The QALY must change, says industry
This article was originally published in Scrip
NICE, the UK National Institute for health and Clinical Excellence, must broaden its main health technology assessment (HTA) tool, the QALY, speakers told the NICE conference last week.
Decisions on drug funding are set to become increasingly difficult. The growing complexity and cost of medical advances mean that the question of a drug's value will become more significant as authorities have to make choices about what they pay for.
Therefore, the QALY (quality adjusted life year, used to measure the clinical effectiveness of drugs) should reflect the values held by society, argued Dr Richard Barker, director general of theABPI, the Association of the British Pharmaceutical Industry. Nevertheless, to achieve this, a better definition of what is valuable is required, he added.
Four key questions could be incorporated into the QALY to make drug assessments easier and better reflect that value of a drug, Dr Barker said. Aside from measuring cost-effectiveness, the QALY should also ask: does the technology produce an economic value for society – for example by reducing the need for a carer? Does it mark a major clinical advance, perhaps for an unmet need or a serious disease? Is it truly transformative – improving the patient's quality of life? And does it mark the beginning of a new wave of innovation that may spark more innovation?
Incorporating the answers to these questions would improve NICE guidance and therefore make it more likely to be universally adopted, he added. Primary care trusts must often make trade-offs to fund a NICE approved drug and tough decisions must be made. However, a clearer vision of the drug's value could make these decisions easier.
"QALYs are good but NICE needs to work harder on qualitative methodologies and its capacity to evaluate the social and environmental impact of new technologies," said Harry Cayton, chief executive of the Council for Healthcare and Regulatory Excellence.
More flexibility from NICE in the factors considered during evaluation would certainly be welcome, said Dr Barker. This is particularly so as innovators will have to offer more flexibility under the new pharmaceutical price regulation scheme, he added.