Pearson S. Health Technology Assessment and Comparative Effectiveness: Recommendations for Improving Health Care Value i

1. Pearson S. Health Technology Assessment and Comparative Effectiveness: Recommendations for Improving Health Care Value in the United States Stirling Bryan and Marthe Gold University of Birmingham, UK City University of New York Medical School, USA

2. Britain Stirs Outcry by Weighing Benefits of Drugs Versus Price Millions of patients around the world have taken drugs introduced over the past decade to delay the worsening of Alzheimer's disease. … But this year, an arm of Britain's government health-care system, relying on some economists' number-crunching, said the benefit isn't worth the cost. It issued a preliminary ruling calling on doctors to stop prescribing the drugs. The Wall Street Journal November 22, 2005; Page A1

3. Technology coverage decision making in the UK • Coverage decisions in the UK taken on two levels: • Local • National – the National Institute for Health & Clinical Excellence (NICE) • NICE • One of its functions is to appraise new and existing health technologies • Technology appraisal ‘guidance’ from NICE is issued to the National Health Service and is mandatory • Coverage decisions informed by independent CEAs • Submissions also received from manufacturers • The new fast-track single technology assessment and ‘NICE blight’!

4. Context for this workshop? • Promoting use of TA and CEA? • Achieving comprehensive health care reform? • Promoting efficiency • Increasing coverage • Promoting equity

5. Two general points • Decision making context • “key decision-makers, such as Medicare and private health plans, have neither the tools nor the stomach to be able to apply cost-effectiveness analysis explicitly.” • “But all this will only help decision-makers if they take matching strides to develop new methods for integrating information about cost-effectiveness into all of the methods they currently use to manage the value of health care.” • It is not just about more and better TA! • Analysis challenge • Value in moving away from systematic reviews alone to reviews plus decision analytic modelling

6. Recommendations • Recommendation 2 • Perspectives of patients and society • Input to analysis or seat at policy table? • Recommendation 3 • Support inclusion of CEA in TA in the US … But how can this be achieved? • Engaging health care organisations is key • Two reservations: • Proposal to sacrifice QALYs in US CEAs • Emphasis given to manufacturers

7. Californian health policy maker views on manufacturer-sponsored CEAs

8. Recommendation 6 • Federal entity to support technology assessment as public good is appealing • Thoughts: • This will not be sufficient – need complementary work on willingness and capability US health care to make use of TA/CEA • Is a ‘new’ federal entity required or could this be taken forward by AHRQ?

9. And finally … • Strong leadership • A necessary requirement • ‘Manufacturers as partners’ • An unhelpful suggestion?