Transcript Commentary on: Pearson S. Health Technology Assessment and

Pearson S. Health Technology
Assessment and Comparative
Effectiveness: Recommendations for
Improving Health Care Value in the
United States
Stirling Bryan and Marthe Gold
University of Birmingham, UK
City University of New York Medical
School, USA
Britain Stirs Outcry by Weighing
Benefits of Drugs Versus Price
Millions of patients around the world have taken
drugs introduced over the past decade to delay
the worsening of Alzheimer's disease. …
But this year, an arm of Britain's government
health-care system, relying on some economists'
number-crunching, said the benefit isn't worth
the cost. It issued a preliminary ruling calling on
doctors to stop prescribing the drugs.
The Wall Street Journal November 22, 2005; Page A1
Technology coverage decision
making in the UK
• Coverage decisions in the UK taken on two levels:
– Local
– National – the National Institute for Health & Clinical
Excellence (NICE)
• NICE
– One of its functions is to appraise new and existing
health technologies
– Technology appraisal ‘guidance’ from NICE is issued to
the National Health Service and is mandatory
– Coverage decisions informed by independent CEAs
– Submissions also received from manufacturers
– The new fast-track single technology assessment and
‘NICE blight’!
Context for this workshop?
• Promoting use of TA and CEA?
• Achieving comprehensive health care
reform?
– Promoting efficiency
– Increasing coverage
– Promoting equity
Two general points
• Decision making context
– “key decision-makers, such as Medicare and private health plans,
have neither the tools nor the stomach to be able to apply costeffectiveness analysis explicitly.”
– “But all this will only help decision-makers if they take matching
strides to develop new methods for integrating information
about cost-effectiveness into all of the methods they currently
use to manage the value of health care.”
– It is not just about more and better TA!
• Analysis challenge
– Value in moving away from systematic reviews alone to reviews
plus decision analytic modelling
Recommendations
• Recommendation 2
– Perspectives of patients and society
• Input to analysis or seat at policy table?
• Recommendation 3
– Support inclusion of CEA in TA in the US … But how
can this be achieved?
• Engaging health care organisations is key
– Two reservations:
• Proposal to sacrifice QALYs in US CEAs
• Emphasis given to manufacturers
Californian health policy maker
views on manufacturersponsored CEAs
Important barrier
Where CEAs have
commercial
sponsorship (e.g. by a
device manufacturer),
there are concerns that
the results will be
biased
Not an important
barrier
Not sure
38
1
4
Missing
2
Recommendation 6
• Federal entity to support technology assessment
as public good is appealing
• Thoughts:
– This will not be sufficient – need complementary work
on willingness and capability US health care to make
use of TA/CEA
– Is a ‘new’ federal entity required or could this be
taken forward by AHRQ?
And finally …
• Strong leadership
– A necessary requirement
• ‘Manufacturers as partners’
– An unhelpful suggestion?