HEDS is part of the School of Health and Related Research (ScHARR) at the University of Sheffield. We undertake research, teaching, training and consultancy on all aspects of health related decision science, with a particular emphasis on health economics, HTA and evidence synthesis.

Thursday, 14 February 2013

NICE says ‘no’ to gout treatment

More accurately, the ACD says ‘no’ to the use of pegloticase (Krystexxa) within its marketing authorisation, for treating severe debilitating chronic tophaceous gout in adults.

From the ACD, “…the Committee concluded that pegloticase effectively lowers the level of uric acid in the blood for a significant proportion of patients with severe gout. However the Committee noted the risk of serious adverse reactions, and concluded that there was considerable uncertainty about the long-term efficacy and safety of pegloticase. As the cost per quality-adjusted life-year was considered to be over £66,000, which is above the £20-30K range normally considered cost-effective, the committee's provisional recommendation is that pegloticase would not represent a cost-effective treatment option for the NHS.”

ScHARR-TAG, with HEDS, were the Evidence Review Group for NICE on this appraisal.  The team - Rachel Archer, Sarah Davis, Lesley Uttley, Anna Cantrell - identified a number of weaknesses in the manufacturer’s cost-effectiveness analysis, with their exploratory analyses summarised in a remarkably one sided tornado plot (below).  Seven amendments to the baseline estimate increased it from around £30,000 per QALY gained to the £67,000 per QALY gained that appears to be highlighted in the ACD.

Source: ERG Report