JUNE 2022

June editor: Chris Skedgel  |  Director

Looking back on OHE's activities in the first half of 2022.

 

As the world has adjusted to a “new normal” in 2022 following the COVID-19 disruptions and anxiety of the last two years, OHE has been busy with a mix of the “new” and the “normal” in the first half of the year.

First, we are tremendously excited to have officially launched OHE’s new £40,000 Innovation Policy Prize as part of our 60th anniversary activities. Having been at the forefront of economics and policy of health and life sciences innovation for the past 60 years, OHE has a rich history of supporting and promoting original thinking to address the important health economics issues of today and the future. The OHE Prize has been created in support of our charitable goal of improving the quantity and quality of debate around health economics issues.

 

We are encouraging researchers from a wide range of disciplines to consider “how can policymakers design a system to generate fair prices that balances access and innovation throughout the lifecycle of medicines?” To enter, individuals or teams should submit a concise explanation of their proposed solution along with a short summary by 18 September. From these, a shortlist will be invited to submit a more-detailed solution. Entries will be assessed on a combination of originality, feasibility, and clarity by our distinguished panel of judges. Representatives of the winning and runner-up entries will be invited to a special event in London in December to present their ideas and collect their share of the prize fund. Full details of the question, the entry and submission process, and our panel of judges are available at the OHE Prize Hub.

 

I look forward to updating you on the first round of entries and their ideas in a later OHE bulletin.

Second, members of the OHE team were delighted with a return to the “normal” as they travelled to Washington D.C for ISPOR’s first in-person meeting in longer than any of us care to think about.  OHE’s delegation included our Chief Executive Graham Cookson, Vice-President Lotte Steuten, and Director Emeritus Adrian Towse, as well as team members Chris Sampson, Margherita Neri, and Claire Green.

 

Adrian had a busy ISPOR, moderating issue panels on the future of severity-weighting in health technology assessment and the challenges of health technology assessment of gene therapies. In the first, panellists discussed whether severity should be treated as a quantitative element of an evaluation or as a context factor as part of deliberative discussion, and if as a quantitative element, how should this measure be operationalised?. In the second, panellists discussed evidence-based recommendations for how to address issues around evidence generation, uncertainty, cost and affordability, and limitations of current value perspectives that currently present challenges to the assessment of gene therapies.

 

Lotte taught a short-course on "Early-stage Health Technology Assessment", a catch-all term for methods used to inform industry and other stakeholders about the potential value of new technologies in development, including quantifying and managing uncertainty. In its inaugural year, the short-course exceeded expectations by attracting 35 students from 8 countries. Lotte also co-hosted a Women in HEOR Dinner table and, as one of ISPOR’s Board of Directors, fulfilled the various functions associated with that leadership role. 

 

Chris chaired an ISPOR Special Interest Group (SIG) forum on open-source modelling, which he previously introduced here. Despite expressions of support for open-source modelling from researchers, practical examples of such models are few and far between, owing in part to concerns around legal issues and secure data sharing. This forum discussed how it might be possible to overcome these concerns.

 

Margherita presented a framework for defining the degree of pressure on a health system and for describing its potential impact. The COVID-19 pandemic has made it apparent that health technologies like vaccines can help reducing pressure on health systems. This research is a first step in conceptualising the value of protecting health systems for similar pressures in the future.

 

Finally, we hosted a social event at the (in)famous Watergate Hotel as part of our ongoing 60th anniversary celebrations to discuss the past, present and future of health economics. First, Adrian and Dr Julia Slejko (University of Maryland, US) discussed the experience of QALYs versus the patient experience. Next, Graham and Dr Stacie Dusetzina (Vanderbilt University, US) debated whether the proposed US drug price reform will lower prices, and at what cost. Finally, Lotte and Dr Blythe Adamson (Flatiron, US) spoke about ways to speed up high-quality evidence generation for accelerated approvals.

 

The entire OHE team is looking forward to new developments and new opportunities in 2022, including an upcoming summer party in June to continue celebrating our anniversary, the OHE Prize event in December, and more prosaically, an upcoming office move. We will keep you updated on all of these developments!

MY TOP READ OF THE MONTH

“We need to be sure we are removing as many barriers to vaccine access as possible, and putting equity at the forefront of any proposal on the table.”

STAT. What happens when the government stops buying Covid-19 vaccines?   |  17 May, 2022

STAT has recently reported that the US government is preparing to stop paying for COVID-19 vaccines, leaving them to be purchased by insurers or individuals as any other medicine in the US health system. This would mark an end to direct public provision of vaccines that is common in socialised health systems but less typical in the largely-private US system.

 

In the absence of the US government’s enormous purchasing power it is likely that there will be substantial increases in the price of the vaccines. The article notes that there is an expectation that the cost per dose for the Moderna vaccine may rise from US$16.50 to around US$60.

 

There is a tension between the value of vaccines to society, well-demonstrated by the

“new normal” enabled by the COVID-19

vaccines, and the individual or health system willingness-to-pay for vaccines. As OHE has discussed, rewarding the value provided by vaccines is essential to continued innovation and development, but full value-based pricing can have negative implications for vaccine access and equity, as well as for uptake and the overall effectiveness of vaccination strategies. As highlighted by OHE, this tension is particularly acute in low and middle-income countries.

 

Although this move can be seen as a transition to a more “business as usual” model for vaccines in the US, the article quotes Ingrid Katz, an associate professor at Harvard Medical School who studies global health and vaccine equity, who emphasises, “This isn’t business as usual. We have lost over 1 million people. We need to be sure we are removing as many barriers to vaccine access as possible, and putting equity at the forefront of any proposal on the table.”

NEW OHE LITERATURE

Let’s talk about (health) inequalities

In the sixth and final instalment of OHE’s review of NICE’s revised technology evaluation guidance manual, Patricia Cubi-Molla describes how NICE is trying to give greater consideration to health inequalities between different groups in society in its assessments of health technologies.

 

One of the key challenges NICE faces is understanding which inequalities society sees as ‘unfair’, and therefore of policy concern, and which inequalities may be seen as ‘fair’ in some respects. Likewise, she highlights the limited leverage HTA may have over the sources of many health inequalities. 

Accounting for Preference Heterogeneity in Discrete Choice Experiments

OHE’s David Mott co-authored a recent article in Value in Health with other members of the ISPOR Health Preferences Research SIG, reviewing how preference heterogeneity is considered in discrete choice experiments.

 

They observe that formal consideration of heterogeneity is growing but call for more discussion, alignment, and explicit guidance around best practice.

 

ISPOR Issue Panel roundup: Are Our HTA Methods Fit for Purpose for Gene Therapies?

Nadine Henderson summarises one of OHE’s Issue Panels at ISPOR discussing distinct HTA challenges in assessing gene therapies and some practical solutions.

 

She notes that gene therapies have the potential to transform lives as well as benefit society and health systems but that they are also associated with distinct challenges. These include how to assess clinical effectiveness and costs, and uncertainty around long-term outcomes, as well as questions around how to account for additional elements of value.

NEWS HIGHLIGHTS

Insomniacs in England to be offered app treatment instead of sleeping pills

NICE has approved its first “digital therapeutic”, recommending the app Sleepio over sleeping pills for individuals with insomnia. It is expected that the £45 app will be at least as effective as sleeping pills whilst avoiding costs associated with GP visits and prescription sleep medicines, some which can be addictive.

 

OHE followed this decision particularly closely as members of our team contributed to the economic evidence presented to NICE as part of the appraisal process.

Monkeypox cases investigated in Europe, US, Canada and Australia

Cases of monkeypox are being investigated in the UK and several other European countries as well as the US, Canada and Australia. According to the article, monkeypox is a rare viral infection, most common in remote parts of Central and West Africa. It is usually mild and most people recover within a few weeks.

 

The current outbreak does not present a serious risk to the public. The spread of an uncommon African virus through countries in Europe, North America and the Pacific does, however, provide a reminder of the ongoing risk of zoonotic viruses. Continued development of vaccines and antiviral medicines will be essential to maintaining our current “new normal”.

Pfizer announces plan to sell patented drugs for nonprofit prices to low income countries

Pfizer has announced that it will make some patented medicines available at a "not-for profit price"  to 45 of the worlds poorest countries that currently lack access to many innovative treatments.

 

Pfizer's plans include 23 medicines and vaccines that treat infectious diseases, certain cancers, and rare and inflammatory diseases. This includes their COVID-19 treatment Paxlovid and big-selling breast cancer drug, Ibrance.

 

Pfizer's "Accord for a Healthier World" covers much of Africa and Southeast Asia.

UPCOMING EVENTS

60th Anniversary Summer Drinks Reception

16 JUNE  |   Join us for an exclusive summer drinks reception to celebrate OHE’s 60th anniversary on 16 June at No.4 Hamilton Place, London W1J 7BQ

 

During the evening, we will have a few short speeches celebrating OHE's rich history and our significant contributions to health economics, as well as the impact of health economics in general over the past 60 years. British weather permitting, we will finish the evening with a drink and a lite bite to eat on a roof terrace overlooking Hyde Park.

 

Book your free ticket today.

The Value of a QALY towards the End of Life and its Determinants: Experimental Evidence

21 JUNE  |  Join our first hybrid free-to-attend Lunchtime Seminar presented by Peter Zweifel, Emeritus of the University of Zurich. Peter will be sharing evidence and findings from an online survey involving 1,529 Swiss individuals in 2014 on the individual or societal willingness to pay for end-of-life medical interventions.

 

Book your free ticket today.

Collaborating on payment models to unlock the potential of multi-indication therapies

22 JUNE  |  A panel of international experts and thought leaders discuss why change is needed, the challenges arising, and how they can be overcome at our upcoming free-to-attend virtual Masterclass. Delegates will be presented with a multi-stakeholder view on the need for and opportunities associated with payment models that recognise value at the indication-level, leveraging the findings of the OHE Consensus Programme.

 

Book your free ticket today.