation looks at rates of GDP spend on health care, distinguishing between categories of country (i.e. levels of GDP pre capita). It looks at the relationship between rates of spending and moves to universal health coverage, and explores alternative ways of increasing expenditure and making decisions about which services to provide with the money available.
The role of real world data and evidence in building a sustainable & efficien...Office of Health Economics
This presentation defines RWD and RWE in the context of digital health, and looks at potential uses for RWD and RWE. It briefly sets out the current landscape in Malaysia and looks at the challenges in using RWE. In particular, the issues of access, governance and ensuring good quality are considered.
The aim of this educational symposium was to discuss why we should seek value across the health care system and how we can apply existing research methods to measure the value of services. While considerable political attention in developed countries continues to be focused on drug spending, there is also growing awareness of the significant contribution of non-drug components of health care (e.g., hospital services and inefficient care delivery) to overall spending growth and patient affordability. At the same time, there is growing interest in making greater use of value assessment and value-based payment to control spending and better align it with care quality. In order to promote greater value, and to do so in ways that respond to the needs of payers and patients, it is essential to assess value across both drug- and non-drug interventions and health care services. This panel will offer expert viewpoints to identify and discuss gaps in value information, rationale and approaches to track and reduce system-wide low value care, and research methods for how to measure health care services.
Role Substitution, Skill Mix, and Provider Efficiency and Effectiveness : Les...Office of Health Economics
Graham participated in an organised session on Monday July 15th 2019. In the session he presented his paper with his co-author Ioannis Laliotis from the London School of Economics. The paper revisits the relationship between workforce and maternity outcomes in the English NHS in an attempt to contribute knowledge to an important policy question for which there has been a paucity of research.
This research explores the feasibility of introducing an Outcome-Based Payment approach for new cancer drugs in England. A literature review explored the current funding landscape in England, the available evidence on existing OBP schemes internationally, and
which outcomes cancer patients value most. Two focus groups and an online survey with patients and carers, as well as interviews with NHS and government stakeholders, healthcare
professionals, and pharmaceutical industry representatives, provided additional evidence on the feasibility and suitability of OBP schemes
Understanding what aspects of health and quality of life are important to peopleOffice of Health Economics
Poster presentation from the EuroQol Plenary Meeting 2019, Brussels, Belgium. By Koonal Shah, Brendan Mulhern, Patricia Cubi-Molla, Bas Janssen, and David Mott.
Koonal presented as part of an organised session on ‘moving beyond conventional economic approaches in palliative and end of life care’. He summarised the empirical evidence on the extent of pubic support for an end of life premium, before discussing some novel approaches that have been used in recent studies. His presentation was discussed by Helen Mason of Glasgow Caledonian University.
Author(s) and affiliation(s): Koonal Shah, Office of Health Economics
Event: iHEA Congress
Date: 17/07/2019
Location: Basel, Switzerland
Assessing the Life-Cycle Value Added of Second Generation Antipsychotics in S...Office of Health Economics
This research presented in a poster at HTAi 2019, Cologne (Germany) by a team of OHE and IHE researchers, estimates the value added by second generation antipsychotics over their life-cycle in the UK and Sweden. It concludes that considering the entire life-cycle, the value added by SGAs to the system is higher than the expected value estimated at launch. P&R decisions should consider how to measure, capture and take into account the value added by medicines over the long-run.
Author(s) and affiliation(s): Mikel Berdud (Office of Health Economics, London), Niklas Wallin-Bernhardsson (Institute for Health Economics, Stockholm), Bernarda Zamora (Office of Health Economics, London), Peter Lindgren (Institute for Health Economics, Stockholm), Adrian Towse (Office of Health Economics, London)
Event: HTAi 2019 Annual Meeting
Date: 18/06/2019
Location: Cologne, Germany
There is growing recognition that HTA and contracting systems for antimicrobials need to be adapted to help fight the threat of antimicrobial resistance (AMR), but there is little agreement on how. This poster reports findings from a literature review, expert interviews and face-to-face discussions at a Forum on the current HTA and payment systems for antibiotics across Europe and a number of recommendations for adapting these systems to respond to the challenges of AMR.
Author(s) and affiliation(s): Margherita Neri (OHE) Grace Hampson (OHE) Christopher Henshall (OHE visiting fellow, independent consultant) Adrian Towse (OHE)
Event: HTAi annual conference 2019
Date: 18/06/2019
Location: Cologne, Germany
Assessing the Life-cycle Value Added of Second-Generation Antipsychotics in S...Office of Health Economics
This study aims to guide access decisions and drive the discussion on access and price, through recognition of the dynamic nature of value added by pharmaceutical innovation over the long-run. The analysis of the life-cycle value of risperidone estimates the value generated in the UK and Sweden. Results show that health systems were able to appropriate most of the life-cycle value generated, and this is larger than estimated at launch.
Author(s) and affiliation(s): Mikel Berdud(1), Niklas Wallin-Bernhardsson(2), Bernarda Zamora(1), Peter Lindgren(2), and Adrian Towse(1) (1) Office of Health Economics (2) The Swedish Institute for. Health Economics
Event: XXXIX JORNADAS DE ECONOMÍA DE LA SALUD
Date: 12/06/2019
Location: Albacete, Spain
Prescribed Specialised Services (PSS) Commissioning for Quality and Innovation (CQUIN) schemes were launched in 2013 in England with the aim of improving the quality of specialised care and achieving value for money. During this presentation, Marina Rodes Sanchez described the key features of the schemes and discussed its strengths and weaknesses based on international pay-for-performance literature.
Author(s) and affiliation(s): Yan Feng, Queen Mary University of London; Søren Rud Kristensen, Imperial College London; Paula Lorgelly, King’s College London; Rachel Meacock, University of Manchester; Marina Rodes Sanchez, Office of Health Economics; Luigi Siciliani, University of York; Matt Sutton, University of Manchester
Event: XXXIX Spanish Health Economics Association Conference
Date: 12/06/2019
Location: Albacete, Spain
In this session, Meng Li sets out estimates of real option value for drugs arguing that option value matters and can be calculated. Adrian Towse sets out likely payer concerns about incorporating real option value into decision making. Meng Li responds to these concerns. Jens Grueger sets out how industry considers investment opportunities, arguing that if patients (and society) have preferences these need to be reflected in P&R decisions.
Author(s) and affiliation(s): Meng Li, Postdoctoral Research Fellow, Leonard D Schaeffer Center, University of Southern California, Los Angeles, CA, USA. Adrian Towse, Emeritus Director, Office of Health Economics, London, UK Jens Grueger, formerly Head of Global Access, Senior Vice President at F. Hoffmann-La Roche
Event: ISPOR 2019
Location: New Orleans, USA
Date: 21/05/2019
MCDA OR WEIGHTED CEA BASED ON THE QALY? WHICH IS THE FUTURE FOR HTA DECISION ...Office of Health Economics
In this ISPOR session Chuck Phelps and Adrian Towse debated the case for and against using MCDA to support HTA decision making, as compared to weighting or augmenting a QALY based ICER approach. Chuck Phelps argued for use of MCDA, Adrian Towse for weighting the QALY. Nancy Devlin set the scene and moderated.
Author(s) and affiliation(s): Nancy Devlin, Director, Centre for Health Policy, University of Melbourne, Australia Adrian Towse, Emeritus Director, Office of Health Economics, London, UK Chuck Phelps, University of Rochester, Rochester, NY USA
Event: ISPOR 2019
Location: New Orleans, USA
Date: 21/05/2019
This presentation by Morris Kleiner (University of Minnesota), was made during the discussion “Competition and Regulation in Professions and Occupations” held at the Working Party No. 2 on Competition and Regulation on 10 June 2024. More papers and presentations on the topic can be found out at oe.cd/crps.
This presentation was uploaded with the author’s consent.
Have you ever wondered how search works while visiting an e-commerce site, internal website, or searching through other types of online resources? Look no further than this informative session on the ways that taxonomies help end-users navigate the internet! Hear from taxonomists and other information professionals who have first-hand experience creating and working with taxonomies that aid in navigation, search, and discovery across a range of disciplines.
This presentation, created by Syed Faiz ul Hassan, explores the profound influence of media on public perception and behavior. It delves into the evolution of media from oral traditions to modern digital and social media platforms. Key topics include the role of media in information propagation, socialization, crisis awareness, globalization, and education. The presentation also examines media influence through agenda setting, propaganda, and manipulative techniques used by advertisers and marketers. Furthermore, it highlights the impact of surveillance enabled by media technologies on personal behavior and preferences. Through this comprehensive overview, the presentation aims to shed light on how media shapes collective consciousness and public opinion.
0x01 - Newton's Third Law: Static vs. Dynamic AbusersOWASP Beja
f you offer a service on the web, odds are that someone will abuse it. Be it an API, a SaaS, a PaaS, or even a static website, someone somewhere will try to figure out a way to use it to their own needs. In this talk we'll compare measures that are effective against static attackers and how to battle a dynamic attacker who adapts to your counter-measures.
About the Speaker
===============
Diogo Sousa, Engineering Manager @ Canonical
An opinionated individual with an interest in cryptography and its intersection with secure software development.
Acorn Recovery: Restore IT infra within minutesIP ServerOne
Introducing Acorn Recovery as a Service, a simple, fast, and secure managed disaster recovery (DRaaS) by IP ServerOne. A DR solution that helps restore your IT infra within minutes.
Sharpen existing tools or get a new toolbox? Contemporary cluster initiatives...Orkestra
UIIN Conference, Madrid, 27-29 May 2024
James Wilson, Orkestra and Deusto Business School
Emily Wise, Lund University
Madeline Smith, The Glasgow School of Art
1. Professor Adrian Towse
Director, Office of Health Economics
AES 18th June 2015
Granada
Reflections on Value Based Pricing /
Assessment
2. Reflections on Value Based Assessment
18th June 2015 2
Agenda
• VBP context
• Regulating pharmaceuticals
• VBP versus VBA, PBRSA’s, MIPS
• What do we value?
• Eliciting social preferences
• Aggregating elements of value
• Threshold and decision making in the NHS
• Reforming the Cancer Drugs Fund
• Conclusions
3. Reflections on Value Based Assessment
18th June 2015 3
Value Based Pricing (VBP) Context
VBP was initially proposed in an Office of Fair Trading Report
on the Pharmaceutical Price Regulation Scheme (PPRS)
VBP initially proposed by the Government was intended to:
1. Introduce a broader definition of value
2. Replace NICE appraisal with an algorithm
3. Impose / negotiate prices with the industry
4. End the 5 year PPRS negotiated agreements
5. Get rid of “no” or “restricted/optimised” decisions from
NICE (and so get rid of anti-NICE, anti-DH Daily Mail
headlines)
6. Enable the Cancer Drugs Fund to be got rid of
4. Reflections on Value Based Assessment
18th June 2015 4
Agenda
• VBP context
• Regulating pharmaceuticals
• VBP versus VBA, PBRSA’s, MIPS
• What do we value?
• Eliciting social preferences
• Aggregating elements of value
• Threshold and decision making in the NHS
• Reforming the Cancer Drugs Fund
• Conclusions
5. Reflections on Value Based Assessment
18th June 2015 5
VBP versus Value Based Assessment
• Health systems should set
price (WTP) for health gain
reflecting insurees
preferences
• Optimal global R&D comes
from prices reflecting value
at local CE thresholds for
patent duration
• Price setting by
governments/HTA bodies
can lead to:
• commercial uncertainty
• opportunistic behaviour
6. Reflections on Value Based Assessment
18th June 2015 6
Impact of patient access schemes
If all positive
decisions since 2009
where a PAS was
implemented were
assumed to be a
“not recommended”
decision in the
absence of a PAS
(bar labelled
“without PAS”) the
share of not
recommended
decisions increases
to 47%
Chart: share of decision outcome for all medicines
decisions from 2009 to Q3 2013, with and “without” PAS
Source: OHE analysis
from NICE website
7. Reflections on Value Based Assessment
18th June 2015 7
Need for flexible pricing, multi-indication pricing and
more Performance-based risk sharing agreements
(outcomes-based Patient Access Schemes)
8. Reflections on Value Based Assessment
18th June 2015 8
Agenda
• VBP context
• Regulating pharmaceuticals
• VBP versus VBA, PBRSA’s, MIPS
• What do we value?
• Eliciting social preferences
• Aggregating elements of value
• Threshold and decision making in the NHS
• Reforming the Cancer Drugs Fund
• Conclusions
9. Reflections on Value Based Assessment
18th June 2015 9
What do we value?
• A lot of variation in what is
valued by payers / HTA
• Core is (i) health gain (life
extending, improved health
status) (ii) reducing system cost
• How far beyond this?
• Is this decided by:
1. The (extra-welfarist)
decision maker
2. The (welfarist) search for
social / individual
preferences
3. Or 1. informed by 2.?
10. Reflections on Value Based Assessment
18th June 2015 10
Eliciting social preferences: End of life
findings highlight the challenges
11. Reflections on Value Based Assessment
18th June 2015 11
EEPRU work – approach and findings (i)
• Discrete Choice Experiment (DCE) with 3669 respondents
• Chose whether NHS should treat patient group A or B,
who differed in terms of four attributes: life expectancy
without treatment; HRQOL without treatment; survival
gain from treatment; and HRQOL gain from treatment.
• These attributes were used to explore Therapeutic
Improvement (TI), derive Burden of Illness (BOI), QALY
gain and End of Life (EOL).
• Respondents preferred to treat patients with larger QALY
gains, but at a diminishing rate meaning there was no
support for TI
• Respondents preferred to treat patients with a shorter life
expectancy (EOL)
12. Reflections on Value Based Assessment
18th June 2015 12
EEPRU work – approach and findings (ii)
• Results suggested some support for BOI. Excluding
respondents “misunderstanding” the DCE task (remaining
sample 2247) had positive, significant and robust BOI
coefficients
• Using the marginal rate of substitution to estimate
weights indicated that 1 unit of BOI is equivalent to 0.04
QALYs gained, and EOL is equivalent to 3.331 QALYs
gained
• Robust and consistent support for EOL in general (but
this conceptually overlaps with BOI and the two should
not be used together)
• Overall the results indicate that a QALY is not a QALY and
provide a basis for determining QALY weights.
.
13. Reflections on Value Based Assessment
18th June 2015 13
Absolute and Proportional QALY Shortfall
Definitions
QoL
With current
treatment
Area D
Area B
Area C
Area A
Time
Absolute QALY shortfall is total potential health going forwards (Areas A+B+C+D) minus current health
prospects (Area D), i.e. Areas A+B+C.
Proportional QALY shortfall is the ratio of health lost to total potential health going forwards, i.e. Areas
A+B+C as a proportion of Areas A+B+C+D.
Fair Innings (Proportional QALY shortfall from birth) is not shown in Figure 1.
14. Reflections on Value Based Assessment
18th June 2015 14
Rationale
Absolute shortfall - Gavin Roberts, Economic Advisor, DH
“The rationale behind this approach is simply that society cares
about the absolute loss of quality of life and duration of
illnesses. That is, larger losses of quality of life are more important
than smaller losses. Longer durations of disease are more
important than shorter durations of disease. Diseases which cause
very premature death are more important than those which cause
less premature death.”
Proportional shortfall - Stolk et al (2004)
“The trouble with the [absolute shortfall] approach may be that
substantial differences in health prospects may exist not only
because of different illnesses, but also because of age differences.
Hence, unequal health prospects may not always be considered
unfair and inequitable.”
15. Reflections on Value Based Assessment
18th June 2015 15
Preferences and Value based pricing /
assessment: where have we got to/
• EEPRU study showed incremental innovation had a higher
value than breakthrough, so DH dropped it
• Operational model of EEPRU-based severity weights and
DH societal value given to NICE in 2012 with DH
instruction to have positive and negative effects.
• 2013 PPRS includes commitment to keep current NICE
thresholds in place for 5 years (2013-18)
• NICE consults in early 2013 on “severity” weight using
proportional QALY shortfall and on “social impact” weight
using absolute QALY shortfall with £20K - £50K threshold
range. Only positive effects. Will replace End of Life (EoL)
• October 2013 NICE announces no mandate for change.
EoL will stay. NICE will discuss with DH.
•
16. Reflections on Value Based Assessment
18th June 2015 16
Agenda
• VBP context
• Regulating pharmaceuticals
• VBP versus VBA, PBRSA’s, MIPS
• What do we value?
• Eliciting social preferences
• Aggregating elements of value
• Threshold and decision making in the NHS
• Reforming the Cancer Drugs Fund
• Conclusions
17. A reordering of process?
Safety
Efficacy,
effectiveness
Value for
money (CE)
Other factors of
value to D-M
(ethical issues,
social values,
feasibility of
implementation,
unmet needs,
innovation value,
legal issues, …)
Affordability
(BIA)
Criteria: broader definition of value
(risks, benefits)
Overall D-M Framework:
Opportunity costs
(value-for-money)Source: Ron Goeree,
Director PATH Research
Institute, Professor,
McMaster University
18. Reflections on Value Based Assessment
18th June 2015 18
Scientific judgment is usually about an effect
(positive or negative), its size, the ways in which it
can be achieved, for whom, for how long, ……….
Value judgments tend to be in a different
territory but they might be about, for example,
how worthwhile a technology is, how defensible
the tough bits of the decision are, how tolerant of
uncertainty the committee ought to be, …inter-
personal comparisons … whether the [outcome
measure] was a good tracker of the relative health
benefits of the interventions that were compared.
Different types of judgement
Source: A.J. Culyer. Deliberative Processes in Decisions about Health Care
Technologies. OHE Briefing , 2009
19. Reflections on Value Based Assessment
18th June 2015 19
Aggregating elements of value
• Weighting multiple criteria relevant to the decision
(MCDA):
• A pure deliberative process does not use any formal
structure and so is a “black box” to outsiders and
potentially to itself over time (may lead to a lack of
consistency and a lack of clear signals as to what
matters)
• A pure algorithmic approach does not need a Committee
• Is there something workable (theoretically robust and
practical) in between?
20. Reflections on Value Based Assessment
18th June 2015 20
Agenda
• VBP context
• Regulating pharmaceuticals
• VBP versus VBA, PBRSA’s, MIPS
• What do we value?
• Eliciting social preferences
• Aggregating elements of value
• Threshold and decision making in the NHS
• Reforming the Cancer Drugs Fund
• Conclusions
21. Reflections on Value Based Assessment
18th June 2015 21
The cost-effectiveness threshold (i)
Source: Dakin et al, OHE Research Paper, November 2013
22. Reflections on Value Based Assessment
18th June 2015 22
The cost-effectiveness threshold (ii)
Claxton et al (2013)
Schaffer et al (2013)
Barnsley et al (2013)
23. Reflections on Value Based Assessment
18th June 2015 23
The cost-effectiveness threshold (iii)
• The DH is “unofficially” using £15K as its
version of the CHERP81 £13K figure
• The PPRS guarantees NICE use the existing
threshold of £20K-£30K plus up to £50K for EoL
• We are struggling to understand what an
appropriate threshold might be:
• OHE work in Scotland and Wales
• Use of “local” PBMA and MCDA approaches
• Better data measurement is key (PROMS?)
24. Reflections on Value Based Assessment
18th June 2015 24
Reality of marginal service decisions – costs
per QALY ranges
Schaffer, S.K., Sussex, J., Devlin, N. and Walker, A. (2013) Searching for cost-effectiveness thresholds in NHS Scotland.
Research Paper 13/07. London: Office of Health Economics.
25. Reflections on Value Based Assessment
18th June 2015 25
Agenda
• VBP context
• Regulating pharmaceuticals
• VBP versus VBA, PBRSA’s, MIPS
• What do we value?
• Eliciting social preferences
• Aggregating elements of value
• Threshold and decision making in the NHS
• Reforming the Cancer Drugs Fund
• Conclusions
26. Reflections on Value Based Assessment
18th June 2015 26
• Access to cancer drugs not approved by NICE.
• Set up in 2010-11 with a budget of £50 million, increased
to £200 million for next three years, and to £280m for
2014-5 and 2015-6
• Underspent for first three years, last year (2014-5)
overspent
• NHS England has introduced rationing criteria for the CDF
27. Reflections on Value Based Assessment
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Trends in decision for cancer medicines pre
and post establishment of cancer drugs fund
(Q4 2010- Q3 2013)
Source: OHE analysis
from NICE website
28. Reflections on Value Based Assessment
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Agenda
• VBP context
• Regulating pharmaceuticals
• VBP versus VBA, PBRSA’s, MIPS
• What do we value?
• Eliciting social preferences
• Aggregating elements of value
• Threshold and decision making in the NHS
• Reforming the Cancer Drugs Fund
• Conclusions
29. Reflections on Value Based Assessment
18th June 2015 29
Conclusions
1. VBA is a better way forward than VBP. Renamed VBA in 2012 PPRS
agreement. So VBA is alive! (… just)
2. Work on the broader definition of value needs to continue. It
requires better understanding of the preferences of the public and of
patients. We need to invest in preference elicitation
3. Price flexibility by indication / subgroup and outcomes-based CED/
PBRSA schemes are important for getting dynamic and static
efficiency from the use of drugs. Reform of the CDF offers a way
forward to try more of these approaches
4. A deliberative process is necessary in value assessment. Introducing
structure to this process (MCDA) is a challenge
5. We need to thinking about decision making in the other 90% of NHS
spending. We might have a better basis for understanding the
relevant cost-effectiveness threshold and improve NHS efficiency.
30. Reflections on Value Based Assessment
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References
• Buxton, M., Longworth, L., Raftery, J., Schulpher, M. and Towse, A., 2014. Reforming the Cancer Drug
Fund. BMJ 2014; 349 doi: (Published 28 November 2014) Cite this as: BMJ 2014;349:g7276.
• Claxton et al. Methods for the estimation of the National Institute for Health and Care Excellence cost-
effectiveness threshold
• Dakin et al, OHE Research Paper, November 2013
• Danzon, P.; Towse, A.; Mestre-Ferrandiz, J 2015. Value-based Differential Pricing: Efficient Prices For
Drugs In A Global Context. Health Economics Volume: 24 Issue: 3 Pages: 294-301
• Linley and Hughes. Societal views on NICE, cancer drugs fund and value-based pricing criteria for
prioritising medicines: a cross-sectional survey of 4118 adults in Great Britain. Health Econ. 2013
Aug;22(8):948-64. doi: 10.1002/hec.2872. Epub 2012 Sep 7
• Rowen et al. 2014 Update: Eliciting societal preferences for weighting QALYs according to burden of
illness, size of gain and end of life. EEPRU Policy Research Unit in Economic Evaluation of Health and
Social Care Interventions. RR018 Date March 2014
• Raftery, J.P. (2014) NICE's cost-effectiveness range: should it be lowered? PharmacoEconomics, 32, (7),
613-615. (doi:10.1007/s40273-014-0158-6). (PMID:24811892).
• Schaffer, S.K., Sussex, J., Devlin, N. and Walker, A. (2013) Searching for cost-effectiveness thresholds
in NHS Scotland. Research Paper 13/07. London: Office of Health Economics.
• Shah, K.K., Tsuchiya, A. and Wailoo, A.J., 2014. Valuing health at the end of life: A stated preference
discrete choice experiment. Social Science & Medicine, 124, pp.48-56.
• Towse and Barnsley. Approaches To Identifying, Measuring, And Aggregating Elements Of Value.
International Journal of Technology Assessment in Health Care Volume: 29 Issue: 4 Pages: 360-364
Published: 2013 Health Technology Assessment Volume: 19 Issue: 14