A. Introduction to Health Economics. Dr Alan Haycox Reader in Health Economics Health Economics Unit University of Liverpool Management School
|
|
- Tamsin Riley
- 6 years ago
- Views:
Transcription
1 A. Introduction to Health Economics Dr Alan Haycox Reader in Health Economics Health Economics Unit University of Liverpool Management School
2 Introduction to Health Economics Programme The programme will be broken down into four sections: 1. Introduction to health economics 2. Economics modelling: Theory & Practice 3. Value of new drugs including new cancer drugs: Scottish Medicines Consortia (SMC) Scotland 4. Value of new drugs including new cancer drugs: NICE (England)
3 Methods of economic evaluation and other techniques The four types of health economic evaluation are: CMA CEA CUA CBA We will also cover measuring health related quality of life as well as economic modelling
4 The Four Methods of economic evaluation Cost Minimisation Analysis (CMA) Cost Effectiveness Analysis (CEA) Cost Utility Analysis (CUA) Cost Benefit Analysis (CBA)
5 Cost Minimisation Analysis (CMA) Simplest of all methods of economic evaluation Does not mean benefits are ignored they have to be proven to be equivalent Once benefits have been proven to be equivalent, analysis needs only to consider costs
6 Example - CMA of generic formulations and different treatments Two drugs with exactly the same pharmaceutical components with differing costs, e.g. different formulations of paclitaxel Two approaches to cancer surgery with similar outcomes but different costs, i.e. one approach more invasive requiring more extensive analgesia
7 Cost-Effectiveness Analysis (CEA) Health benefits are measured in natural units reflecting a single dominant therapeutic goal Reduction in blood pressure (treatment) Increase in cases detected (screening) CEA is only useful and undertaken if a single dimension dominates the health outcome to be compared
8 Example - CEA of alternative Approaches to cervical screening How much more does the more effective screening system cost? (incremental costs) How many more cases are detected by the more effective screening system? (incremental effectiveness) What is the incremental cost-effectiveness ratio (ICER)? ICER = incremental cost/incremental effectiveness
9 (-) Incremental costs (+) The Cost-effectiveness Plane Existing technology dominates Costeffectiveness ratio (additional cost per additional success) Costeffectiveness ratio (cost saved per reduced success) New technology dominates (-) Incremental effectiveness (+)
10 Probability cost-effective Incorporating cost-effectiveness thresholds (CEAC s) for decision-making ,000 50,000 20,000 Ceiling ratio
11 Cost Utility Analysis (CUA) Incorporates the effects on morbidity (quality of life) and mortality (quantity of life) The most commonly used index is the qualityadjusted life-year (QALY) A QALY is calculated by aggregating the number of years gained from a health care intervention, weighted by the relative value attached to each future health state Issues underlying outcome analysis for CUA are explored in detail in the next session
12 Measuring Quality of Life (QoL) QoL weights reflect the subjective level of wellbeing experienced in different health states; the more preferable a health state the higher will be its associated value Perfect health = 1 Death = 0 We will return shortly to the methods used to help determine QoL. In the meantime, give a brief overview to determine QALY gains
13 Preference elicitation methods There are three main methods for direct measurement used in cost utility analysis. Visual Analogue Scale (VAS) Standard Gamble (SG) Time Trade-off (TTO)
14 Visual Analogue Scale (VAS) Individuals are asked to indicate where on the line between the best and the worst imaginable health states they would rate a pre-defined health state
15 VAS We would like you to indicate on this scale how good or bad is your health today, in your opinion. Please do this by drawing a line from the box below to wherever point on the scale indicates how good or bad your current health state is Your own health state today
16 Standard Gamble Alternative 1: Health state H 1 with certainty Choice With probability p: Full health, H 2 Alternative 2: Gamble With probability (1-p): Death, H 3
17 Standard Gamble board Choice A % Chance % Chance PERFECT HEALTH DEATH Choice B Some problems in moving about No problems with self-care No problems with usual activities Moderate pain or discomfort Not anxious or depressed
18 The time trade-off method QOL A =1 Value of health QOL B 0 LOL A LOL B Years QALY A = QALY B
19 Cost-benefit analysis This requires all costs and benefits to be measured in the same unit money In cost-benefit analysis an activity should be undertaken if the sum of the benefits are greater than the sum of the costs The difficulties of converting all benefits (pain, anxiety, disability, death) to a monetary equivalence implies that CBA is rarely used in health economic analyses
20 Summary Which tool for which analysis? What is the context of the analysis? What is the nature of the comparison being made? What is the nature of the outcome arising from the competing options?
21 Conclusion - What Health Economics aims to achieve Efficiency: Does the allocation of scarce resources maximise the achievement of health outcomes? Equity: Is the sharing of health care resources fair between people? The manner in which we are attempting to achieve these aims is explored in the following presentations
22 What is Health Related Quality of Life? A multi-dimensional concept that encompasses the physical, emotional and social components associated with an illness or its treatment
23 Measuring Health-Related Quality of Life (HRQoL) Pain P 4 B P 3 P 2 A = P 0 D 0 = Normal health P 1 P 0 A D 0 D 1 D 2 D Disability B = P 4 D 3 = Total disability & severe pain
24 What are Q of L weights? Such weights reflect the subjective level of wellbeing experienced in different health states; the more preferable a health state the higher will be its associated weight. Perfect health = 1 Death = 0
25 Measuring Health Gain in Theory 1 Prognosis with intervention QUALITY OF LIFE = Health gain Prognosis without intervention 0 ONSET OF ILLNESS INTERVENTION DEATH TIME
26 Two types of Measure Generic instruments Designed to have broad application across a wide range of disease states eg sickness impact profile, Nottingham health profile, EuroQol Disease specific instruments designed to assess the impact of specific disease states eg arthritis impact measurement scale, back pain disability questionnaire
27 Calculating QALYs A Simple Example Survival and associated health states With treatment X Without treatment X 10 years in improved health 8 years in poorer health Preference weights for health states With treatment X 0.7 Without treatment X 0.5
28 QALY Analysis for Treatment X With treatment X Survival = 10 years Q of L = 0.7 Without treatment X Survival = 8 years Q of L = 0.5 QALYs = (10 X 0.7) = 7.0 QALY = (8 X 0.5) = 4.0 QALY gain = 3.0 Q.A.L.Y s ( ) Cost of intervention = 45,000 Cost per QALY = 15,000
29 QALYs For and against their use in health economic evaluations For Generic multi-dimensional Easy to apply Provides practical guidance in allocating health care resources between very different therapeutic interventions Against Too superficial to measure the full benefits from health care? Insufficiently sensitive to capture small changes in the patient s Q of L Can we really measure quality of life in only five questions?
30 Measuring gains from different types of intervention = Health gain Quality of life Improved survival (increased length of life) only Time
31 Measuring gains from different types of intervention = Health gain Quality of life Improved quality of life only Time
32 Measuring gains from different types of intervention = Health gain Quality of life Improved survival and improved quality of life Time
33 Measuring gains from different types of intervention = Health gain = Health loss Quality of life Improved survival at expense of decreased quality of life Time
34 Conclusion of this section Accurate health outcome measurement is vital in determining the value and hence priority that should be placed on competing healthcare interventions. For cancer, this includes screening, initial management (adjuvant treatment, surgery, radiotherapy), management of advanced disease and end of life The need for sensitivity and practicality may pull in different directions QALYs assume that all health interventions aim either to make us live longer (quantity) or live better (quality)
35 B. Economic Modelling Theory & Practice
36 Therapeutic interventions are messy and complex Limited understanding of how things work Disease/Treatments/Services Limited evidence of effectiveness A better treatment? How much better and is it better for all patients? Evidence limited in time and place Are RCTs valid for other situations and in other countries? Variable quality and limited availability of evidence How to fill gaps? What is the comparative value of RCTs, observational data and expert opinion?
37 Hence we need to model in order to 1. Extrapolate beyond the results of a trial 2. Link intermediate clinical endpoints to final outcomes 3. Generalise to alternative settings 4. Synthesise head-to-head comparisons where relevant trials do not exist
38 1. Extrapolating beyond the results of a trial Economic evaluations require long term analyses to comprehensively assess the costs and benefits arising from an intervention Techniques A range of techniques are available to extrapolate outcome data into the future e.g. constant benefits or linear extrapolation
39 2. Linking intermediate endpoints to final outcomes where necessary Where RCTs only report intermediate clinical endpoints e.g. Hypercholesterolaemia (changes in HDL/LDL) Response rates to length of survival Disease free progression to length of survival Economic evaluations in comparing cost-effectiveness attempt to consider harder outcomes Life-years gained Techniques Logistic equations and other methods are used to try and determine impact on length of survival
40 3. Generalising to alternative settings Costs Costs differ from one setting (e.g. country) to another Techniques Adapt analyses to take account of local unit costs, comparators and patterns of care Efficacy Patients are carefully selected in clinical trials Compliance in trials is artificially high Techniques Develop an impact model that identifies factors underlying the success of a healthcare intervention and dichotomise between locally specific and generalisable
41 4. Synthesising head-to-head comparisons RCTs do often compare an active drug vs. Placebo; alternatively an add-on drug to an existing regimen and not a replacement. Clinicians need to know whether a new drug is superior to existing therapeutic interventions not as an add on especially when scarce resources Techniques Modelling allows for the results of more than one trial to be incorporated thus facilitating indirect comparisons between drugs
42 Stages in developing an economic model 1. Define the problem and your objective 2. Identify all relevant factors and how they inter-relate 3. Search for data/information to quantify those relationships 4. Choose an appropriate methodology/structure 5. Construct and calibrate the model 6. Test/validate model 7. Revise/correct model (return to stage 5 as required) 8. Apply model results to problem/decision
43 Knowledge requirements for modelling Epidemiological: Population at risk, mortality, effects Medical: Nature of the disease and how well do the treatment and comparators work? Economic Resources consumed at each stage of the treatment process
44 Data requirements for modelling Parameter estimates for each possible outcome or health state Probabilities of occurrence of each outcome or health state Cost for each resource consumed during the process of care provision
45 Types of model 1. Decision Tree Model all possible treatment paths and outcomes Each alternative is shown as a branch Each branch is connected by a decision (choice) node Outcomes are connected to branches by probability (chance) nodes Terminal health states / outcomes totalled for costs & benefits
46 Types of model 2. Markov Chain Based on movements between defined health states caused by events Individuals may enter the system at one or more source states Individuals progress from one state to another according to a set of transition probabilities Transitions occur at predetermined intervals (cycle period) Model may include one or more sink or terminal states (no exit)
47 Example of a simple Markov Model 1-p 1 -p 3 1-p 2 1 Patient Asymptomatic disease p 1 Progressive disease p 2 Death p 3 p n = transitional probability
48 How robust are health economic analyses? Issue to be addressed: Do limitations in either the quality or availability of evidence affect the recommended decision? If the decision is not altered despite reasonable variations in key assumptions/parameters, then the analysis can be considered to be robust Two types of uncertainty: Structural (is the model design correct?) Parameter (are the values correct?)
49 Techniques for handling uncertainty Structural: scenario analysis Re-run the analysis with alternate assumptions and model structures Parameter: sensitivity analysis (SA) Re-run the analysis with different parameter values One-way SA, Multi-way SA, Extreme values SA, Probabilistic SA
50 Incremental Cost Presentation of results of sensitivity analysis 1. Cost-Effectiveness Plane Incremental QALY
51 Probability cost-effective Presentation of results of sensitivity analysis 2. CE Acceptability Curve ,000 20,000 30,000 40,000 50,000 60,000 Value of ceiling ratio
52 Using the results of modelling A model simply provides a structure (good or bad) that organises complex relationships and data enabling them to be interpreted and manipulated By predicting and comparing costs and outcomes of competing interventions, it enables decision-makers to address problems in a more systematic manner
53 Good economic modelling practice A good model provides a structure that allows data to be interpreted and used. However, to maximise the value of the model, certain principles should be followed: Keep analyses simple Keep analyses transparent Make explicit the quality of the underlying data Keep a focus on uncertainty Compare the results obtained in your model to others
54 Conclusion - converting numbers to knowledge Remember: Numbers are meaningless Data = numbers with meaning and a source of integrity Information = data interpreted Knowledge = information in action
55 C. Value of new drugs including new cancer drugs: Scottish Medicines Consortia (SMC), Scotland
56 Only limited number of new products having reasonable health gain SMC recently analysed their guidance for 281 new products and indications (all drug classes) issued between April 2002 and September 2008 Data extracted from base case QALY gain estimates provided by the manufacturers showed: Overall median health gain QALY Mean health gain QALYs (standard deviation 1.72) This broken down as: 22% offered no benefit 28% offered >0 0.1 QALY 25% offered > QALY 13% offered > QALY 12% offered >1 QALY Ref: Andrew Walker and Ailsa Brown EACPT 2009
57 Recent examples of new drugs not recommended by SMC as economic concerns Drug Disease Reason for rejection Cost/ QALY Sunitinib (SUTENT) GIST and mrcc Economic case not proven Pemetrexed (ALIMTA) Metastatic NSCL cancer Economic case not proven Up to 53,000 AVASTIN and ERBITUX Metastatic ca colon/ rectum Economic case not proven Rimonabant (ACCOMPLIA) Obesity Economic case not proven Not assessed - no comparator Aliskiren (RASILEZ) Essential hypertension High costs with comparable efficacy 11-14/ year (generic ACEi) vs Ref: SMC website
58 SMC and new anti-cancer medicines recently reviewed 61 cancer medicines reviewed 36 for advanced/metastatic cancer 25 for earlier/adjuvant treatment Median QALY gain (over current treatment) 0.38 for advanced cancer 0.30 for earlier/adjuvant treatment Mean QALY gain (over current treatment) 0.52 for both groups
59 What do these mean and median QALY gains imply in reality? Median health gain 6 months with quality of life 70% of normal Mean health gain 8-9 months with QoL 70% Only 6 drugs (10%) offered 1 QALY 22 drugs (36%) offered 0.2 QALY = 3 months at 70% of normal QoL Overall
60 Some individual cancer drugs had considerable health gain Some of the greatest health-gains are with really innovative drugs: Trastuzumab 2.4 QALYs Nilotinib 2.1 QALYs Bortezomib 1.1 QALYs Even if these are expensive, they may offer good value-for-money The issue subsequently becomes affordability and opportunity costs (workshop)
61 Health gain with cancer drugs similar to other disease area Anti-cancer drugs are much like new drugs for other disease areas Musculoskeletal (11) 0.66 QALY Infections (33) 0.11 QALY Endocrine (24) 0.07 QALY Cardiovascular (33) 0.05 QALY CNS and pain (55) 0.04 QALY Overall new drugs in general do not appear to be as valuable as many would like to think!
62 D. Value of new drugs including new cancer drugs: NICE (England)
63 What does NICE mean by cost-effective? More effective and less costly More effective and more costly AND additional effect is worth the extra cost Less effective and less costly AND the cost saving is large enough to compensate for the loss of effect What is the cost-effectiveness threshold for acceptance? NICE does not use a precise ICER threshold above which a technology would automatically be defined as not cost effective or below which it would
64 Why do NICE use a costeffectiveness threshold? The appropriate threshold to be used is that of the opportunity cost of programmes displaced by new, more costly technologies If most plausible estimate is below 20,000 per QALY gained: cost effective use of NHS resources Above 20,000: are there benefits not captured by the QALY? Has quality of life aspect been adequately measured? Above 30,000 need to identify an increasingly stronger case for supporting the technology as an effective use of NHS resources
65 End of life care: The NICE criteria Introduced 5 January 2009, revised July 2009 Three criteria in order to qualify: The treatment is indicated for patients with a short life expectancy, normally <24 months There is sufficient evidence to indicate that the treatment offers an extension to life, normally of at least an additional 3 months, compared to current NHS treatment The treatment is licensed or otherwise indicated for small patient populations
66 End of life care: The NICE process For eligible treatments, the Committee will consider: The impact of giving greater weight to QALYs achieved in the later stages of terminal diseases, using the assumption that the extended survival period is experienced at the full quality of life anticipated for a healthy individual of the same age The magnitude of the additional weight that would need to be assigned to the QALY benefits in this patient group for the cost-effectiveness of the technology to fall within the current threshold range Committee requires that the assumptions used in the reference case economic modelling are plausible, objective and robust
67 End of life care: Specifying the comparator The comparator for the technology being assessed is very important because the choice to a large extent determines the incremental costs and incremental effects (and thus the cost per QALY) Relevant comparators might include: Therapies routinely used in the NHS Current best practice What is expected to be replaced (SMC) Do nothing (e.g. best supportive care)
68 End of life care: Measurement of health benefit The incremental QALYs as a result of a treatment have two components: Changes in survival Changes in health-related quality of life The main challenge with estimating changes in survival arises because the data on clinical effectiveness typically means that long-term overall survival must be extrapolated from short-term progression-free survival data Two challenges recur with quality of life data 1. The absence of data 2. Unsatisfactory measure of quality of life
69 Case study: Cetuximab for locally advanced squamous cell cancer of head and neck Cetuximab with radiotherapy versus radiotherapy alone in patients considered unsuitable for chemotherapy RCT showed significant improvement in duration of locoregional control, overall and progression-free survival, and overall response rate for the combination than for radiotherapy alone (Bonner et al, NEJM 2006) Manufacturer estimated a cost per QALY of 6,390 Committee rejected the submission highlighting uncertainties regarding the clinical evidence (e.g. RT regimens used in trial not typical of UK current practice, high proportion of patients in trial suitable for chemotherapy, and no clinical benefit demonstrated in patients with poor performance status)
70 End of life care: The importance of sub-groups Cost-effectiveness generally varies across sub-groups Important because ICER for entire patient group may be above the threshold but there may be sub-groups for whom the intervention is cost-effective Similarly, an ICER below the threshold for the patient group as a whole may hide ICERs for particular subgroups above the cost-effectiveness threshold RCTs often under-powered to assess treatment effects in sub-groups
71 Additional analysis presented following appeal Karnofsky performance status Hazard Rate Confidence Interval to , to , to ,200 Cost effectiveness to 2.78 RT dominant < to ,000
72 NICE recommendation (June 2008) The Committee concluded that Cetuximab in combination with radiotherapy is clinically and cost-effective in patients with locally advanced squamous cell cancer of the head and neck who have a Karnofsky performance status score of 90% or greater and for whom platinum-based chemoradiotherapy treatment is contraindicated
73 NICE evaluation: A summary ICERs and cost-effectiveness Understanding the economic model Key elements to watch out for: Appropriate comparators Relevant sub-groups Measurement of health benefit Analysis of uncertainty
74 The importance of HTA: Conclusion No health system can afford to fund all new healthcare interventions so we inevitably have to prioritise and choose HTA simply attempts to identify the healthcare interventions that provide sufficient clinical benefit to justify their cost HTA enables health systems to optimise the amount of patient benefit obtained from the limited resources available to the healthcare system HTA also enables an informed debate to be undertaken with the industry concerning the importance of linking drug pricing to drug effectiveness
Pharmacoeconomics: from Policy to Science. Olivia Wu, PhD Health Economics and Health Technology Assessment
Pharmacoeconomics: from Policy to Science Olivia Wu, PhD Health Economics and Health Technology Assessment Potential conflicts of interest - none 2 Pharmacoeconomics: from policy to science - Why the need
More informationNICE decisions on health care provisions in England
NICE decisions on health care provisions in England Matt Stevenson, Professor of Health Technology Assessment (HTA), ScHARR, University of Sheffield, UK A quick introduction I am Technical Director of
More informationCritical Appraisal Skills. Professor Dyfrig Hughes Health Economist AWMSG
Critical Appraisal Skills Professor Dyfrig Hughes Health Economist AWMSG Critical appraisal of economic evaluations Quality of the underlying evidence Quality of the analysis Quality of reporting 1. Quality
More informationTechnology appraisal guidance Published: 6 September 2017 nice.org.uk/guidance/ta476
Paclitaxel as albumin-bound nanoparticles with gemcitabine for untreated metastatic pancreatic cancer Technology appraisal guidance Published: 6 September 2017 nice.org.uk/guidance/ta476 NICE 2018. All
More informationNICE Guidelines for HTA Issues of Controversy
NICE Guidelines for HTA Issues of Controversy Mark Sculpher, PhD Professor of Health Economics University of York, UK LMI, Medicines Agency in Norway and the Norwegian Knowledge Centre for the Health Services:
More informationAn Introduction to Costeffectiveness
Health Economics: An Introduction to Costeffectiveness Analysis Subhash Pokhrel, PhD Reader in Health Economics Director, Division of Health Sciences Why do we need economic evaluation? 2017 2 Patient
More informationBasic Economic Analysis. David Epstein, Centre for Health Economics, York
Basic Economic Analysis David Epstein, Centre for Health Economics, York Contents Introduction Resource use and costs Health Benefits Economic analysis Conclusions Introduction What is economics? Choices
More informationPemetrexed for the maintenance treatment of locally advanced or metastatic non-small cell lung cancer
DOI: 10.3310/hta14suppl2/05 Pemetrexed for the maintenance treatment of locally advanced or metastatic non-small cell lung cancer J Greenhalgh,* C McLeod, A Bagust, A Boland, N Fleeman, Y Dundar, J Oyee,
More informationUstekinumab for the treatment of moderate to severe psoriasis
DOI: 10.3310/hta13suppl3/10 Health Technology Assessment 2009; Vol. 13: Suppl. 3 Ustekinumab for the treatment of moderate to severe psoriasis E Gospodarevskaya, J Picot, K Cooper, E Loveman* and A Takeda
More informationSetting The setting was secondary care. The economic study was conducted in the USA.
HER-2 testing and trastuzumab therapy for metastatic breast cancer: a cost-effectiveness analysis Elkin E B, Weinstein K C, Winer E P, Kuntz K M, Schnitt S J, Weeks J C Record Status This is a critical
More informationNational Institute for Health and Clinical Excellence. Health Technology Appraisal. Prucalopride for the treatment of chronic constipation in women
Health Technology Appraisal Summary form Prucalopride for the treatment of chronic constipation in women Comment 1: the draft remit Appropriateness Movetis Movetis entirely welcomes the opportunity to
More informationUsing Health Economics to Inform the Development of Medical Devices. Matthew Allsop MATCH / BITECIC
Using Health Economics to Inform the Development of Medical Devices Matthew Allsop MATCH / BITECIC Overview Background to MATCH Overview of health economics in product development Concepts relating to
More informationModule 1 What is economics and economic evaluation?
Designing Economic Evaluation Alongside Clinical Studies Health Economics Short Course For more information and course dates, please visit our website http://mdhs-study.unimelb.edu.au/short-courses/mspghshort-courses/designing-economic-evaluation-alongsideclinical-studies/overview
More informationTechnology appraisal guidance Published: 30 August 2017 nice.org.uk/guidance/ta472
Obinutuzumab with bendamustine for treating follicular lymphoma refractory to rituximab Technology appraisal guidance Published: 30 August 2017 nice.org.uk/guidance/ta472 NICE 2018. All rights reserved.
More informationEconomic Evaluation. Introduction to Economic Evaluation
Economic Evaluation Introduction to Economic Evaluation This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of
More informationNICE Single Technology Appraisal of cetuximab for the treatment of recurrent and /or metastatic squamous cell carcinoma of the head and neck
NICE Single Technology Appraisal of cetuximab for the treatment of recurrent and /or metastatic squamous cell carcinoma of the head and neck Introduction Merck Serono appreciates the opportunity to comment
More informationTechnology appraisal guidance Published: 28 September 2016 nice.org.uk/guidance/ta411
Necitumumab for untreated advanced or metastatic squamous non-small-cell lung cancer Technology appraisal guidance Published: 28 September 2016 nice.org.uk/guidance/ta411 NICE 2017. All rights reserved.
More informationErlotinib for the first-line treatment of EGFR-TK mutation positive non-small cell lung cancer
ERRATUM Erlotinib for the first-line treatment of EGFR-TK mutation positive non-small cell lung cancer This report was commissioned by the NIHR HTA Programme as project number 11/08 Completed 6 th January
More informationAccess to newly licensed medicines. Scottish Medicines Consortium
Access to newly licensed medicines Scottish Medicines Consortium Modifiers The Committee has previously been provided with information about why the SMC uses modifiers in its appraisal process and also
More informationEconomic evaluation of end stage renal disease treatment Ardine de Wit G, Ramsteijn P G, de Charro F T
Economic evaluation of end stage renal disease treatment Ardine de Wit G, Ramsteijn P G, de Charro F T Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion
More informationBackground 1. Comparative effectiveness of nintedanib
NCPE report on the cost effectiveness of nintedanib (Vargatef ) in combination with docetaxel for the treatment of adult patients with locally advanced, metastatic or locally recurrent non-small cell lung
More informationCost-effectiveness of tolvaptan (Jinarc ) for the treatment of autosomal dominant polycystic kidney disease (ADPKD)
Cost-effectiveness of tolvaptan (Jinarc ) for the treatment of autosomal dominant polycystic kidney disease (ADPKD) The NCPE has issued a recommendation regarding the cost-effectiveness of tolvaptan (Jinarc
More informationEuropean Experience and Perspective on Assessing Value for Oncology Products. Michael Drummond Centre for Health Economics, University of York
European Experience and Perspective on Assessing Value for Oncology Products Michael Drummond Centre for Health Economics, University of York Outline of Presentation The European landscape on access to
More informationTechnology appraisal guidance Published: 1 November 2017 nice.org.uk/guidance/ta483
Nivolumab for previously treated squamous non-small-cell lung cancer Technology appraisal guidance Published: 1 November 2017 nice.org.uk/guidance/ta483 NICE 2018. All rights reserved. Subject to Notice
More information4. Aflibercept showed significant improvement in overall survival (OS), the primary
Cost effectiveness of aflibercept (Zaltrap ) in combination with FOLFIRI in the treatment of adult patients with metastatic colorectal cancer (mcrc) that is resistant to or has progressed after an oxaliplatin
More informationTechnology appraisal guidance Published: 23 February 2011 nice.org.uk/guidance/ta214
Bevacizumab in combination with a taxane for the first-line treatment of metastatic breast cancer Technology appraisal guidance Published: 23 February 2011 nice.org.uk/guidance/ta214 NICE 2018. All rights
More informationTechnology appraisal guidance Published: 26 July 2017 nice.org.uk/guidance/ta459
Collagenase clostridium histolyticum for treating Dupuytren's contracture Technology appraisal guidance Published: 26 July 2017 nice.org.uk/guidance/ta459 NICE 2017. All rights reserved. Subject to Notice
More informationTechnology appraisal guidance Published: 7 March 2018 nice.org.uk/guidance/ta509
Pertuzumab with trastuzumab and docetaxel el for treating HER2-positive breast cancer Technology appraisal guidance Published: 7 March 20 nice.org.uk/guidance/ta509 NICE 20. All rights reserved. Subject
More informationCost-effectiveness of Daratumumab (Darzalex ) for the Treatment of Adult Patients with Relapsed and Refractory Multiple Myeloma.
Cost-effectiveness of Daratumumab (Darzalex ) for the Treatment of Adult Patients with Relapsed and Refractory Multiple Myeloma. The NCPE has issued a recommendation regarding the cost-effectiveness of
More informationTechnology appraisal guidance Published: 28 October 2009 nice.org.uk/guidance/ta183
Topotecan for the treatment of recurrent and stage IVB cervical cancer Technology appraisal guidance Published: 28 October 2009 nice.org.uk/guidance/ta183 NICE 2018. All rights reserved. Subject to Notice
More information1. Comparative effectiveness of liraglutide
Cost-effectiveness of liraglutide (Victoza ) for the treatment of adults with insufficiently controlled type 2 diabetes as an adjunct to diet and exercise. The NCPE has issued a recommendation regarding
More informationrosuvastatin, 5mg, 10mg, 20mg, film-coated tablets (Crestor ) SMC No. (725/11) AstraZeneca UK Ltd.
rosuvastatin, 5mg, 10mg, 20mg, film-coated tablets (Crestor ) SMC No. (725/11) AstraZeneca UK Ltd. 09 September 2011 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product
More informationScottish Medicines Consortium
Scottish Medicines Consortium sorafenib 200mg tablets (Nexavar ) (No. 321/06) Bayer Plc 6 October 2006 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises
More informationCost effectiveness of
Cost effectiveness of brentuximab vedotin (Adcetris ) for the treatment of adult patients with relapsed or refractory CD30 positive Hodgkin Lymphoma who have failed at least one autologous stem cell transplant.
More informationBackground Comparative effectiveness of nivolumab
NCPE report on the cost effectiveness of nivolumab (Opdivo ) for the treatment of locally advanced or metastatic squamous non-small cell lung cancer after prior chemotherapy in adults. The NCPE has issued
More informationSummary Background 1. Comparative effectiveness of ramucirumab
Cost-effectiveness of ramucirumab (Cyramza ) for the treatment of adult patients with advanced gastric cancer or gastro-oesophageal junction adenocarcinoma with disease progression following previous treatment
More informationCost-effectiveness of endovascular abdominal aortic aneurysm repair Michaels J A, Drury D, Thomas S M
Cost-effectiveness of endovascular abdominal aortic aneurysm repair Michaels J A, Drury D, Thomas S M Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion
More informationTechnology appraisal guidance Published: 29 June 2011 nice.org.uk/guidance/ta227
Erlotinib monotherapy for maintenance treatment of non-small-cell lung cancer Technology appraisal guidance Published: 29 June 2011 nice.org.uk/guidance/ta227 NICE 2018. All rights reserved. Subject to
More informationBevacizumab added to a taxane for the first-line treatment of metastatic breast cancer
Appendix I Bevacizumab added to a taxane for the first-line treatment of metastatic breast cancer Primary Care Trusts (PCTs) provide a unique perspective on the technology, which is not typically available
More informationScottish Medicines Consortium
Scottish Medicines Consortium cetuximab 2mg/ml intravenous infusion (Erbitux ) (279/06) MerckKGaA No 9 June 2006 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product
More informationHow to carry out health technology appraisals and guidance. Learning from the Scottish experience Richard Clark, Principal Pharmaceutical
The Managed Introduction of New Medicines How to carry out health technology appraisals and guidance. Learning from the Scottish experience Richard Clark, Principal Pharmaceutical Analyst July 10 th 2009,
More informationTechnology appraisal guidance Published: 16 May 2018 nice.org.uk/guidance/ta520
Atezolizumab for treating locally advanced or metastatic non-small-cell lung cancer after chemotherapy Technology appraisal guidance Published: 16 May 2018 nice.org.uk/guidance/ta520 NICE 2018. All rights
More informationCost-effectiveness of evolocumab (Repatha ) for hypercholesterolemia
Cost-effectiveness of evolocumab (Repatha ) for hypercholesterolemia The NCPE has issued a recommendation regarding the cost-effectiveness of evolocumab (Repatha ). Following NCPE assessment of the applicant
More informationEconomic issues in Hepatitis C. Richard Grieve London School of Hygiene and Tropical Medicine
Economic issues in Hepatitis C Richard Grieve London School of Hygiene and Tropical Medicine Acknowledgements Mild Hepatitis C study Principal Investigators: Howard Thomas, Janice Main Centre co-ordinators
More informationStratified Cost-Effectiveness Analysis (with implications for sub-group analysis) (and applications to value-based pricing)
Stratified Cost-Effectiveness Analysis (with implications for sub-group analysis) (and applications to value-based pricing) Andrew H Briggs William R Lindsay Chair of Health Economics Stratified CEA: Overview
More informationA CASE STUDY OF VALUE OF INFORMATION
A CASE STUDY OF VALUE OF INFORMATION, Research Fellow 1/19 Background The ISPOR good practices for performance-based risk-sharing arrangements task force recommends using value of information analysis
More informationlevetiracetam 250,500,750 and 1000mg tablets and levetiracetam oral solution 100mg/1ml (Keppra ) (No. 397/07) UCB Pharma Ltd
Scottish Medicines Consortium Resubmission levetiracetam 250,500,750 and 1000mg tablets and levetiracetam oral solution 100mg/1ml (Keppra ) (No. 397/07) UCB Pharma Ltd 11 January 2008 The Scottish Medicines
More informationA cost effectiveness analysis of treatment options for methotrexate-naive rheumatoid arthritis Choi H K, Seeger J D, Kuntz K M
A cost effectiveness analysis of treatment options for methotrexate-naive rheumatoid arthritis Choi H K, Seeger J D, Kuntz K M Record Status This is a critical abstract of an economic evaluation that meets
More informationPonatinib for treating chronic myeloid leukaemia and acute lymphoblastic leukaemia
Ponatinib for treating chronic myeloid leukaemia and acute lymphoblastic leukaemia Single Technology Appraisal 2 nd Committee meeting: 16 March 2017 Committee C FOR PUBLIC Key issues Absence of direct
More informationTechnology appraisal guidance Published: 8 November 2017 nice.org.uk/guidance/ta487
Venetoclax for treating chronic lymphocytic leukaemia Technology appraisal guidance Published: 8 November 2017 nice.org.uk/guidance/ta487 NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationEverolimus, lutetium-177 DOTATATE and sunitinib for treating unresectable or metastatic neuroendocrine tumours with disease progression MTA
Everolimus, lutetium-177 DOTATATE and sunitinib for treating unresectable or metastatic neuroendocrine tumours with disease progression MTA 1 st Appraisal Committee meeting Cost Effectiveness Committee
More informationAn exploration of the cost-effectiveness of interventions to reduce. differences in the uptake of childhood immunisations in the UK using
An exploration of the cost-effectiveness of interventions to reduce differences in the uptake of childhood immunisations in the UK using threshold analysis National Collaborating Centre for Women s and
More informationIntroduction. Onco-Pharmacoeconomy Training Course. Turkey ISPOR Training Course
Onco-Pharmacoeconomy Training Course Turkey ISPOR Training Course Introduction Dr Alan Haycox Reader in Health Economics Health Economics Unit University of Liverpool Management School Course objectives
More informationTechnology appraisal guidance Published: 24 August 2016 nice.org.uk/guidance/ta402
Pemetrexed ed maintenance treatment for non-squamous non-small-cell lung cancer after pemetrexed ed and cisplatin Technology appraisal guidance Published: 24 August 2016 nice.org.uk/guidance/ta402 NICE
More informationEconomic Analyses in Clinical Trials
Economic Analyses in Clinical Trials Natasha Leighl (and Nicole Mittmann) Committee on Economic Analysis, NCIC CTG Natasha.Leighl@uhn.on.ca; Nicole.Mittmann@sunnybrook.ca Financial Disclosures Research
More informationValue Based Health Care in the UK: NICE, VBP and the Cost-effectiveness Threshold. Eldon Spackman, MA, PhD
Value Based Health Care in the UK: NICE, VBP and the Cost-effectiveness Threshold Eldon Spackman, MA, PhD Background to NICE NICE s current position on the threshold Two concepts of the threshold Why the
More informationPriority setting at a national level NICE - England. Gillian Leng Deputy Chief Executive, NICE September 2016
Priority setting at a national level NICE - England Gillian Leng Deputy Chief Executive, NICE September 2016 Areas to cover The role of NICE in the UK health system General approach to appraising new drugs
More informationSetting The setting was secondary care. The study was carried out in the UK, with emphasis on Scottish data.
Cost-effectiveness of thrombolysis with recombinant tissue plasminogen activator for acute ischemic stroke assessed by a model based on UK NHS costs Sandercock P, Berge E, Dennis M, Forbes J, Hand P, Kwan
More informationTechnology appraisal guidance Published: 18 July 2018 nice.org.uk/guidance/ta531
Pembrolizumab for untreated PD- L1-positive metastatic non-small-cell lung cancer Technology appraisal guidance Published: 18 July 2018 nice.org.uk/guidance/ta531 NICE 2018. All rights reserved. Subject
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Colorectal cancer: diagnosis and management of colorectal cancer 1.1 Short title Colorectal cancer 2 The remit The Department
More informationBevacizumab in combination with a taxane for the first-line treatment of metastatic breast cancer
Issue date: February 2011 Bevacizumab in combination with a taxane for the first-line treatment of metastatic breast cancer This guidance was developed using the single technology appraisal process NICE
More informationAddressing health equity concerns in costeffectiveness
Addressing health equity concerns in costeffectiveness analysis? Distributional Cost-Effectiveness Analysis Miqdad Asaria m.asaria@lse.ac.uk @miqedup Overview 1) Introduction 2) Distributional CEA 3) Case
More informationScottish Medicines Consortium
Scottish Medicines Consortium fentanyl 50 micrograms / dose, 100 micrograms/dose, 200 micrograms / dose nasal spray (Instanyl ) No. (579/09) Nycomed UK Ltd 09 October 2009 The Scottish Medicines Consortium
More informationCost-effectiveness of cladribine (Mavenclad ) for the
Cost-effectiveness of cladribine (Mavenclad ) for the treatment of adult patients with highly active relapsing multiple sclerosis (MS) as defined by clinical or imaging features The NCPE has issued a recommendation
More information1. Comparative effectiveness of vedolizumab
Cost-effectiveness of vedolizumab (Entyvio ) for the treatment of adult patients with moderately to severely active ulcerative colitis who have had an inadequate response with, lost response to, or were
More informationCost-effectiveness of ixazomib (Ninlaro ) for the Treatment of Adult Patients with Multiple Myeloma who have Received at Least One Prior Therapy
Cost-effectiveness of ixazomib (Ninlaro ) for the Treatment of Adult Patients with Multiple Myeloma who have Received at Least One Prior Therapy The NCPE has issued a recommendation regarding the cost-effectiveness
More informationTechnology appraisal guidance Published: 26 October 2016 nice.org.uk/guidance/ta416
Osimertinib for treating locally advanced or metastatic EGFR T790M mutation- positive non-small-cell lung cancer Technology appraisal guidance Published: 26 October 2016 nice.org.uk/guidance/ta416 NICE
More informationBotulinum toxin type A for the prevention of headaches in adults with chronic migraine
Botulinum toxin type A for the prevention of headaches in adults with chronic migraine Issued: June 2012 guidance.nice.org.uk/ta260 NICE has accredited the process used by the Centre for Health Technology
More informationTechnology appraisal guidance Published: 31 August 2017 nice.org.uk/guidance/ta473
Cetuximab for treating recurrent or metastatic squamous cell cancer of the head and neck Technology appraisal guidance Published: 31 August 2017 nice.org.uk/guidance/ta473 NICE 2018. All rights reserved.
More informationTechnology appraisal guidance Published: 15 December 2010 nice.org.uk/guidance/ta211
Prucalopride for the treatment of chronic constipation in women Technology appraisal guidance Published: 15 December 2010 nice.org.uk/guidance/ta211 NICE 2018. All rights reserved. Subject to Notice of
More informationStated Preference Methods Research in Health Care Decision Making A Critical Review of Its Use in the European Regulatory Environment.
Stated Preference Methods Research in Health Care Decision Making A Critical Review of Its Use in the European Regulatory Environment. Kevin Marsh, Evidera Axel Mühlbacher, Hochschule Neubrandenburg Janine
More informationTechnology appraisal guidance Published: 24 August 2016 nice.org.uk/guidance/ta405
Trifluridine tipirracil for previously treated metastatic colorectal cancer Technology appraisal guidance Published: 24 August 2016 nice.org.uk/guidance/ta405 NICE 2018. All rights reserved. Subject to
More informationNICE DSU TECHNICAL SUPPORT DOCUMENT 8: AN INTRODUCTION TO THE MEASUREMENT AND VALUATION OF HEALTH FOR NICE SUBMISSIONS
NICE DSU TECHNICAL SUPPORT DOCUMENT 8: AN INTRODUCTION TO THE MEASUREMENT AND VALUATION OF HEALTH FOR NICE SUBMISSIONS REPORT BY THE DECISION SUPPORT UNIT August 2011 John Brazier 1 and Louise Longworth
More informationCost-effectiveness Analysis for HHS
Cost-effectiveness Analysis for HHS Edward Broughton, PhD., MPH Director of Research and Evaluation, USAID ASSIST Project, University Research Co., LLC Ukraine: 1 Mali: 1 Nigeria: 1 2 Uganda: 6 Burundi:
More informationTechnology appraisal guidance Published: 26 April 2017 nice.org.uk/guidance/ta442
Ixekizumab for treating moderate to severe ere plaque psoriasis Technology appraisal guidance Published: 26 April 2017 nice.org.uk/guidance/ta442 NICE 2017. All rights reserved. Subject to Notice of rights
More informationTechnology appraisal guidance Published: 27 January 2016 nice.org.uk/guidance/ta380
Panobinostat for treating multiple myeloma after at least 2 previous treatments Technology appraisal guidance Published: 27 January 2016 nice.org.uk/guidance/ta380 NICE 2017. All rights reserved. Subject
More informationIn keeping with the Scottish Diabetes Group criteria, use should be restricted to those who:
Advice Statement 009-18 July 2018 Advice Statement What is the clinical and cost effectiveness of Freestyle Libre flash glucose monitoring for patients with diabetes mellitus treated with intensive insulin
More informationReal-world observational data in costeffectiveness analyses: Herceptin as a case study
Real-world observational data in costeffectiveness analyses: Herceptin as a case study DR BONNY PARKINSON, PROFESSOR ROSALIE VINEY, ASSOCIATE PROFESSOR STEPHEN GOODALL AND PROFESSOR MARION HAAS ISPOR AUSTRALIA
More informationTechnology appraisal guidance Published: 7 February 2018 nice.org.uk/guidance/ta505
Ixazomib with lenalidomide and dexamethasone for treating relapsed or refractory multiple myeloma Technology appraisal guidance Published: 7 February 2018 nice.org.uk/guidance/ta505 NICE 2018. All rights
More informationClinical and Cost Effectiveness of Darbepoetin alfa in Cancer Treatment-induced Anaemia
Clinical and Cost Effectiveness of Darbepoetin alfa in Cancer Treatment-induced Anaemia 8 th November 2004 A report for the National Institute for Clinical Excellence prepared by Amgen Ltd. EXECUTIVE SUMMARY
More informationClopidogrel versus aspirin for secondary prophylaxis of vascular events: a cost-effectiveness analysis Schleinitz M D, Weiss J P, Owens D K
Clopidogrel versus aspirin for secondary prophylaxis of vascular events: a cost-effectiveness analysis Schleinitz M D, Weiss J P, Owens D K Record Status This is a critical abstract of an economic evaluation
More informationTechnology appraisal guidance Published: 20 December 2017 nice.org.uk/guidance/ta496
Ribociclib with an aromatase inhibitor for previously untreated, hormone receptor- positive, HER2-negative, e, locally advanced or metastatic breast cancer Technology appraisal guidance Published: 20 December
More informationCost-effectiveness of Obinutuzumab (Gazyvaro ) for the First Line Treatment of Follicular Lymphoma
Cost-effectiveness of Obinutuzumab (Gazyvaro ) for the First Line Treatment of Follicular Lymphoma The NCPE has issued a recommendation regarding the cost-effectiveness of obinutuzumab (Gazyvaro ). Following
More informationSummary 1. Comparative effectiveness of sapropterin dihydrochloride
Cost-effectiveness of sapropterin dihydrochloride (Kuvan ) for the treatment of hyperphenylalaninaemia (HPA) in adults and paediatric patients of all ages with phenylketonuria (PKU) who have been shown
More informationSetting The setting was secondary care. The economic study was carried out in Canada.
Anastrozole is cost-effective vs tamoxifen as initial adjuvant therapy in early breast cancer: Canadian perspectives on the ATAC completed-treatment analysis Rocchi A, Verma S Record Status This is a critical
More informationTechnology appraisal guidance Published: 9 August 2017 nice.org.uk/guidance/ta465
Olaratumab atumab in combination with doxorubicin orubicin for treating advanced soft tissue sarcoma Technology appraisal guidance Published: 9 August 17 nice.org.uk/guidance/ta465 NICE 17. All rights
More informationCost-effectiveness of apremilast (Otezla )
Cost-effectiveness of apremilast (Otezla ) alone or in combination with Disease Modifying Antirheumatic Drugs (DMARDs) for the treatment of active psoriatic arthritis in adult patients who have had an
More informationPharmacoeconomics of Trastuzumab (Herceptin )
Pharmacoeconomics of Trastuzumab (Herceptin ) Breast Cancer Press Seminar (2008.3.3) Department of Health Economics and Epidemiology Research Graduate School of Medicine, The University of Tokyo Takashi
More informationPeginterferon alfa and ribavirin for the treatment of chronic hepatitis C. Part review of NICE technology appraisal guidance 75 and 106
Issue date: September 2010 Peginterferon alfa and ribavirin for the treatment of chronic hepatitis C Part review of NICE technology appraisal guidance 75 and 106 National Institute for Health and Clinical
More informationCost-Utility Analysis (CUA) Explained
Pharmaceutical Management Agency Cost-Utility Analysis (CUA) Explained Cost-Utility Analysis (CUA) at PHARMAC Questions and Answers go to page 9 >> This document explains the process that PHARMAC generally
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Technology Appraisals. Patient Access Scheme Submission Template
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Technology Appraisals Patient Access Scheme Submission Template Bevacizumab in combination with fluoropyrimidine-based chemotherapy for the first-line
More informationResubmission. Scottish Medicines Consortium
Scottish Medicines Consortium Resubmission aripiprazole 5mg, 10mg, 15mg, 0mg tablets; 10mg, 15mg orodispersible tablets; 1mg/mL oral solution (Abilify ) No. (498/08) Bristol-Myers Squibb Pharmaceuticals
More informationCan you bring these to the attention of the committee when it meets. I hope to be there, and will gladly talk the committee trough them.
L Jeremy Powell NICE By Email 17 th Aug 2011 Dear Jeremy, Thank you for the opportunity to contribute to this TA. I have forwarded to NICE the necessary paperwork including our comment form. I have a number
More informationThe cost-utility of screening for depression in primary care Valenstein M, Vijan S, Zeber J E, Boehm K, Buttar A
The cost-utility of screening for depression in primary care Valenstein M, Vijan S, Zeber J E, Boehm K, Buttar A Record Status This is a critical abstract of an economic evaluation that meets the criteria
More informationType of intervention Secondary prevention and treatment; Other (medication coverage policy design).
Cost-effectiveness of full Medicare coverage of angiotensin-converting enzyme inhibitors for beneficiaries with diabetes Rosen A B, Hamel M B, Weinstein M C, Cutler D M, Fendrick A, Vijan S Record Status
More informationCost-effectiveness of nivolumab with ipilimumab (Opdivo with Yervoy ) for the treatment of advanced (unresectable or metastatic) melanoma.
Cost-effectiveness of nivolumab with ipilimumab (Opdivo with Yervoy ) for the treatment of advanced (unresectable or metastatic) melanoma. The National Centre for Pharmacoeconomics (NCPE) has issued a
More informationTechnology appraisal guidance Published: 16 December 2015 nice.org.uk/guidance/ta370
Bortezomib for previously untreated mantle cell lymphoma Technology appraisal guidance Published: 16 December 2015 nice.org.uk/guidance/ta370 NICE 2018. All rights reserved. Subject to Notice of rights
More informationroflumilast 500 microgram tablets (Daxas ) SMC No. (635/10) Nycomed Ltd
roflumilast 500 microgram tablets (Daxas ) SMC No. (635/10) Nycomed Ltd 06 August 2010 (Issued 10 September 2010) The Scottish Medicines Consortium (SMC) has completed its assessment of the above product
More informationTechnology appraisal guidance Published: 14 December 2011 nice.org.uk/guidance/ta239
Fulvestrant for the treatment of locally advanced or metastatic breast cancer Technology appraisal guidance Published: 14 December 2011 nice.org.uk/guidance/ta239 NICE 2018. All rights reserved. Subject
More information