What is ‘Bayesian Hierarchical Modelling’ and how can it be used to evaluate oncology treatments studied in basket trials?

Should payers cover a new oncology treatment targeting specific biomarkers across multiple tumor types? One the one hand, one could require a separate trial for each tumor type. While this would be convincing evidence, it also is very expensive to conduct clinical trials for every tumor type, particularly if treatment efficacy is homogenous across tumor…

Why does the UK pay less for medicines?

According to the OECD, In 2021 the U.S. spent $1,432/capita on pharmaceuticals compared to only $517/per capita in the UK. The UK’s figure was slightly higher that Poland and Norway, but less than Latvia, the Slovak Republic, Portugal and Romania. How does the UK spend so little on drugs? Many people focus on the efforts…

NICE’s new Severity Adjustment

In the United Kingdom, the National Institute for Health and Care Excellence (NICE) made an update to their health technology evaluations manual in January 2022. Of particular interest, section 6.2 of the manual states that the review committee “will consider the associated absolute and proportional QALY shortfall.”  The committee defined QALY shortfall two ways: Absolute…

What influences NICE decisions?

The National Institute for Health and Care Excellence (NICE) claims that although cost-effectiveness is highly valued in its health technology appraisal process, it sates that there are other factors considered relevant.  However, no explicit weight is assigned to these other factors.  Do they matter? A paper by Dakin et al. (2015) tries to answer this question by looking…

What does a NICE health economist do?

What role do health economists at the UK’s National Institute for Health and Clinical Excellence (NICE) play and how do they conduct their cost effectiveness analyses for new treatments? I answer this question today based on NICE’s own documents.  According to their guidelines manual, the role of the health economist in clinical guideline development is to:…

Should the U.S. get NICE?

All health services researches know that comparative-effectiveness research is a vital link towards improving quality and decreasing cost.  Comparative effectiveness examines different medical treatments and evaluates which are the most cost effective.  The UK’s NICE (National Institute for Health and Clinical Excellence) publishes clinical appraisals regarding which treatments the NHS should cover. Should the U.S. create a…