Presentation (CTI)

OBJECTIVES: Long-term therapies for progressive, fatal diseases with no active treatment face significant barriers for cost-effectiveness due to incremental costs over the model time horizon. In extreme cases, a new therapy that substantially increases survival would not be cost-effective even if it were provided free. The objective was to explore potential policies for chronic treatments that might reduce the negative impact of improving survival on cost-effectiveness.
METHODS: We built a simple 6-state model (including death) to model a putative progressive disease from a UK National Health Service perspective. We assumed that some patients had existing comorbidities and that the new treatment initially improved health state occupancy followed by stabilisation and increased mean survival by 17.5 life years. We explored ICER-reducing scenarios including population restrictions, QALY weights, differential discounting, and reducing costs of incremental survival.
RESULTS: The ICER with and without drug costs was £505,681 and £33,080 per QALY, respectively. Thus, the treatment was not cost-effective at NICE’s upper standard threshold. The most impactful scenario was applying an uncapped QALY weight equal to 10% of the undiscounted incremental life years gained (LYG), which reduced the ICER to £114,733 per QALY. Another scenario applied drug costs only over the survival period of standard of care, in order to exclude costs incurred due to excess survival in the treatment arm. This scenario resulted in a similar reduction in the ICER to £120,620 per QALY. Other scenarios reduced the ICER to between £221,214 and £493,670 per QALY.
CONCLUSIONS: Payers may often restrict treatments to patients without existing comorbidities in order to improve cost-effectiveness. We identified a number of policy options which improved cost-effectiveness without the need to withhold access from such patients. Applying uncapped QALY modifiers based on LYG would help treatments which improve survival to be cost-effective more effectively than. capped modifiers based on QALY gain..