ABSTRACT

Background

The National Institute for Health and Care Excellence (NICE) makes recommendations on the reimbursement of new drugs utilizing an Incremental Cost-Effectiveness Ratio (ICER) threshold range that has been in use since 2004 and has remained unchanged.

Research design and MethodS

To model how the NICE cost-effectiveness thresholds would vary if inflation was accounted for and their potential effects on appraisal outcomes, all single technology appraisal (STA) recommendations published in 2019 were identified. The outcome and most plausible ICERs were then evaluated against thresholds, after taking inflation into account.

Results

41 STAs with base-case ICERs were identified. For general STAs, 46% of ICERs were ≤£20,000/QALY, 27% were £20,000-£30,000/QALY and 27% >£30,000/QALY. Cumulatively, there was a 43% decrease in the purchasing power of the pound from 2004 to 2019 due to inflation. To compensate, the NICE ICER threshold would have to increase to £28,584-£42,876/QALY. Using inflation-adjusted thresholds led to an absolute increase of 18% and 12% of STAs whose ICERs fell below the lower and upper bounds of this threshold range, respectively.

Conclusion

By not adjusting for inflation, the NICE ICER thresholds have declined in real terms. Whether ICER thresholds should be dynamic to reflect factors like inflation requires further research.

中文翻译：

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在 NICE 成本效益阈值内考虑通货膨胀

摘要

背景

美国国家健康与护理卓越研究所 (NICE) 使用自 2004 年以来一直在使用且保持不变的增量成本效益比 (ICER) 阈值范围对新药的报销提出建议。

研究设计与方法

为了模拟在考虑通货膨胀的情况下 NICE 成本效益阈值将如何变化及其对评估结果的潜在影响，确定了 2019 年发布的所有单一技术评估 (STA) 建议。在考虑通货膨胀后，然后根据阈值评估结果和最合理的 ICER。

结果

确定了 41 个具有基本情况 ICER 的 STA。对于一般 STA，46% 的 ICER ≤20,000 英镑/QALY，27% 为 20,000-30,000 英镑/QALY，27% >30,000 英镑/QALY。从 2004 年到 2019 年，由于通货膨胀，英镑的购买力累计下降了 43%。作为补偿，NICE ICER 门槛必须提高到 28,584-42,876 英镑/QALY。使用通胀调整阈值导致 ICER 分别低于该阈值范围下限和上限的 STA 绝对增加 18% 和 12%。

结论

由于未根据通货膨胀进行调整，NICE ICER 阈值实际上已经下降。ICER 阈值是否应该是动态的以反映通货膨胀等因素需要进一步研究。