MODELLING VALUE USING AN UNPRECEDENTED APPROACH
- Demonstrate cost-effectiveness at the target price even though:
a) The SMC comparator was different to the clinical trial comparator, rendering indirect comparison infeasible
b) Primary and secondary endpoints of the clinical trial were not used in clinical practice
Respecting the technical:
- Global decision tree model developed by an external agency had two core issues
- Did not allow for long-term extrapolation or comparison to the SMC comparator, and
- Relied on clinical measures not relevant to clinical practice.
Delivering the practical:
- We recommended a new modelling approach via a Markov model based on:
- Treatment satisfaction rather than disease severity (treatment satisfaction was the only clinical measure assessed in clinical practice and experts validated this)
- The Model facilitated long-term extrapolation, capturing treatment benefits over a longer period
- In addition to a base case using ITT data, subgroup analyses were conducted considering patients using both the study treatment and comparator concomitantly; both scenarios demonstrated cost-effectiveness.
- The product was recommended by the SMC at the target price submitted
- The adapted model reduced ICERS substantially from the previous global model
- The cost-effectiveness analysis was subsequently published in the European Health Economics Journal
Acronyms: SMC, Scottish Medicines Consortium; ICERS, Incremental Cost-Effectiveness Ratios; ITT data, Intention-To-Treat data.