Experts divided on UK value-based pricing amid uncertainty over details
Experts have voiced a range of opinions on the UK's expected move to value-based drugs pricing, stretching from broadly endorsing the approach to condemning it, with consensus only on that "we don't know much more now than a year ago."
Speaking at NICE's annual conference on Tuesday, professor of health technology assessment at England's Southampton university, James Raftery, likened value-based pricing (VBP) to the Britain's cancer drugs fund, describing it as one of "more political fixes for difficult decisions."
The cancer drugs fund and NICE's more generous end-of-life criteria were brought in to avoid the government being linked with negative publicity of denying patients drugs.
He put the multiple sclerosis risk-sharing scheme in the same category, arguing the evidence showed the price of the drugs should be reduced but this never happened.
VBP would fail to provide the UK with better priced or cheaper drugs and would become, "an innovative drugs fund by one criteria or another."
NICE TO KEEP "OPTIMAL USE" GUIDANCE
NICE's director of its Centre for Health Technology Evaluation, Carole Longson joined speakers from the Association of the British Pharmaceutical Industry and Department of Health, in saying "evolution not revolution" was the right approach in implementing VBP.
While NICE's exact role is still not clear - and was not clarified by the DoH at the event - Longson said NICE did not want to lose sensitivity in its guidance.
It wanted the right to retain power to say 'yes' to National Health Service funding in sub-groups of populations rather than in line with a drug's European license.
NICE wanted to retain the power to issue a "very clear and simple ... signal to the NHS that this (particular guidance is the) optimal use of that technology."
DEVELOP DRUGS FOR UK POPULATION
Kay Peters, DoH deputy director for pricing, prescriptions and supply medicines, pharmacy and industry; said VBP would benefit both UK patients and industry by "giving industry the incentive to develop drugs for UK patients."
However, this was challenged by others and comments that, with just 3% of the world market, companies would never develop drugs specifically for the country were heard in conference breaks later in the day.
Peters noted that NICE's role was not yet defined but stressed its capabilities would not be wasted in assessing drugs for the qualities required to gain a higher price.
These would include, meeting an unmet medical need or showing a large therapeutic improvement.
Peters also said VBP would "ramp up slowly" and only include new drugs. The UK's existing drug pricing scheme will "control a huge amount of spend for years to come."
However, while some were sceptical about progress, Peters predicted a sharp increase in VBP activity, saying by this time next year, government and industry would be "deep" in negotiations.
INTERIM ARRANGEMENTS REQUIRED
ABPI director of value and access, Paul Catchpole, spoke of the need for "interim arrangements" as time ticked by with no certainty yet on how the new pricing system would work ahead of its proposed implementation on Jan 1, 2014.
Industry needed time to collect the data to support drugs presented for VBP and could not meet the demands of the system without plenty of time to prepare, he warned.
Catchpole also said the ABPI regarded the quality adjusted life year an acceptable tool on which to base calculations but said the means of measuring "evidence for societal benefits" needed work.
NHS LOSS ELSEWHERE
The format for the new pricing system must take into account what was lost to fund the new treatment, York university, professor of health economics, Mark Sculpher told delegates.
He argued that so-called opportunity costs must figure in the thinking if the true value of drug was being priced - in essence what has been cut to fund the drug must be calculated to allow the net value or benefit to be calculated.
He also pointed out that under VBP a certain uptake of a drug was needed and devices would have to be put in place to ensure the NHS take up was "no lower .., or higher than that implied by value-based pricing."