[Ip-health] Experts tell MPs NICE should slash its maximum QALY price for drug approval

[Joana Ramos]

http://www.hesmagazine.com/story.asp?sectionCode=3D196&storyCode=3D2045418

Experts tell MPs NICE should slash its maximum QALY price for drug approval
HES (Healthcare Equipment & Supplies) Magazine
03 July 2007

<snip>

> Peter Smith from York University's Centre for Health Economics told
> the influential House of Common's Health Select Committee on Thursday
> the reduction was needed to avoid forcing local health bodies to fund
> ever more expensive medicines with limited funds.
>
> Smith conceded that according to his calculations the average cost to
> save a year of a patient's life was =A313,100 (19,500 euros) in cancer
> and =A38,000 (12,000 euros) in circulatory diseases, the Financial Times
> newspaper said.
>
> However, as ever more expensive drugs came on stream, this average
> cost risked being inflated beyond what local health bodies could
> afford, to the detriment of care overall......
>
> Furthermore having a QALY threshold of =A330,000 encouraged companies to
> price to that limit, Smith argued.

<snip>


By APM Health Europe

MPs have been told NICE should slash its maximum cost per
quality-adjusted life year for approving a drug from =A330,000 (45,000
euros) to =A320,000 (30,000 euros).

Peter Smith from York University's Centre for Health Economics told the
influential House of Common's Health Select Committee on Thursday the
reduction was needed to avoid forcing local health bodies to fund ever
more expensive medicines with limited funds.

Smith conceded that according to his calculations the average cost to
save a year of a patient's life was =A313,100 (19,500 euros) in cancer and
=A38,000 (12,000 euros) in circulatory diseases, the Financial Times
newspaper said.

However, as ever more expensive drugs came on stream, this average cost
risked being inflated beyond what local health bodies could afford, to
the detriment of care overall.

Drug companies price to QALY limit

Furthermore having a QALY threshold of =A330,000 encouraged companies to
price to that limit, Smith argued.

Stirling Bryan, director of health economics at the University of
Birmingham, endorsed Smith's recommendations. He also told MPs there was
a need for routine monitoring of the impact of new treatments approved
by NICE.

More testing above =A320,000

NICE has made clear to APM in the past that it does not have a fixed
QALY threshold, rather a sliding scale based on numerous factors
including the availability of other treatments.

In an earlier interview, NICE chief executive Andrew Dillon told APM
that generally speaking, less than =A320,000 per QALY, the appraising
committees are expected to approve on grounds of cost-effectiveness.

Between =A320,000 and =A330,000 the committees are expected to become more
testing and above =A330,000 NICE demands they are "absolutely confident",
for example, in the estimates they are using to calculate cost per QALY.

"Above =A330,000 we expect them to take into account special factors in
the disease or the condition and we looking for their confirmation that
the intervention they are assessing is a significant improvement on what
otherwise might be available," Dillon said at the time.

Approval was possible beyond this price. For example in the case of
Novartis' Glivec (imatinib) for chronic myeloid leukaemia which "cost
between =A340,000 (60,000 euros) and =A350,000 (75,000 euros) per QALY".

Missing the point

However, the Association of the British Pharmaceutical Industry said
NICE already concentrated too closely on the QALY and should expand the
criteria used in its assessments.

A spokesman for the industry body told APM: "Rather than focusing on
reducing the QALY threshold, which is a judgement that is already
focussed on too much, NICE should be thinking about the other facts the
system currently ignores.

"That includes aspects such as reducing cost of social care - keeping
patients out of it - and other associated cost savings that medicines
can bring that are not necessary accounted for in the QALY calculation."

On July 12, the health committee questions industry chiefs as part of
its ongoing investigation into NICE.


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Joana Ramos, MSW
Cancer Resources & Advocacy
Seattle WA USA
+1-206-229-2420
http://ramsolink.info/
www.cancersurvivorsproject.org
www.healthyskepticism.org
www.mavinfoundation.org