PNS17 ASSESSING TECHNOLOGIES THAT ARE EFFECTIVE BUT NOT COST-EFFECTIVE AT ZERO PRICE: AN ALTERNATIVE FRAMEWORK

Abstract

The traditional framework for the financing decision of health technologies relies on the comparison between an incremental cost-effectiveness ratio and a threshold that represents the willingness to pay for a unit of health. A non-expected consequence is that technologies developed for populations with high background or follow-up costs struggle to demonstrate cost-effectiveness. The National Institute for Health and Care Excellence (NICE) faced a financing decision of effective drugs that, even when a zero price was considered, were not cost-effective. This clearly contradicts a common sense approach which assumes that a drug with added therapeutic value and a realistic price should be cost-effective. This paper has two main objectives: 1) the identification, in the Portuguese context, of health technologies with clinical effectiveness but negative cost-effectiveness results even when considering a zero price; 2) to suggest changes in the decision-making process in order to overcome this problem. We believe that the Portuguese regulatory agency is implicitly taking considering a higher willingness to pay for health benefits in some populations. The consideration of equity concerns would explain the apparent inconsistency in some financing decisions. We suggest that equity concerns should be explicitly incorporated in the estimate of incremental benefits by assuming different weights for different patients. We present a simple model based on the foundations of cost-effectiveness in economic theory showing that the exclusion of future and background costs is not a valid solution to this problem and that the introduction of equity weights would be easy to implement and to interpret.