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

The Pfizer List of Values
• Absolute health gain / therapeutic improvement, to individual patients and carer/dependents
– Life years gained
– QoL gained
• Relative improvement
– Severity (baseline/final/alternative QoL level)
– Avoiding sudden death (EoL and rule of rescue)
– Avoiding premature death (fair innings)
• Seemingly supported by new Outcomes Framework, but illegal?
– Availability of (any/suitable) alternative therapy
• Patient preference
– Process of care (eg; convenience, dignity, private cost)
– Nature of condition/health outcomes (eg; cancer dread, HIV stigma, ‘lifestyle’ drugs)
• Population characteristics
– Disadvantaged socio‐economic
– Children
– Immigrants
– Responsibility (eg; smokers)
• Societal perspective
– Patient productivity
– NHS priority TA
– International comparison
• Industry and UK Plc
– Innovation in generic, orphan markets
– Dynamic efficiency
• Quality of evidence and certainty
• Affordable and implementable
VI.A. Common Ground and Significant Differences
Our preliminary account differs from the Pfizer model in some respects, although there are many
similarities. Our groupings of considerations are not the same, and the individual criteria are in some
cases different. The comparison is set out under the following headings: (i) Common Ground (ii)
Significant Differences. No comment is made where the differences are insignificant or
terminological.
VI.A.1. Common Ground
It is no surprise that both lists give priority to factors already commonly used:
Life years gained i.e.; LY of QALY
Health improvement i.e.; QoL, or QA of QALY
In both studies priority is also given to the following additional factors:
Impact on carers ie; 3 rd ‐party well‐being
Severity weighting ie; a QA adjuster.
Avoiding sudden death/Life saving ie; LY adjusters.
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