Since Andrew Lansley announced in 2010 that the NHS would in future use “value based pricing” in its purchases of pharmaceuticals, civil servants and (more recently) the National Institute for Health and Care Excellence (NICE) have been struggling to develop an approach for how this could be implemented. For the twists and turns, see previous blogs on the topic.

At its September board meeting, NICE considered a document on “value based assessment.” This made recommendations based on the results of NICE’s recent consultation. The document provided greater detail than NICE’s press release of 18 September.

NICE consulted on six questions (listed below) and got 900 responses (summarised below) from industry, patient groups, academics, clinical organisations, and the English Department of Health.

Question one asked: “Does proportional QALY [quality adjusted life year] shortfall appropriately reflect burden of illness?” Responses: 28% said “no,” 33% said “yes,” and 39% “partial.”

Question two asked: “Does absolute QALY shortfall provide a reasonable proxy for wider societal impact of a condition?” Responses: 59% said “no,” 10% “yes,” and 31% “partial.”

Question three asked: “Does a maximum weight of 2.5 in circumstances when all modifiers apply function as a reasonable maximum?” Responses: 73% said “no,” 12% “yes,” and 13% “partial.” [The percentages here don’t add up to 100, presumably because of rounding.]

Question four asked: “Should separate weights apply to each modifier?” Responses: 79% said “no,” 5% “yes,” 16% of responses were “partial.”

Question five asked: “Would the proposals improve consistency, predictability, and transparency?” Responses: 72% said “no,” 2% “yes,” and 26% “partial.”

Question six asked: “Would risks result?” Responses: 100% yes.

The DH’s response was that, in general, the maximum weight should be 1.5 times the current lower boundary for cost effectiveness, with a maximum of 2.5 for technologies that meet the end of life criteria, which it considered should be retained.

For more details, go to: http://blogs.bmj.com/bmj/2014/10/22/james-raftery-nice-and-value-based-pricing-is-this-the-end/