Transcript Dillon Presentation - Alliance for Health Reform

Drug evaluation and reimbursement
in the UK
Andrew Dillon
Commonwealth Fund - Alliance for Health Reform
Briefing on international pharmaceutical policy
Washington DC, 7 November 2011
Overview
• In theory, any licenced drug can
be prescribed through the
National Health Service. In
practice, drug use is influenced
by:
–
–
–
NICE guidance
Local formularies
Fiscal pressure
• Budgets for drugs used in the
NHS are held by local hospitals
for secondary care and by
primary care trusts for out-ofhospital prescribing (by General
Practitioners)
English NHS total drug spend 2008
($bn)
Primary care
12.97
60%
Hospital care
5.59
30%
Pharmaceutical Price Regulation
Scheme
• Introduced in 1957, the PPRS is a voluntary agreement
between the Department of Health and the UK branded
drugs industry
2009 PPRS agreement
Date
Price adjustment
• Its objectives are to:
–
–
–
–
Deliver value for money
Encourage innovation
Promote access and uptake
Provide stability and predictability
Feb 2009
-3.9%
Jan 2010
-1.9%
Jan 2011
+0.1%
Jan 2012
+0.2%
Jan 2013
+0.2%
• Member companies sign up to portfolio price control,
within which they can price individual products as they
wish
PPRS and NICE
• NICE appraises most but not all new drugs and new
indications
• Companies can increase or decrease the price of a
drug, after a NICE appraisal of the first indication, if they
have a new indication with more patient benefit or if
they have evidence of increased benefits for the
indication.
• Companies can offer ‘patient access schemes’, which
effectively reduce the price the NHS pays. These
schemes are either:
– Financially-based schemes, or
– Outcomes-based schemes
NICE: appraisal paradigm
Outcomes
for patients
Impact on
health
system
resources
Stakeholder
perspectives
Scientific
and social
value
judgements
NICE: cost effectiveness analysis
1
x
Probability of
rejection
x
Rituximab for
follicular lymphoma
Imatinib for
chronic myeloid
leukaemia (blast
phase)
Trastuzumab for
early stage HER-2
positive breast
cancer
x
0
16
32
Cost per QALY ($’000)
48
64
80
Most new health technologies bring
additional value
Decision
Yes
Recommendations
276
(63%)
Optimised
83
(19%)
Only in research
24
(5%)
No
55
(13%)
82% of NICE
advice is positive
Breakdown of all decisions contained in published NICE Technology Appraisals
1–236 (January 2000 to October 2011)
Note: 6 withdrawn recommendations and 10 non-submissions are not included
Value based pricing
• Recent UK Government proposals designed to extend
the definition of value in UIK drug appraisal and
reimbursement decisions
• Increased focus on:
– Wider societal benefits
– Products which address areas of unmet need or high
burden of illness
– New products with particularly innovative features
• Seen as an evolution of and not a replacement for the
PPRS and NICE arrangements