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Despite a growing view that QALYs may be an insufficient outcome measure to fully capture the benefits of public health interventions [ 5– 7, 21], 85% of 200 cost per QALY estimates relating to NICE public Health Guidance produced a cost-per QALY of under the NICE threshold of £20,000 per QALY [ 3].
"You know - you failed the Nice threshold but by the way, we'll still pay for it.
People with very severe depression did see benefits above the NICE threshold, but even that was not a ringing endorsement.
Olaparib was also rejected last month by the Cancer Drugs Fund, which pays for expensive drugs that exceed the Nice threshold.
While this remains cost-effective using the NICE threshold, it emphasises the added value of protection against HPV6/11 diseases.
The results were most sensitive to discount rates, duration of vaccine protection and utility scores but remained below the NICE threshold of £30,000/QALY so that HPV vaccination in the German setting can be considered to be cost-effective (Figure 4).
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The aim of this paper is to estimate the incremental cost per QALY of RM strategies compared with usual care, so as to determine which RM strategy should be recommended according to typical NICE thresholds for cost-effectiveness.
68 Cost and QALY data will be combined to calculate an incremental cost-effectiveness ratio (ICER) and net monetary benefit (INMB) statistic, 69 which will indicate whether the group CB programme is cost-effective compared with NICE thresholds of £20 000–£30 000 per QALY gained.
However, although the argument that we should be looking beyond QALYs is indeed compelling it should also be made clear that QALYs, and their common currency, do provide an useful way of deeming if public health interventions are cost-effective in relation to NICE thresholds [ 9] an argument that could be difficult to make without them.
Records of the four Scottish Breast Cancer Family clinics were scrutinised for the period January 1994 December 2003 to identify any women referred but discharged because the level of familial risk was judged to fall below the (pre-NICE) threshold.
The effects on referrals for genetic testing are likely to be confounded by the change in NICE guidance threshold that was heralded in January 2013 and ratified in June.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com