Journal round-up: Value in Health 24(5)

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This issue is dominated by an impressive COVID-19 themed section featuring seven articles and an editorial focussed on the health economics of COVID-19. The editorial is well worth a read as it gives a summary of the key findings of the papers featured not just in this special COVID-19 themed issue but also in the journal’s previous themed section from November 2020. There are articles considering a wide range of economic issues, including the cost-effectiveness of different social distancing strategies, examination of the QALY losses averted by infection prevention, and the methodological challenges of interpreting imperfect trial data.

A paper by Towse et al. tackled the large and pressing question of how should the world pay for a coronavirus disease vaccine? In many affluent countries, vaccine development and distribution have made incredible progress, whilst much of the world has been left behind. To address this, the authors propose a collaborative market-based finance mechanism for the world to incentivise and pay for the development of, and provide access to, second and third-generation COVID-19 vaccines. The mechanism builds upon principles of HTA and cost-effectiveness and is referred to as the Benefit-Based Advance Market Commitment (BBAMC). It is too complex to outline here (10 stages!), and how it would work in practice remains to be seen, but it is certainly a worthwhile contribution.

My personal highlight is the policy discussion section, which includes only one paper, reviewing 10 years of NICE’s End of Life (EoL) criteria. This is of great interest personally as it is particularly relevant to my own previous research in the EoL context. The EoL criteria have always felt a bit arbitrary, lacking a proper evidence base, and likely to have unintended consequences. In essence, they shift the cost-effectiveness threshold from £20,000-£30,000 to £50,000 per QALY should certain EoL criteria be met. This paper reviewed all NICE single technology appraisals (STAs) between 2009 and 2019 and extracted data on EoL criteria and cost-effectiveness assessment. The review found a lack of consistency and transparency within STAs regarding EoL criteria assessment. Perhaps the least surprising finding (to a cynic like myself at least) is that they observed that most EoL technologies were priced between £30,000 to £50,000 per QALY, suggesting that companies may have adjusted their pricing strategy to the higher EoL cost-effectiveness threshold [shocked face]. The paper suggests that new guidelines should be introduced to improve transparency and consistency, and it provides various suggestions on how to achieve this.

This issue also features three cancer-related economic evaluations; one costing study for advanced breast cancer, one cost-utility analysis of different chemotherapy administration methods for oesophageal cancer, and one budget impact analysis of tyrosine kinase inhibitor discontinuation for those with chronic myeloid Leukaemia with sustained deep molecular response (not even sure what most of that means).

There are also two preference-based assessments, two systematic reviews, and two methodological papers, one of which considers how best to deal with missing data and looks very useful. Overall, this is a bumper issue, and Value in Health remains one of my favourite health economics journals.


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