December 2022
Guest editor: Mireia Jofre-Bonet | Chief Research Officer
Despite the obvious troubles the world is experiencing, we close the year 2022 in higher spirits than in 2021. At OHE, we have reasons to feel more positive indeed. As COVID-19 lessened its grip on our lives, we have attended more conferences and meetings face-to-face. Whilst our own events continue to make the best of virtual and hybrid arrangements, with 15 held on 20 different themes attended by about 2,500 people across 87 countries.
The celebration of 60 years of OHE took many shapes, from the launch of a bi-
annual OHE Innovation Prize and face-to-face gatherings with speeches and discussion, to articles on the history of health economics and creating an OHE timeline for our forthcoming new website. The anniversary has allowed us to reflect on the long way health economics and OHE have come since 1962 and strengthened our direction of travel. Thus, despite some sad departures, our team has expanded and incorporated more bright individuals and an energetic communication and external affairs team. To top it off, we have moved into our brand-new offices in the Hay’s Galleria near London Bridge.
Our research outputs have also continued strongly in 2022. We delivered a substantial program of work on the economics of Antimicrobial Resistance. A blog series shared our views on the NICE and NHS England AMR pilot, a massive step towards tackling AMR. Research co-authored by OHE also showed that the pay-off for implementing pull incentives, such as those trialled in England and proposed in the US PASTEUR Act, is enormous. If the G7 countries paid their fair share of the global incentive payments, the global impact would be enormous: 518,000 lives saved over the next decade and almost 10 million by 2053.
Over the past year, OHE has also been involved in a broad programme of research considering the role of informal (unpaid) caring in HTA decision-making. This includes undertaking research to understand whether and how different HTA bodies worldwide measure and account for the effects of informal caring on the health and quality-of-life of carers and how this information should be included in economic models that inform HTA decisions. We find that relatively few HTA submissions account for carer effects, and those that do are concentrated in just a handful of disease areas. OHE has also identified the potential for ‘perverse’ HTA decisions stemming from what we term the “Carer QALY Trap”. In some circumstances, the conventional QALY maximisation framework can imply that life extensions for patients with carers have less value than for those without carers. In extreme circumstances, this can lead to recommending against life extensions for patients with carers.
In 2022, we have continued working extensively on innovation, precision, and value. Aligning price with value is challenging for some new, highly innovative therapies or new uses of existing therapies, where treatment effects may vary widely between patients or between indications. The one-price-for-one-drug policy is too blunt a tool to appropriately balance access, affordability, and innovation. To benefit from the potential of exciting new treatment developments, we need to evolve how we reimburse our medicines. Investment in more and better data is key to supporting this. Find more about these topics in the reports Payment Models for Multi-Indication Therapies; Health Technology Assessment of Gene Therapies: Are Our Methods Fit for Purpose?; Health Technology Assessment Challenges Associated with Tumour-Agnostic Therapies. Collaborating on payment models to unlock the potential of multi-indication therapies. Being at the forefront of the research on innovative payment methods for advanced and multi-indication therapies has paid off in terms of recognition. In 2022, OHE, along with 17 consortium partners, won a HORIZON grant on innovative pricing, funded by the European Commission.
OHE’s work in 2022 did not stop there and also tackled methods for the valuation of health interventions on children and using the EQ-5D-3L; productivity in primary care; calculating the carbon print of the pharmaceutical sector; and the challenge of creating a measure of resilience and sustainability for healthcare systems, among others.
We look forward to progressing all aspects of this body of work in 2023 and we close up this Bulletin wishing you all the best for the festive break!
MY TOP READ OF THE MONTH
“Health problems are now contributing to a shrinking UK workforce. This is over half a million below pre-Covid levels, with some surveys suggesting as much as two-thirds of this reflects poor health. In the UK, around 2.5mn people are now economically inactive due to ill health.”
Worsening health in an economic headwind | November 2022
According to Office of National Statistics data, the number of economically inactive people due to long-term sickness is at a record high, having jumped by half a million since the start of the COVID-19 pandemic. The highest rates are among 50- to 64-year-olds, but younger groups are also affected. The primary conditions having experienced the highest increases are mental health (now over 300,000), back and neck problems (now about 250,000), and other health problems or
disabilities (about 340,000). The main reason cited varies by age group, with younger people citing mental health.
NHS’s long waiting lists for community mental health care, knee and hip replacements, and cardiac surgery might lie on the other side of the coin. Long-term illness is not evenly distributed across income levels and regions and exacerbates pre-existing health inequalities in England and Wales.
NEW OHE LITERATURE
Tackling the climate crisis is an international priority. Healthcare has a high carbon footprint, accounting for 5% of the UK's carbon footprint (Lenzen et al., 2020), and NHS England has estimated that the manufacture, supply, and use of pharmaceuticals account for 25% of the NHS's total carbon footprint (NHS England, 2020).
This report, commissioned by ABPI and authored by OHE, sets out the high-priority activities that the NHS, UK government and industry should undertake to tackle these challenges.
Valuing and pricing the components of a combination therapy gives rise to several challenges for companies, payers and HTA bodies, particularly when different companies own two or more of the products in combination, each of which seeks a value-based price for their product.
This OHE-authored paper seeks to contribute to the emerging debate on this policy challenge by articulating an approach to solving the value attribution problem. The solution we propose assumes the price of the backbone therapy will differ in combination use, as do the two alternative proposals from the literature that we compare our approach with.
The R&D pipeline for new antimicrobials is sparse because market failures stop private companies from capturing a sufficient return on investment despite their very high social value. In this paper, the authors show that a subscription-type model in the Paster Act program will likely generate a very high social ROI.
From the US domestic perspective, ROI is calculated at 6:1 over 10 years and 28:1 over 30 years in terms of value of averted death/disease and associated hospital costs. Globally, ROI grows to 27:1 and 125:1 respectively.
Based on these high social returns, the authors encourage the US Congress to urgently finance and authorise a subscription program for new antimicrobials, with particular consideration for the PASTEUR Act.
NEWS HIGHLIGHTS
In pursuing a tobacco-free generation by 2040, the EU is introducing minimum excise duty on cigarettes from 1.80 to 3.60 per 20-unit packs and extending taxation to new tobacco products such as vapes and heated tobacco. Vapes might have an excise duty of 20 per cent and heated tobacco products of 55 per cent.
The World Health Organisation and the US Centers for Disease Control and Prevention (CDC) warn that reductions in vaccination rates and surveillance during the COVID-19 pandemic have resulted in the spread of measles to all regions of the world.
In 2021, it was estimated that there were 9 million cases and 128,000 deaths due to measles outbreaks. In the UK, 89.2% of children at 24 months had completed their first dose of Measles, Mumps and Rubella (MMR) which is a decrease from 90.3% in 2020 and well below the WHO target of 95%. In 2021, about 61 million measles vaccine doses were postponed or missed because of COVID-19- related delays in 18 countries, 40 million being children's first doses. The damage to immunisation programmes is one of the dangerous disruptions caused by the pandemic that might have long-lasting effects.
A report prepared by the OECD for the 2020 German Presidency of the Council of the European Union, with support from the German Federal Ministry of Health, concludes that: “Digital transformation in the health sector is not a simple matter of technical change, but requires an adaptive change in human attitudes and skills as well as of legal frameworks and the organisation of work”.
Among other recommendations, the report calls for establishing foundations for an ethical, human-centred digital change. To enable this change, the authors point out that without promoting appropriate human expertise and skills, society will not be able to use “digital technologies to add value”. The report calls for the existing legal and organisational frameworks and the provision of formation courses to enable hybrid health care.
UPCOMING EVENTS & ON-DEMAND
On-demand | Virtual
This webinar brought together a collection of some of the leading decision-makers and eminent policymakers from the UK Government’s COVID-19 response through the world-leading vaccination programme and extensive antiviral rollout. The speakers discussed their experiences in government and how to handle risk, uncertainty and imperfect information in emergency situations and key lessons that should be applied for future pandemic preparedness.
24 January | Virtual
RESCHEDULED EVENT
Join us virtually to hear the 2022 OHE Innovation Policy Prize winner present their solution – an original, globally feasible, and theoretically grounded piece of research.
You will also hear our expert judging panel discuss the challenges we’re facing regarding ‘fair pricing’ and the broader range of ideas and solutions we received.
Register your free ticket today.
