Spotlight on OHE: Assessing Value and Balancing Needs in Health Care

During the last quarter of 2011, OHE team members were involved in discussions and presentations in a range of forums, covering each of OHE’s three areas of focus. This post reviews their activities.

During the last quarter of 2011, OHE team members were involved in discussions and presentations in a range of forums, covering each of OHE's three areas of focus: the financing, organisation and delivery of health care; HTA methods and processes; and the economics and regulation of the pharmaceutical and life sciences industries. Those through November are summarised below.  For additional details, please contact the team member noted.

Financing, Organisation and Delivery of Health Care

Assessing value for money

Nancy Devlin is the co-author of a paper published by the Centre of Health Economics at the University of York that examines the relationship between risk-adjusted hospital costs and patients’  outcomes.[1]

As part of a strategic financial leadership program, Nancy gave a presentation at the CASS Business School on value for money and health care to Directors of Finance for NHS organisations.  She also gave a seminar to MSc students at City University London on current issues in valuing health and international research on them.

Containing spending on medicines and ensuring access

Policies intended to contain and shape spending for prescription medicines was the focus of several OHE activities during the third quarter of 2011.

Jorge Mestre-Ferrandiz participated in a roundtable in Madrid, organized by Contenidos de Salud, that discussed the issues involved in ensuring access to orphan drugs for paediatric use.

At the ISPOR Congress in November, Ruth Puig-Peiró delivered a presentation that summarized a literature review on Patient Access Schemes, Flexible Pricing Schemes and risk sharing schemes, all of which are becoming increasingly common approaches to shaping access to new drugs.

Value based pricing (VBP), due to take effect for newly approved medicines in the UK beginning in January 2014, was the topic of four presentations and discussions. Jon Sussex discussed the economic principles behind, and possible options for, value based pricing in the UK at the NextLevel Pharma conference and in a parallel session at NHS North West's Health Innovation and Education Clusters conference.

Martina Garau discussed the principles and practice of VPB in the UK policy context at the European Pharmaceutical Pricing and Reimbursement conference in October. Adrian Towse was a panellist in the VPB session at the November ISPOR meeting, addressing issues that will present a practical challenge in implementing VBP.   Nancy Devlin delivered a guest lecture on current and future issues in value based pricing in the UK at the highly-regarded annual short course on health technology assessment at the University of Groningen.

Spending trends

Trends in drug spending were addressed by Jon Sussex in two forums. In November, he addressed an audience from the Wales National Assembly, discussing the recent OHE report on Health and the Use of Medicines in Primary Care in Wales. In October, John participated in a parallel session at the Annual Conference of the Institute of Healthcare Management in Scotland, presenting UK medicines bill projections to 2014.

HTA Methods and Processes

The societal perspective

Which HTA approaches will produce the best result was the subject of several of the OHE team members' outside professional activities in the last quarter of 2011. Two of these considered adopting broader, societal approaches to HTA. At the NICE methods review workshop in Manchester in October, Nancy Devlin participated in a discussion that considered what effects should be included in NICE technology assessments if a societal perspective were to be adopted. At a November meeting sponsored by Epposi, the Brussels-based think tank, Martina Garau participated in discussions about how HTA agencies at national level can consider societal benefits that ensure not only good health outcomes, but also sustainable economies.

Examining the bases for decisions

Nancy Devlin was involved in three forums that focused on the methods and approaches for multi-criteria decision analysis (MCDA) and how these might be used to go beyond cost-effectiveness analysis to explicitly consider a greater range of criteria in health technology appraisal. Two of these were at ISPOR in November. In October, Nancy participated in the NICE Structured Decision-Making Methods Review Workshop with a presentation that examined the potential benefits of Appraisal Committees adopting a more structured approach to decision-making and HTA, such as multi-criteria decision analysis, rather than relying on deliberative processes.

Nancy also participated in a NICE methods review process workshop in London in November. She provided updates on progress in using the EQ-5D-5L, including plans for launching a study in England in 2012.

With Nils Gutacker (University of York), Nancy Devlin gave a presentation at the Advisory Group project meeting on the NIHR/Health Service Research grant-funded project: 'Combining routinely collected data on costs and patient outcomes to measure the outcomes/cost ratios of hospital procedures and identify variations across providers'.  The presentation provided an overview of the project and its current status, including initial results from analyses of the PROMs data.

National Institute for Health and Clinical Excellence

Two of OHE's activities during this time focused exclusively on NICE. Koonal Shah participated at a University of Sheffield seminar in late November, presenting preliminary findings from an empirical study on the relative priority members of the general public would give to life extending treatments at the end of life.  He also presented an overview of NICE’s technology appraisal and clinical guideline development activities to a delegation of Dutch commissioners visiting the UK on a study trip.

Economics and Regulation of the Pharmaceutical and Life Sciences Industries

Innovation

In October, Adrian Towse participated in a panel sponsored by the Harvard School of Public Health and Boston University that focused on what global initiatives could encourage the development of more medicines to counter antimicrobial resistance.  In November, he participated in a symposium on the economics of personalized medicine, discussing the four public policy challenges they present: clinical utility, regulatory, reimbursement and IP.

Jon Sussex gave a keynote presentation, ‘What's Economics Got to Do It?', at the conference to launch the University College London and Imperial College EPSRC Centre for innovative Manufacturing in Emergent Macromolecular Therapies.  Specifically, he described how economic considerations are vital to life sciences research, from evaluating returns to public and charitable research, to driving commercial R&D decisions, and increasingly determining pricing and reimbursement levels, including through VPB.

Pricing and Reimbursement

The OHE team addressed various aspects of pricing and reimbursement (P&R) during the last quarter of 2011.  At the ISPOR Europe meeting in November, Adrian Towse and Lou Garrison (University of Washington) presented an intermediate level short course on risk sharing/performance-based arrangements for drugs and other medical products. The course covered both theory and practice, including several examples of performance based schemes from Europe, the United States and Australia.  Also at ISPOR, Adrian moderated and presented in a session on developing good research practices for performance-based risk sharing, presented by the ISPOR Performance-Based Risk Sharing Arrangements Good Research Practices Task Force, of which he is a member.

In November, Adrian Towse presented at the Shanghai ISPOR Forum on Pharmaceutical Pricing/Reimbursement and HTA, organized by the Fudan Center for Pharmacoeconomic Research and Evaluation.  His presentation combined elements from two recent research products: The Evolution of HTA in Emerging Markets Health Care Systems, an OHE publication, and the NBER paper on pharmaceutical pricing in emerging markets, co-authored by Towse, Danzon and Mulcahy.