Article title: Use of the incremental cost-effectiveness ratio for decision-making policies—what is the problem? A perspective paper
Authors: Brougham, M., Schlander, M., Telser, H., Bakshi, S., & Sola-Morales, O.
Journal: Expert Review of Pharmacoeconomics & Outcomes Research
DOI: http://doi.org/10.1080/14737167.2022.2064847
The Article Highlights section was incorrect in the published PDF. It has now been corrected with the below Article Highlights section.
Article Highlights
• Reimbursement decisions that spark public controversy, as seen in past NICE decisions to reject a range of effective but expensive treatments for rare diseases, are potential signals that the processes used to reach such decisions do not reflect the wider social welfare objectives of society.
• This notion is supported by recent higher-than-expected estimates of societal WTP for treatments for rare childhood dementias in the UK.
• QALY based ICER decision making systems have a number of known weaknesses, particularly in accounting for observed societal preferences (who benefits, the type of benefit, a “fair chance” – to coin short-hand names for but three), to the extent that extra-welfare characteristics are often either ignored or considered in an unsystematic and inconsistent fashion.
• At times, attempts have been made to address these weaknesses – such as through the provision of multiple ICER thresholds in the case of NICE’s Highly Specialised Technology (HST) evaluations for ultra-rare diseases albeit these thresholds appear particularly arbitrary in light of the Office of Health Economics £20k equivalence estimate of £900k for ultra-orphan diseases.
• Nevertheless, in the absence of substantive scope for discretion within existing processes, we suggest there are a range of alternative means (including MCDA and Cost-Benefit Analysis based on WTP measures) by which to mitigate these known weaknesses.
• HTA bodies considering process evolution should consider these approaches, already widely utilised outside of the healthcare system, as they have the potential to result in more comprehensive, systematic and accountable decision making.