USING ECONOMIC EVALUATIONS IN DRUG REIMBURSEMENT DECISIONS ‘NICE’ experiences from overseas. Michael Drummond Centre for Health Economics University of York United Kingdom. OUTLINE OF PRESENTATION. Some background. International guidelines for economic evaluation.
Centre for Health Economics
University of York
Reimbursement or Listing
Ethics and Conduct
Australia Belgium Finland The Netherlands Norway Ontario Portugal Sweden United Kingdom
Government or Payers
CCOHTA (Canada) PHS Panel (USA) AMCP (USA)
Langley et al (USA) Alban et al (DK)
LDI Task Force (USA) Rovira et al (Spain) Hannover (Germany) BESPE (Belgium) BMJ Working Party (UK) Garattini et al (Italy) College of Economists (France)
LDI Task Force (USA)
Appraisal Process Diagrammatic Timeline GUIDELINES
= Department of Health
= National Assembly of Wales
= National Health Service
: National Institute for Clinical Excellence.
Guide to the technology
ocess. 1: Introduction and background to the appraisal
. London, NICE, 2001.NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE (NICE) APPRAISAL PROCESS
Coronary artery stents in the treatment of IHD (May 2000).
Implantable cardioverter defibrillators for arrhythmias (September 2000)
Pioglitazone for type 2 diabetes mellitus (March 2001).
Rosiglitazone for type 2 diabetes mellitus (August 2000).
Hearing aid technology (July 2000).
Laparoscopic surgery for inguinal hernia (January 2001).
Proton pump inhibitors for dyspepsia (July 2000).
Interferon alpha and ribavirin for hepatitis C (October 2000).
Zanamivir for the treatment of influenza (November 2000).
Malignant disease and immunosuppression
Taxanes for breast cancer (June 2000 and September 2001).
Fludarabine for chronic b-cell lymphocytic leukaemia (September 2001).
Topotecan for advanced ovarian cancer (August 2001).
Docetaxel, paclitaxel, gemcitabine and vinorelbine for non-small cell cancer (June 2001).
Gemcitabine for the treatment of pancreatic cancer (May 2001).
Temozolomide for malignant glioma (April 2001).
Laparoscopic surgery for colorectal cancer (December 2000).
Liquid based cytology for cervical screening (June 2000).
Taxanes for ovarian cancer (May 2000).
Mental health/central nervous system
Donepezil, rivastigmine and galantamine for Alzheimer’s disease (January 2001).
Methylphenidate for attention deficit hyperactivity disorder (October 2000).
Orlistat for the treatment of obesity in adults (March 2001).
Riluzole for motor neurone disease (January 2001).
Sibutramine for obesity in adults (October 2001).
Musculo skeletal and joint
COX II selective inhibitors for osteoarthritis and rheumatoid arthritis (July 2001).
Hip prostheses for primary hip replacement (April 2000).
Autologous cartilage transplantation for full thickness cartilage defects in knee joints (December 2000).
Oral and maxillofacial
Wisdom teeth – appropriate removal (March 2000).
Inhaler systems for under-5s (August 2000).
Debriding agents and specialist wound care clinics for difficult to heal surgical wounds (April 2001).
NICE GUIDANCE ON THE USE OF CENTRAL LEVEL (2)COX II SELECTIVE INHIBITORS (CELCOXIB, ROFECOXIB, MELOXICAM AND ETODOLAC) FOR OSTEOARTHRITIS AND RHEUMATOID ARTHRITIS
Cox II selective inhibitors are not recommended for routine use in patients with rheumatoid arthritis (RA) or osteoarthritis (OA). They should be used in preference to standard NSAIDs, when clearly indicated as part of the management of RA or OA, only in patients who may be at ‘high risk’ of developing serious gastrointestinal adverse effects.
Source: George et al. PharmacoEconomics 2001; 19(11): 1103-1109.
Barbieri et al, 2003.
30 CENTRAL LEVEL (3)
G or PG
LG or NG
TGENERALIZABILITY OF STUDIES BY METHODOLOGY