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Introducing 'more patient reality' into NHS spending decisions
Date:1/24/2013

A study by health economists at the University of York has, for the first time, produced an estimate of the impact on other NHS patients of new and more costly drugs and other treatments.

This research suggests a refinement of the way the National Institute for Health and Clinical Excellence (NICE) gauges the cost-effectiveness of new interventions. It also has implications for the prices that the NHS can afford to pay for new drugs when the value-based pricing scheme for all new drugs is introduced by the Government in 2014.

The project was funded by the Medical Research Council Methodology Research Programme to establish methods that can estimate the cost-effectiveness threshold for NICE using routinely available data.

NICE assesses the health benefits of new drugs and other treatments. It also assesses whether these benefits are greater than the health likely to be lost for other NHS patients as other treatments are displaced to accommodate the additional NHS costs. To make this assessment NICE uses a 'threshold', which represents how much additional NHS cost would displace an amount of health; measured by quality-adjusted life years (QALY).

Since 2004 NICE has used a threshold range of 20,000 to 30,000 per QALY. It has been widely recognised for many years that this range is not based on evidence. The researchers at York have estimated a more accurate threshold to be 18,317 per QALY (based on 2008 expenditure).

Analysis of the uncertainty surrounding this estimate indicates that the chance the threshold is less than 20,000 per QALY is 64 per cent and the chance that it is less than 30,000 is 92 per cent.

Although there are other sources of uncertainty, there are good reasons to believe that 18,317 per QALY is, on balance, likely to be an overestimate of the 'true' threshold especially for new drugs that impose greater costs on the NHS. The research found no evidence that the threshold had increased with the NHS budget (2007 to 2
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Contact: David Garner
david.garner@york.ac.uk
44-019-043-22153
University of York
Source:Eurekalert

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