OBJECTIVES: To determine the relationship between quality-adjusted life years (QALYs) and reimbursement decisions in solid-state oncology in the UK.

METHODS: The analysis included solid-state oncology reimbursement decisions from 2009 to 2017 from the Scottish Medicines Consortium (SMC) and National Institute for Health and Care Excellence (NICE). Non-submissions, abbreviated submissions, decisions with no incremental QALYs, and QALYs from sensitivity ICERs were excluded from the data set. Appropriate statistical analyses were performed.

RESULTS: The dataset included 300 incremental QALYS: 47.7% from SMC decisions and 52.3% from NICE decisions. Decisions were made across 15 solid-state cancers, with 25.3% of decisions for breast cancer and another 24.0% of decisions for non-small-cell lung cancer (NSCLC). Forty-seven percent of the observations received a positive reimbursement decision.

Incremental QALYs ranged from -0.26 to 4.73, with a mean=0.47 (SD=0.58) and a median=0.26. A logistic regression found a significant positive relationship between QALYs and decisions, with the likelihood of positive reimbursement increasing by 72.41% per QALY gained (p=0.001). By agency, mean QALY values were significantly higher in SMC reviews than in NICE reviews, 0.57 vs. 0.38, respectively (p=0.0038), while the chance of a positive reimbursement decision was 42.64% more likely per QALY gained for SMC than for NICE.

Upon further examination, a significant negative relationship was found between QALYs and the decision for breast cancer drugs, with the likelihood of positive reimbursement decreasing by 554.53% percent per QALY gained (p=0.027). No significant relationship was found for NSCLC (the only other cancer type with enough data to analyze).

CONCLUSIONS: As incremental QALY values increase, there appears to be a significant increase in the likelihood of a positive reimbursement decision, although the strength of this relationship may vary by reimbursement agency. For breast cancer and NSCLC, this relationship may be confounded by, or due to, drug cost, which warrants further analysis.