What Values Should Count in Value Based Pricing for the NHS - UCL

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Contents I. Introduction: Value Based Pricing and Multi‐Criteria Decision Analysis ........................................ 4 II. Multiple Criteria Decision Analysis: Philosophical and Decision Analysis Perspectives ................. 6 II.A. Value pluralism ............................................................................................................................ 6 II.B. Technical literature from decision analysis and psychology ....................................................... 7 III. Populating a Long List ........................................................................................................................ 7 III.A. Reasons for inclusion or exclusion on the list............................................................................. 7 III.B. Value Types ................................................................................................................................. 8 III.C. Value Summary ........................................................................................................................... 9 IV. The List of Values ............................................................................................................................ 10 IV.A. Category I: Health Related Quality of Life and Well‐Being Gains ............................................. 10 IV.A.1. Degree of life extension to patient (QALY 1) ..................................................................... 10 IV.A.2. Degree of health gain to patient (QALY 2) ........................................................................ 10 IV.A.3.Impact on patient’s well‐being ........................................................................................... 11 IV.A.4. Impact on health of carer .................................................................................................. 12 IV.A.5.Impact on carers’ well‐being .............................................................................................. 12 IV.A.6. Impact on health gain of family or dependents ................................................................ 12 IV.A.7. Impact on well‐being of family and dependents ............................................................... 13 IV.A.8. Unavailability of alternative treatment ............................................................................. 13 IV.A.9. Leading to other definitive treatments ............................................................................. 14 IV.B. Category II: Prioritized Subgroups ............................................................................................ 15 IV.B.1.Severity of illness ................................................................................................................ 16 IV.B.2. Pre‐existing health state .................................................................................................... 16 IV.B.3. Life saving treatments ....................................................................................................... 17 IV.B.4. Life extension for those near the end of life ..................................................................... 17 IV.B.5.Type of illness and “dread”: Cancer ................................................................................... 18 IV.B.6.Children and adolescents ................................................................................................... 18 IV.B.7.Socially disadvantaged population ..................................................................................... 19 IV.B.8. Individual responsibility ..................................................................................................... 19 IV.B.9. NHS responsibility .............................................................................................................. 20 IV.B.10.Immigration status ........................................................................................................... 20 2
IV.C. Category III: Industrial .............................................................................................................. 21 IV.C.1.Innovation 1: Dynamic efficiency ....................................................................................... 21 IV.C.2. Innovation 2: Generic markets .......................................................................................... 22 IV.C.3. Promoting domestic industry and economic growth ........................................................ 22 IV.C.4.Patient Productivity ............................................................................................................ 23 IV.C.5. Orphan drugs ..................................................................................................................... 23 IV.D. Category IV: Political Drivers .................................................................................................... 24 IV.D.1.National Priority Area ......................................................................................................... 24 IV.D.2.International Comparison .................................................................................................. 25 IV.D.3.Inter‐Departmental Comparison ........................................................................................ 25 IV.D.4. Budget Impact ................................................................................................................... 25 IV.D.5. Uncertainty of outcome .................................................................................................... 26 IV.D.6. Stakeholder Persuasion ..................................................................................................... 26 IV.D.7.Cross‐Department Effects .................................................................................................. 27 V. The UCL List of Values ....................................................................................................................... 27 The UCL List of Values ....................................................................................................................... 27 VI. Comparison between the UCL and the Pfizer List of Values........................................................... 29 The UCL List of Values ....................................................................................................................... 29 The Pfizer List of Values .................................................................................................................... 31 VI.A. Common Ground and Significant Differences .......................................................................... 31 VI.A.1. Common Ground ............................................................................................................... 31 VI.A.2. Significant Differences ....................................................................................................... 32 VI.A.3. Cases of Non‐overlap......................................................................................................... 32 VI.A.4. Conclusion to Comparing UCL and Pfizer Lists .................................................................. 32 VII. Next Steps ....................................................................................................................................... 33 VII.A. Next Steps for Phase I .............................................................................................................. 33 VII.B. Next Steps for Phase II: Understanding the Varieties of Methods for Trading Off Values ..... 33 VII.B.1. The welfare economic model: Eliciting public preferences .............................................. 33 VII.B.2.The decision analysis model: Maximization subject to constraints .................................. 33 VII.B.3. The judicial model: Coherence in legal reasoning ............................................................ 34 VII.B.4. Conclusion to Next Steps for Phase II: Algorithms versus Deliberation ........................... 34 VII.C. Practical Questions for Phase II ........................................................................................... 34 VIII. Conclusion: Interim Recommendations for Inclusion ................................................................... 35 References ............................................................................................................................................ 37 3
Page 1: What Values Should Count in HTA for
Page 5 and 6: This paper does not attempt to addr
Page 7 and 8: II.B. Technical literature from dec
Page 9 and 10: Health and Quality of Life Gains in
Page 11 and 12: important elements of health states
Page 13 and 14: educe such impact, is an enlightene
Page 15 and 16: IV.B. Category II: Prioritized Subg
Page 17 and 18: therefore, good reason to include t
Page 19 and 20: Summary judgement on inclusion: Amb
Page 21 and 22: Reasons for exclusion: i) It is not
Page 23 and 24: presumed increased tax revenue) act
Page 25 and 26: IV.D.2.International Comparison Def
Page 27 and 28: ii) iii) Such a consideration opens
Page 29 and 30: framework. The remaining challenge
Page 31 and 32: The Pfizer List of Values • Absol
Page 33 and 34: There are many clear cases where a
Page 35 and 36: question as to whether people will
Page 37 and 38: References Baker, R, Bateman, I, Do

What Values Should Count in Value Based Pricing for the NHS - UCL

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