OBJECTIVES:

The National Institute for Health and Care Excellence (NICE) recently updated how they evaluate health technologies, replacing the end-of-life criteria with severity modifiers. Severity modifiers are set with quality-adjusted life year (QALY) weights of x1.2 and x1.7 which are applied to the standard willingness-to-pay (WTP) threshold range of between £20,000 and £30,000 per QALY gained. This poster aims to investigate how these changes will affect WTP for treatments.

METHODS:

Previous NICE health technology assessments (HTAs) were reviewed to identify case studies where the maximum WTP threshold would have changed with the introduction of the severity modifiers. We aimed to identify one example where the WTP threshold would increase under the new methods, and one where it would decrease.

RESULTS:

Both identified examples were oncology treatments. Eribulin (TA515) met the end-of-life criteria allowing for a WTP threshold of up to £50,000 per QALY. However, under the new methods this would be reduced to £36,000. Conversely trifluridine–tipiracil (TA669) which previously did not reach end-of-life criteria would now have an upper WTP threshold of £50,000, increased from £30,000.

CONCLUSIONS:

These method changes have put a focus on increasing health gains in the most severe diseases. While the introduction of severity modifiers is intended to be healthcare budget neutral, there will be winners and losers.

Going forward, quality-adjusted life expectancy of the general population, and shortfalls in both life expectancy and quality of life under current standard of care for a health condition will determine the applicable WTP threshold. As the number of determining factors increases, under certain circumstances, sufficient uncertainty in one or more of these factors could lead to disputes over which modifier applies. Greater clarity is required to support the identification of the applicable modifier, and methods to incorporate uncertainty within modelling should be explored.