TURNING HTA OUTCOMES INTO RELEVANT METRICS FOR SUBNATIONAL COMMISSIONING. A COPD POPULATION IMPACT MODEL FOR IMPLEMENTING NICE TA1142 AT THE LOCAL LEVEL
Author(s)
Rob Rawlinson, MA.
Sanofi, Reading, United Kingdom.
Sanofi, Reading, United Kingdom.
OBJECTIVES: To develop a population-level NHS activity budget impact model quantifying the health system value of implementing NICE Technology Appraisal TA1142 (dupilumab for uncontrolled COPD with raised eosinophils) across NHS Integrated Care Boards (ICB) and Health Boards in England, Wales, Scotland, and Northern Ireland, beyond drug acquisition cost.
METHODS: A HTML-based model was developed using a sequential population cascade: diagnosed COPD prevalence 1.7%; blood eosinophil ≥300 cells/μL prevalence 37%; uncontrolled on maximal therapy 50%. Unit costs were from NHS National Cost Collection 2023/24 and PSSRU 2023. Efficacy was derived from BOREAS, NOTUS, and a pooled analysis: 38% reduction in ED visits/hospital admissions (RR 0.62; NNT=16), 30% fewer systemic corticosteroid courses, and 34% fewer corticosteroid days. Lung function followed the NICE TA1142 company submission model: +160 mL FEV₁ gain retained through year three, then natural history decline resumes (38 mL/year, ECLIPSE), yielding a stable +274 mL advantage. Patient outcomes included EQ-5D (+0.037 QALY/patient/year), SGRQ, CAT, and WPAI productivity. Drug acquisition costs excluded (confidential Patient Access Scheme).
RESULTS: Applied to Kent and Medway ICB (population 1,891,000), the model identifies 5,947 eligible patients, with 892 commencing in Year 1 (15% uptake). Without dupilumab, the cohort experiences 1,606 moderate-to-severe exacerbations/year (1.8/patient/year); with dupilumab this falls to 996, avoiding 610 annually (−38%). Hospital admissions fall 348 to 216 (132 avoided); A&E 580 to 360 (220 avoided); GP contacts 7,322 to 5,891 (1,431 avoided); OCS courses 965 to 675 (289 fewer). NHS activity savings total £618,000/year (£692/patient), with 33 QALYs gained in Year 1. At 50% uptake by Year 3, savings exceed £2 million. The model generates equivalent outputs for all 64 NHS organisations, with interactive visualisations and a commissioner-ready PDF report.
CONCLUSIONS: This tool provides commissioners with transparent, evidence-based quantification of the population health and activity cost value of dupilumab under TA1142, supporting local business cases and medicines optimisation planning.
METHODS: A HTML-based model was developed using a sequential population cascade: diagnosed COPD prevalence 1.7%; blood eosinophil ≥300 cells/μL prevalence 37%; uncontrolled on maximal therapy 50%. Unit costs were from NHS National Cost Collection 2023/24 and PSSRU 2023. Efficacy was derived from BOREAS, NOTUS, and a pooled analysis: 38% reduction in ED visits/hospital admissions (RR 0.62; NNT=16), 30% fewer systemic corticosteroid courses, and 34% fewer corticosteroid days. Lung function followed the NICE TA1142 company submission model: +160 mL FEV₁ gain retained through year three, then natural history decline resumes (38 mL/year, ECLIPSE), yielding a stable +274 mL advantage. Patient outcomes included EQ-5D (+0.037 QALY/patient/year), SGRQ, CAT, and WPAI productivity. Drug acquisition costs excluded (confidential Patient Access Scheme).
RESULTS: Applied to Kent and Medway ICB (population 1,891,000), the model identifies 5,947 eligible patients, with 892 commencing in Year 1 (15% uptake). Without dupilumab, the cohort experiences 1,606 moderate-to-severe exacerbations/year (1.8/patient/year); with dupilumab this falls to 996, avoiding 610 annually (−38%). Hospital admissions fall 348 to 216 (132 avoided); A&E 580 to 360 (220 avoided); GP contacts 7,322 to 5,891 (1,431 avoided); OCS courses 965 to 675 (289 fewer). NHS activity savings total £618,000/year (£692/patient), with 33 QALYs gained in Year 1. At 50% uptake by Year 3, savings exceed £2 million. The model generates equivalent outputs for all 64 NHS organisations, with interactive visualisations and a commissioner-ready PDF report.
CONCLUSIONS: This tool provides commissioners with transparent, evidence-based quantification of the population health and activity cost value of dupilumab under TA1142, supporting local business cases and medicines optimisation planning.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA369
Topic
Economic Evaluation, Health Technology Assessment
Topic Subcategory
Decision & Deliberative Processes, Value Frameworks & Dossier Format
Disease
Biologics & Biosimilars, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)