How the Assessment of Burden of Illness might change NICE Decisions: A Retrospective Analysis under Value-Based Pricing

Background: Value based price (VBP) is the price that reflects the value to patients, carers, society and the economy which delivers health benefits that exceed the health predicted to be displaced both elsewhere in the NHS and in the welfare economy, due to their additional cost. VBP is constituted of the the burden of illness (BoI), the cost of illness due to its severity and unmet need. It will replace the existing PPRS in September 2014. Objective: To address the question of how moving to a VBP system from the current Pharmaceutical Price Regulation Scheme (PPRS) might change selected old non-recommended and optimised NICE appraisal decisions dependent on the BoI, which considered to be a key driver of VBP. Methodology: Two classification measures were identified and used in order to categorise the selected diseases into higher, medium and lower burden. After a categorisation matrix was constructed, information about the BoI assessment along with the cost and clinical effectiveness of each disease were applied to the analysis so as to make recommendations of how NICE decisions might have changed under VBP and the BoI assessment. Results: A categorisation of the diseases into higher, medium, and lower burden was attempted and it was evident that the decisions differed with respect to the different measurement tool that were used. In some cases BoI played a trivial role into the assessment of NICE decisions due to the fact that clinical effectiveness was considered a more important factor. In other cases, where the ICER was bounded into the recommended range of £20,000 and £30,000, the nonrecommended or optimised decisions might change under VBP.