Do NICE’s Severity Modifier Criteria Identify Severe Conditions: An Update

Speaker(s)

Mohindru B1, Davies N2, Buchanan V1
1Cogentia, Cambridge, CAM, UK, 2Cogentia Healthcare Consulting, Cambridge, Cambridge, UK

BACKGROUND: NICE’s single technology appraisal (STA) methods include QALY severity modifiers of 1.2 and 1.7, leading to potential upper cost-effectiveness thresholds of £35,000 and £50,000, respectively. The weighting is calculated by assessing the absolute and proportional shortfall in QALYs discounted at 3.5% between people with the condition and the general population. We previously demonstrated that a significant proportion of products appraised via the Highly Specialised Technology (HST) route, which is reserved for “chronic and severely disabling” ultra-rare conditions, would not have achieved a severity modifier if appraised via the STA route.

OBJECTIVES: To update our previous analysis, assessing whether conditions routed via HST would qualify for severity modifiers using NICE’s QALY shortfall assessment methods.

METHODS: All HSTs published on the NICE website were evaluated. Information was extracted from the following categories: 1) discounted QALYs on current standard of care, 2) age at baseline, 3) gender distribution and lastly, 4) health outcomes discount rate. For evaluable HSTs, the QALY shortfall calculator was used to calculate the absolute and proportional QALY shortfall and severity modifier.

RESULTS: 31 HSTs were analysed, of which 16 had sufficient data published to calculate a severity weight. Of these, 8 (50%), 3 (19%) and 5 (31%) achieved a severity weight of 1.7, 1.2 and 1, respectively. Of the 7 HSTs that were allocated a QALY weight by the NICE HST committee, 1 (14%) did not achieve a severity weight.

CONCLUSIONS: One third of conditions previously considered “severe and disabling” by NICE would not be allocated a QALY weighting using NICE’s severity modifier criteria. We believe that a key determinant is the use of discounted QALYs in assessing shortfall, which penalises chronic diseases where morbidity and mortality accumulate over a longer duration. The use of discounted QALYs contrasts with HST, which considers undiscounted QALYs for its QALY modifier.

Code

HTA169

Topic

Economic Evaluation, Health Policy & Regulatory, Health Technology Assessment

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis, Decision & Deliberative Processes, Reimbursement & Access Policy, Thresholds & Opportunity Cost

Disease

Drugs