Comments
Health Economic Evaluation
It is difficult to make decisions regarding competing therapies on the basis of cost per QALY, as significant numbers of therapies have not undergone cost-utility analysis. The other problem is that cost-utility analysis doesn't solve the problem of equity in healthcare delivery - it may be that a particularly expensive therapy benefits a very deprived population of people.
I believe the QIPP Rightcare workstream offers a useful paradigm by addressing inappropriate variation in healthcare delivery. Using the NHS Atlas of Variation, one needs only to look at the rate of knee replacements in association pre-operative EQ-5D scores in certain PCTs to realise that something is very broken in the system.
Addressing this unwarranted variation would go some way to potentially addressing economic shortfalls, equity and quality at the same time.
However, I would agree that NICE's threshold should reduce, and we should be making it our priority to fund therapies that offer the those therapies that are the "best value" to the UK population, despite high profile advocacy.
Thanks for your comment Mark.
Thanks for your comment Mark. I completely agree with you re. the importance of ensuring equity, and the concept of value being vital.
Although reducing unwarranted variations is a huge step to achieving better value healthcare across the board, we will still need to face up to the fact that newer, more expensive treatments will be subject to advocacy on the basis of individuals' lobbying power, rather than any overall sense of "value" to the system? The NHS is political, despite all the protestations to the contrary. The cancer drugs fund is a prime example of good advocacy, but not necessarily good value.