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My first mention in this whistlestop tour of February’s PharmacoEconomics offering goes to the latest publication from those leading the effort to improve patient utility evidence informing NICE appraisals. A previously documented model mapping between EQ-5D-5L and EQ-5D-3L is applied to large-scale UK population survey data, addressing key limitations of earlier efforts to understand EQ-5D-3L utility since the advent of the EQ-5D-5L instrument. As if to illustrate the predominance of the EQ-5D-5L questionnaire, a separate study maps responses from the generic PROMIS-29 questionnaire to Australian EQ-5D-5L utility values. Elsewhere, a third outcome measure-focused study in this issue: a systematic review of psychometric properties of some commonly used preference-based outcome measures for children and adolescents.
Next stop, two pharma-sponsored cost-effectiveness analyses. The first sets out to assess the merit of outcomes-based payment arrangements using a CAR-T therapy case study. It comes to the staggeringly unsurprising conclusion that making payment contingent on results reduces uncertainty about up-front cost-effectiveness estimates. The second finds that the addition of a pharmaceutical nasal spray to standard care for treatment-resistant depression patients may be cost-effective if a societal perspective is taken. That is, if the expected salary cost of time away from work is included. Aside from the issue of who pays for healthcare versus who benefits from salary, a ‘societal perspective’ that only places value on those in society who are engaged in paid work has my head in my hands. A separate systematic review of cost-of-illness studies adopts a similar habit, characterising the societal cost of schizophrenia as a split between direct healthcare and non-healthcare costs and productivity losses, though the authors do recognise they are only providing part of the picture.
Luckily enough, February’s issue also contains a review of societal perspective definitions in guideline documents produced by different HTA agencies, and not everyone’s at it. The authors call for international consensus and clearer guidance, though explicitly stating a position on such a matter may not be in the interest of HTA agencies, nor many wider societal stakeholders. Ultimately, it seems we’re cursed here – as elsewhere – to disproportionately value those things we can measure, and especially those things we can measure in money. Seven papers down, and treating brevity like the virtue it is, all that remains is to mention an editorial announcing a series of papers reporting critical reviews of health economic models by disease area.