A published survey<\/a> to do with cancer drugs was summarised. It explored societal preferences for the cancer drugs fund and other criteria, including those proposed for rewarding new medicines under the future VBP system, by means of a choice based experiment with 4,118 UK adults via web based surveys. Preferences were determined by asking respondents to allocate fixed funds between different patient and disease types reflecting nine specific prioritisation criteria. Respondents supported prioritisation for severe diseases, and for unmet needs, provided they offered substantial health benefits. The results did not support the end-of-life premium, the prioritisation of children,\u00a0 disadvantaged populations, the special funding status for treatments of rare diseases, nor the Cancer Drugs Fund.<\/p>\nA second unpublished survey was reported which had been commissioned by the department. This was a complex, discrete choice experiment, with pilot, feedback, and qualitative elements.\u00a0 Over 3,000 people were interviewed online but with somewhat different results than the other survey. This found\u00a0 that size of QALY mattered\u00a0 but at a decreasing rate\u00a0 (supporting Therapeutic Innovation and Improvement), end of life was also prioritised (higher social value if short life expectancy or at end of life). But it\u00a0 found no support for\u00a0 Burden of Illness (QALYs lost per patient\u00a0 with current best practice treatment).<\/p>\n
Conclusions:<\/p>\n
The research presented supported\u00a0 prioritisation\u00a0 for severity in some form but not necessarily in the form of\u00a0 Burden of Illness which is proposed for Value Based Pricing.\u00a0 Some research supported a higher weight for big as opposed to small QALY gains\u00a0 (supporting Therapeutic Innovation). The results were mixed\u00a0 regarding prioritising patients close to the end of life. It was not possible to reach consensus on which dimensions the public value, whether positively or negatively, let alone enable these preferences to be quantified as weights to the QALY.<\/p>\n
The contrasting results of the two surveys might have been due to how they handled age. Age was included in one survey\u00a0 but explicitly excluded in the other survey for legal and political reasons.<\/p>\n
Overall, I left convinced that it was proving very hard to improve on NICE\u2019s current method of\u00a0 informed deliberation.\u00a0 But that\u00a0\u00a0 NICE’s current exceptions to \u201ca QALY is a QALY is a QALY\u201d in the form of the cancer drugs fund and the end of life criteria get little or no support. How these conundrums will be resolved will be the subject of a further workshop early in 2013.<\/p>\n
James Raftery<\/strong> is a health economist with several decades experience of the NHS. He is Professor of Health Technology Assessment at Southampton University. A keen “NICE-watcher,” he has provided economic input to technical assessment reports for NICE but has never been a member of any of its committees. The opinions expressed here are his personal views.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"This blog reports on a workshop held by the Department of Health on 28 November 2012 under Chatham House rules, that is the discussion can be reported but not attributed. This workshop aimed to provide a framework for “a part of the government exploring use of QALY weights” in value based pricing (VBP), specifically: Burden […]<\/p>\n
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