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.

Tuesday, 20 January 2015

Not cost-effective at zero price

NICE DSU published a report assessing technologies that are not cost-effective at a zero price recently.  The abstract is below:

Photo by Leo-seta via Flickr CC BY 2.0

"In a National Institute for Health and Care Excellence (NICE) appraisal of a new drug (pertuzumab)
in metastatic breast cancer the appraisal consultation document (ACD) concluded that pertuzumab, when used in accordance with its licensed indication, did not represent a cost-effective use of NHS resources. The manufacturer had indicated in their comments on the ACD that when using plausible assumptions (those preferred by the evidence review group) there was no price at which pertuzumab would be cost-effective (it was not cost-effective at zero price). The issue driving this relatively high incremental cost-effectiveness ratio (ICER) appeared to be that the drug was given in combination with another drug (also the comparator) and any additional progression-free survival (PFS) was accompanied by the costs of both pertuzumab and the comparator drug. In view of the fact that the technology was associated with substantial benefits in terms of both progression-free and overall survival, the Institute's Guidance Executive decided not to issue the Final Appraisal Documents (FAD) pending further exploration of the issue.

The Decision Support Unit (DSU) was asked to explore the circumstances in which clinically effective technologies are not cost-effective even at a zero price. In the light of this exploration, the DSU was asked to consider the usual rules for assessing cost-effectiveness and their appropriateness or otherwise in these circumstances."