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if you think your novel, orphan disease products ICER is stuck at greater than 1 million.. THINK AGAIN | THINK FIECON More case studies

DRIVING A >£1M ICER FOR ACCEPTABLE LEVELS FOR REIMBURSEMENT

 

  • Supporting a product undergoing a NICE HST appraisal for a severe and debilitating rare disease across England and Wales
CHALLENGE
  • Cost-effectiveness modelling developed by an external agency produced unacceptably high ICERs (>£1 million per QALY) for reimbursement
  • FIECON were brought in with 3 months till submission deadline to reduce the ICER and lead the NICE process
Action
Respecting the technical:
  • Undertook a model review that identified implementation errors increasing the ICER, and other structural and context deficiencies that meant the model was not demonstrating the product’s value
Delivering the practical:
  • Developed strategic recommendations for ways to robustly reduce the ICER
  • Corrected implementation errors and conducted a complete re-analysis of the statistical modelling in the key areas identified, including: parametric modelling for mortality and treatment discontinuation, recalculating transition probabilities to highlight product effectiveness improved over time, compliance and carer disutility
  • Proposed and supported a patient/carer survey and Delphi panel to re-parameterise key inputs in the model

result
  • Submitted a robust, well-written, and strategically thought-out submission which allowed the product to demonstrate the potential to be cost-effective within the 3 month deadline
  • Reduced ICER substantially to <£150k per QALY using robust methodology for the next Committee meeting, which allowed a commercial agreement to be made between the manufacturer and NICE
  • Rolled out the NICE HEOR strategy as the Global HEOR strategy, implementing this across country launches in Central Europe, Eastern Europe and Canada
Acronyms: DSU - Decision Support Unit; ICER - Incremental Cost-Effectiveness Ratio; NICE - National Institute for Health and Care Excellence; SMC - Scottish Medicines Consortium; HSE - Health Services Executive; STA - Single Technology Appraisal; HEOR - Health Economics and Outcomes Research; QALY - Quality adjusted life year