Fair Funding Decisions: Consistency of the Time Horizons Used in the Calculation of Quality-Adjusted Life Years for Therapies for Very Rare Diseases by the National Institute for Health and Care Excellence in England

Jasmin Barman-Aksözen (), Nicole Hentschel (), Mårten Pettersson, Eva Schupp, Francesca Granata, Cornelia Dechant, Mehmet Hakan Aksözen and Rocco Falchetto
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Jasmin Barman-Aksözen: International Porphyria Patient Network (IPPN), Hegarstrasse 3, 8032 Zurich, Switzerland
Mårten Pettersson: International Porphyria Patient Network (IPPN), Hegarstrasse 3, 8032 Zurich, Switzerland
Eva Schupp: International Porphyria Patient Network (IPPN), Hegarstrasse 3, 8032 Zurich, Switzerland
Francesca Granata: International Porphyria Patient Network (IPPN), Hegarstrasse 3, 8032 Zurich, Switzerland
Cornelia Dechant: International Porphyria Patient Network (IPPN), Hegarstrasse 3, 8032 Zurich, Switzerland
Mehmet Hakan Aksözen: International Porphyria Patient Network (IPPN), Hegarstrasse 3, 8032 Zurich, Switzerland
Rocco Falchetto: International Porphyria Patient Network (IPPN), Hegarstrasse 3, 8032 Zurich, Switzerland

IJERPH, 2024, vol. 21, issue 5, 1-14

Abstract: The National Institute for Health and Care Excellence (NICE) in England uses quality-adjusted life years (QALYs) to assess the cost-effectiveness of treatments. A QALY is a measure that combines the size of the clinical benefit of a treatment with the time the patient benefits from it, i.e., the time horizon. We wanted to know how consistently QALY gains are calculated at NICE. Therefore, we have analysed information on the time horizons used for the QALY calculations of the concluded evaluations conducted under the Highly Specialised Technologies programme for treatments of very rare diseases at NICE. For treatments with final guidance published by December 2023 ( n = 29), a time horizon of median 97.5 years (range: 35 to 125 years) was used to calculate the QALY gains. For most QALY calculations, the accepted time horizon was longer than either the expected treatment duration or the estimated life expectancy. In contrast, for the only technology with a final negative funding decision, i.e., afamelanotide for treating the lifelong chronic disease erythropoietic protoporphyria, a time horizon that was shorter than the expected treatment duration was used. The fairness and consistency of the evaluation process of treatments for very rare diseases at NICE should be reviewed.

Keywords: health economics; quality-adjusted life years; National Institute for Health and Care Excellence; Highly Specialised Technologies programme; rare disease; erythropoietic protoporphyria (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2024
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