NICE, reference pricing not value-based pricing?

The final appraisal determination for the use of abatacept (Orencia) for rheumatoid arthritis after conventional disease-modifying anti-rheumatic drugs (DMARDs) have failed, is now published. As highlighted in our ACD blog post, the Evidence Review Group (ScHARR-TAG) found that:

“The results produced by the ERG indicate that assuming a threshold of £30,000 per QALY certolizumab pegol appears to be the most cost-effective intervention. Whilst abatacept is not expected to be on the efficiency frontier, it has an ICER compared with cDMARDs that is similar to other treatments recommended by NICE. Furthermore, abatacept is expected to have a cost per QALY gained ratio of less than £30,000 or a cost per QALY yielded ratio of more than £30,000 when  compared with all interventions excluding certolizumab pegol.”

Lots of issues here.  It seems that NICE are reference pricing to existing decisions, rather than undertaking independent appraisals.  It also appears that this is leading to threshold creep; it certainly isn’t clear how widespread pricing above £20,000 per QALY is compatible with value based pricing.  The shape of things to come?

Photo credit: Images_of_Money via Flickr Creative Commons