Drivers of High ICERs in SMC Appraisals
Author(s)
Ines Abdelghani, PharmD1, Meriem Fadhel, BE1, Lylia Chachoua, PharmD, PhD1, Wojciech Margas, PhD2, Samuel Aballea, PhD3, Mondher Toumi, MD, PhD, MSc4.
1Clever-Access, Paris, France, 2Clever-Access, Krakow, Poland, 3Inovintell, Rotterdam, Netherlands, 4Aix-Marseille University, Marseille, France.
1Clever-Access, Paris, France, 2Clever-Access, Krakow, Poland, 3Inovintell, Rotterdam, Netherlands, 4Aix-Marseille University, Marseille, France.
OBJECTIVES: This study aims to identify factors associated with acceptance of higher incremental cost-effectiveness ratios (ICER >£30,000 per QALY) by the Scottish Medicines Consortium (SMC).
METHODS: An analysis of SMC reports was conducted using the NaviHTA database for appraisals published between 2018 and 2023. Inclusion were criteria: (1) recommendation of the product for full indication or for a subpopulation; (2) cost-effectiveness result in North-East quadrant and ICER published in report. For cases with multiple comparators, only the highest ICER was considered. Eligible appraisals were reviewed and analysed to identify factors associated with ICER values >£30,000. Logistic regression were used to assess the association between identified factors and ICER values >£30,000.
RESULTS: Of 149 SMC decisions included, 77 had ICERs above £30,000 /QALY. The median ICER for products with value above £30,000 was £56,521, compared to £17,049 for cases below this value. Higher ICER value was mostly frequently associated with oncology treatments (69% of ICER values >£30,000 in oncology vs 39% outside oncology), life-threatening disorder (71 vs 51%), and products meeting SMC orphan criteria (78% vs 41%). Products with higher ICER value more often targeted disease pathophysiology (92% vs 75%) and had a significant impact on survival (34% vs 21%). Low clinical unmet need was exclusively reported for products with ICERs below £30,000. Impact on PRO was not associated with ICER values. Based on the logistic model, only orphan criteria and oncology disease area were independently associated with higher ICER values, with odds ratios of 3.75 (p<0.001) and 2.29 (p=0.027) respectively.
CONCLUSIONS: The analysis suggests that SMC has a higher willingness to pay per QALY for orphan drugs and cancer treatments.
METHODS: An analysis of SMC reports was conducted using the NaviHTA database for appraisals published between 2018 and 2023. Inclusion were criteria: (1) recommendation of the product for full indication or for a subpopulation; (2) cost-effectiveness result in North-East quadrant and ICER published in report. For cases with multiple comparators, only the highest ICER was considered. Eligible appraisals were reviewed and analysed to identify factors associated with ICER values >£30,000. Logistic regression were used to assess the association between identified factors and ICER values >£30,000.
RESULTS: Of 149 SMC decisions included, 77 had ICERs above £30,000 /QALY. The median ICER for products with value above £30,000 was £56,521, compared to £17,049 for cases below this value. Higher ICER value was mostly frequently associated with oncology treatments (69% of ICER values >£30,000 in oncology vs 39% outside oncology), life-threatening disorder (71 vs 51%), and products meeting SMC orphan criteria (78% vs 41%). Products with higher ICER value more often targeted disease pathophysiology (92% vs 75%) and had a significant impact on survival (34% vs 21%). Low clinical unmet need was exclusively reported for products with ICERs below £30,000. Impact on PRO was not associated with ICER values. Based on the logistic model, only orphan criteria and oncology disease area were independently associated with higher ICER values, with odds ratios of 3.75 (p<0.001) and 2.29 (p=0.027) respectively.
CONCLUSIONS: The analysis suggests that SMC has a higher willingness to pay per QALY for orphan drugs and cancer treatments.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HTA20
Topic
Health Technology Assessment
Topic Subcategory
Decision & Deliberative Processes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas