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Friday, October 07, 2022 6:08:09 PM
Orphan Medicinal Products (OMPs) for rare diseases undergo health technology appraisals (HTA) by the National Institute for Health and Care Excellence (NICE). Drugs for ‘very rare’ conditions undergo further extensive Highly Specialized Technology (HST) reviews, to establish the overall magnitude of their therapeutic benefits, cost effectiveness, and budget impact. On April 1, 2017, NICE published an incremental cost-effectiveness ratio (ICER) threshold for OMPs set at £100,000 per quality-adjusted-life-year (QALY) gained, in addition to a QALY weighting dependent on the QALY gain offered by the new treatment.
https://www.valueinhealthjournal.com/article/S1098-3015(17)31915-0/fulltext
Following changes introduced in April 2017, NICE set a maximum additional QALY threshold of £300,000 for highly specialised treatments, under which they will automatically be approved for routine commissioning. This is ten times higher than the standard NICE threshold of £30,000 for non-specialised treatments. The upper limit will vary according to the lifelong impact of the technology on the patient, varying from £100,000 per quality-adjusted life year for treatments that deliver less than 10 QALYs to the patient in their lifetime, up to a maximum of £300,000 for treatments that deliver more than 30 additional QALYs to the patient in their lifetime.
https://researchbriefings.files.parliament.uk/documents/CDP-2019-0022/CDP-2019-0022.pdf
Management have a lot of flexibility with these high thresholds. Though Linda Powers has stressed the need to bring down costs so I expect the firm will charge between 100-150K.
"Big opportunities come infrequently. When it's raining gold, reach for a bucket, not a thimble - Warren Buffett."
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