Does the National Institute for Health and Clinical Excellence only appraise new pharmaceuticals?

   Objectives: To determine the relative extent to which the National Institute for Health andClinical Excellence (NICE) appraises new versus existing technologies, andpharmaceutical versus nonpharmaceutical health technologies.Methods: We categorized technologies within NICE appraisals published between March2000 and June 2006 by type and classified them as new or existing using the timelinebetween launch in the United Kingdom and referral to NICE. We used a 3-year postlaunchcutoff to determine whether a technology was new, with a sensitivity analysis of 1 and5 years.Results: We reviewed 159 technologies from 88 appraisals. Of these, 84 (53 percent)were new (sensitivity analysis 36 to 67 percent) and 75 (47 percent) were existingtechnologies. A total of 119 (75 percent) were pharmaceuticals, 22 (14 percent) weredevices, 14 (9 percent) were procedures, and 4 (3 percent) were categorized asmiscellaneous. Classification according to newness and technology type showed that 62percent (42 to 75 percent) of the pharmaceuticals appraised were new.Conclusions: By developing and applying a definition of new, we have found that thecriticism of the bias toward new technologies is unfounded when applied to the appraisalprogram overall. At the same time, new pharmaceuticals are over-represented in theprogram compared with devices and procedures. This domination may cause inflationarypressures on the health service, but any wholesale move away from the technologicalfrontier may be more costly.</p

Mapping of health technology assessment in selected countries

Objectives: The aim of this study was to develop and apply an instrument to map the level of health technology assessment (HTA) development at country level in selected countries. We examined middle-income countries (Argentina, Brazil, India, Indonesia, Malaysia, Mexico, and Russia) and countries well-known for their comprehensive HTA programs (Australia, Canada, and United Kingdom). Methods: A review of relevant key documents regarding the HTA process was performed to develop the instrument which was then reviewed by selected HTAi members and revised. We identified and collected relevant information to map the level of HTA in the selected countries. This was supplemented by information from a structured survey among HTA experts in the selected countries (response rate: 65/385). Results: Mapping of HTA in a country can be done by focusing on the level of institutionalization and the HTA process (identification, priority setting, assessment, appraisal, reporting, dissemination, and implementation in policy and practice). Although HTA is most advanced in industrialized countries, there is a growing community in middle-income countries that uses HTA. For example, Brazil is rapidly developing effective HTA programs. India and Russia are at the very beginning of introducing HTA. The other middle-income countries show intermediate levels of HTA development compared with the reference countries. Conclusions: This study presents a set of indicators for documenting the current level and trends in HTA at country level. The findings can be used as a baseline measurement for future monitoring and evaluation. This will allow a variety of stakeholders to assess the development of HTA in their country, help inform strategies, and justify expenditure for HTA

Economic evaluation of integrated care: an introduction

BACKGROUND: Integrated care has emerged in a variety of forms in industrialised countries during the past decade. It is generally assumed that these new arrangements result in increased effectiveness and quality of care, while being cost-effective or even cost-saving at the same time. However, systematic evaluation, including an evaluation of the relative costs and benefits of these arrangements, has largely been lacking. OBJECTIVES: To stimulate fruitful dialogue and debate about the need for economic evaluation in integrated care, and to outline possibilities for undertaking economic appraisal studies in this relatively new field. THEORY: Key concepts, including e.g. scarcity and opportunity costs, are introduced, followed by a brief overview of the most common methods used in economic evaluation of health care programmes. Then a number of issues that seem particularly relevant for economic evaluation of integrated care arrangements are addressed in more detail, illustrated with examples from the literature. CONCLUSION AND DISCUSSION: There is a need for well-designed economic evaluation studies of integrated care arrangements, in particular in order to support decision making on the long-term financing of these programmes. Although relatively few studies have been done to date, the field is challenging from a methodological point of view, offering analysts a wealth of opportunities. Guidance to realise these opportunities is provided by the general principles for economic evaluation, which can be tailored to the requirements of this particular field

Burden of early, advanced and metastatic breast cancer in The Netherlands

BACKGROUND: The aim of this study was to estimate the total economic and health related burden of breast cancer in the Netherlands. METHODS: Data on incidence, prevalence, mortality and survival were extracted from the Dutch National Cancer Registry and were used to calculate the economic and health related burden of breast cancer for overall, DCIS (stage 0), early- (stage I), locally advanced- (stage II-III) and metastatic- (stage IV) breast cancer by age groups and by year (if applicable). RESULTS: The overall incidence of breast cancer increased from 103.4 up to 153.2 per 100,000 women between 1990 and 2014. The increase was driven by DCIS and early breast cancer as the incidence of locally advanced and metastatic breast cancer remained stable. Between 1990 and 2014, ten-year overall survival rates increased from 87% to 93% for early breast cancer, 41% to 62% for locally advanced- and from 6% to 9% for metastatic disease. Annually, breast cancer in the Netherlands is responsible for approximately 3100 deaths, 26,000 life years lost, 65,000 Disability Adjusted Life Years (DALYs) and an economic burden of €1.27 billion. CONCLUSIONS: This study provides a comprehensive assessment of the burden of breast cancer and subsequent trends over time in the Netherlands

Selecting new health technologies for evaluation:Can clinical experts predict which new anticancer drugswill impact Danish health care?

 Several countries have systems in place to support the managed entry of new health technologies. The big challenge for these so-called horizon-scanning systems is to select those technologies that require decision support by means of an early evaluation. Clinical experts are considered a valuable source of information on new health technologies, but research on the relevance of their input is scarce. In 2000, we asked six Danish expert oncologists to predict whether a sample of 19 new anticancer drugs would impact Danish health care over the next 5 years. In 2005, we assessed the accuracy of these predictions in a delayed type cross-sectional study. The specificity of the Danish experts' prediction was 1 (95% confidence interval 0.74-1.00) and the sensitivity was 0.63 (0.31-0.86). The negative predictive value was 0.79 (0.52-0.92) and the positive predictive value was 1 (0.57-1.00). This indicates that clinical experts have the ability to predict which new anticancer drugs are unlikely to have an impact. This information can be used to increase the efficiency of selecting new technologies for evaluation. As the experts missed 37% of drugs that are in need of guidance, they should not be relied upon to select drugs relevant for evaluation