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Value Health. 2018 Aug;21(8):938-943. doi: 10.1016/j.jval.2018.01.017. Epub 2018 Mar 21.

Comparing the ICERs in Medicine Reimbursement Submissions to NICE and PBAC-Does the Presence of an Explicit Threshold Affect the ICER Proposed?

Author information

1
Adelaide Health Technology Assessment, School of Public Health, University of Adelaide, Australia. Electronic address: shuhong.wang@adelaide.edu.au.
2
Adelaide Health Technology Assessment, School of Public Health, University of Adelaide, Australia.

Abstract

OBJECTIVES:

The English National Institute for Health and Care Excellence (NICE) and the Australian Pharmaceutical Benefits Advisory Committee (PBAC) require evidence that a new medicine represents value for money before being publicly funded. NICE has an explicit threshold for cost effectiveness, whereas PBAC does not. We compared the initial incremental cost-effectiveness ratios (ICERs) presented by manufacturers in matched submissions to each decision-making body, with the aim of exploring the impact of an explicit threshold on these ICERs.

METHODS:

Data were extracted from matched submissions from 2005 to 2015. The ICERs in these submissions were compared within each pair and with respect to a cost-effectiveness threshold.

RESULTS:

Fifty-eight pairs of matched submissions were identified. The median difference between the ICERs ($2635/quality-adjusted life year [QALY]) was significantly greater than zero (Wilcoxon signed-rank test, P = 0.0299), indicating that the proposed ICERs in the submissions to NICE were higher than those in the matched submissions to PBAC. On 93% of occasions, NICE ICERs were within -$17,772 to +$48,422 of the corresponding PBAC ones (Bland-Altman analysis), demonstrating poor agreement. When an implicit threshold of AUD$50,000/QALY was assumed for PBAC decision making, only eight pairs of submissions had discordant ICERs falling above or below the respective threshold.

CONCLUSIONS:

The significantly higher ICERs in the submissions to NICE than those to PBAC may be a consequence of NICE's explicit willingness-to-pay threshold, and/or other health system factors. Industry may be assuming an implicit threshold for PBAC when constructing their ICERs despite the lack of acknowledgement of such a threshold.

KEYWORDS:

NICE; PBAC; incremental cost-effectiveness ratio (ICER); reimbursement; threshold

PMID:
30098671
DOI:
10.1016/j.jval.2018.01.017
[Indexed for MEDLINE]
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