Asked by: Stephen O'Brien (Conservative - Eddisbury)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, in what circumstances he uses a calculation of the (a) value of preventing a fatality, (b) willingness to pay and (c) cost-per-quality adjusted life year approach to quantify the value of a policy intervention; what other tools he uses to quantify the benefit of a policy intervention; and if he will make a statement.
Answered by Dan Poulter
The Green Book and associated supplementary guidance is publicly available on the Treasury website. It sets out a range of approaches and methods that may be appropriate in a number of different appraisal circumstances.
Asked by: Stephen O'Brien (Conservative - Eddisbury)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, pursuant to the Answer of 24 March 2014, Official Report, column 120W, on haemolytic uraemic syndrome, what discussions NHS England has had with the National Institute for Health and Care Excellence (NICE) since 1 January 2014 on NICE's appraisal of eculizumab; and if he will make a statement.
Answered by Norman Lamb
We understand that NHS England was formally consulted on the scope of the National Institute for Health and Care Excellence's (NICE) evaluation of eculizumab for atypical haemolytic uraemic syndrome. NHS England was also consulted on the evaluation consultation document, which was published on 27 February.
Following the publication of NICE's draft guidance on eculizumab, NICE sought further advice from NHS England on what considerations relating to the management of its specialised commissioning budget it considers should be taken into account in formulating a recommendation. The response from NHS England will be considered by NICE at the next meeting of the evaluation committee.
Asked by: Stephen O'Brien (Conservative - Eddisbury)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, pursuant to the Answer of 31 March 2014, Official Report, column 491W, on medical treatments, what technology appraisals were conducted by the National Institute for Health and Care Excellence in the last five years; what the most plausible cost per quality adjusted life-year for each such appraisal was; what the estimated eligible patient population was for each appraised indication; on which appraisals end-of-life criteria were applied in each final appraisal determination; and on which date each such appraisal was (a) initiated and (b) concluded.
Answered by Norman Lamb
National Institute for Health and Care Excellence (NICE) technology appraisal decisions published between 2000 to end of February 2014 have already been placed in the Library.
NICE has advised that it does hold the most plausible cost per quality adjusted life-year for each technology appraisal, the estimated patient population for each appraised indication, details of appraisals where the end-of-life criteria were applied in each final appraisal determination and the dates each appraisal was initiated and concluded. However, this information could only be provided at disproportionate cost.
Asked by: Stephen O'Brien (Conservative - Eddisbury)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, if he will discuss with the National Institute for Health and Care Excellence (NICE) ensuring that assessments of treatments by NICE conducted through (a) normal technology appraisals and (b) highly specialised technology appraisals is consistent in its (i) engagement with stakeholders and (ii) wider methodological approaches.
Answered by Norman Lamb
We have no plans to do so. As an independent body, the National Institute for Health and Care Excellence is responsible for developing its methods and processes and applying them consistently.
Asked by: Stephen O'Brien (Conservative - Eddisbury)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, how the National Institute for Health and Care Excellence (NICE) assesses the cost-effectiveness of an intervention when the data available are uncertain; what assessment NICE has made of the average range around the most-plausible cost-per-QALY in its technology appraisals; and if he will make a statement.
Answered by Norman Lamb
The National Institute for Health and Care Excellence (NICE) follows a rigorous process in the appraisal of technologies to ensure that judgements regarding the cost-effective use of NHS resources are consistently applied. This includes consideration of the uncertainty generated where available data have serious limitations.
When making judgements on cost effectiveness, the NICE appraisal committee will consider a number of factors including the strength of the clinical-effectiveness evidence, the innovative nature of the technology, the robustness and plausibility of the economic models, the degree of certainty around the incremental cost-effectiveness ratio (ICER), the range and plausibility of the ICERs and the likelihood of decision error and its consequences. Full details of how the Committee takes uncertainty into account is contained within sections 5.8, 6.3 and 6.4 of NICE's Guide to the Methods of Technology Appraisal 2013, which is available at:
http://publications.nice.org.uk/guide-to-the-methods-of-technology-appraisal-2013-pmg9
NICE advises that it has not carried out an assessment of the average range around the most plausible cost-per Quality Adjusted Life Year (QALY) in its technology appraisals. We understand that although NICE usually specifies the most plausible cost-per-QALY for each technology appraisal, it does not normally specify a range for this assessment.
Asked by: Stephen O'Brien (Conservative - Eddisbury)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, pursuant to the Answer of 24 March 2014, Official Report, column 120W, on haemolytic uraemic syndrome, for what reasons it was felt that further advice was needed on the overall cost implications, benefits and affordability of eculizumab; when it was first concluded that such further advice was needed; for what reasons the seeking of that advice was delayed until the National Institute for Health and Care Excellence took on responsibility for assessing highly specialised technologies; and if he will make a statement.
Answered by Norman Lamb
Ministers concluded that further advice was needed on the overall cost implications, benefits and affordability of eculizumab as, while Advisory Group for National Specialised Services (AGNSS) members were convinced of the clinical effectiveness of the drug, they noted the very high costs of the drug and the increasing cost profile for the National Health Service.
AGNSS was informed of this decision on 17 January 2013. On 7 February 2013, the Department conveyed its decision to the National Institute for Health and Care Excellence (NICE) so that NICE could begin preparatory work in advance of taking on formal responsibility for evaluating highly specialised technologies on 1 April 2013.
While NICE carries out its evaluation, the current interim commissioning arrangements by NHS England in line with the ‘Clinical Commissioning Policy Statement: Eculizumab for atypical haemolytic uraemic syndrome' will remain in place. The policy statement is available at:
www.england.nhs.uk/wp-content/uploads/2013/09/e03-hss-a.pdf