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Published byAgatha Gaines Modified over 9 years ago
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Why does SMC say NO We all want the most effective medicines All medicines cost money Health budgets are limited How do we choose?
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How would you choose? Medicine A costs £1m gives 1 person 1 days extra life Medicine B costs £1m gives a thousand people 1 years extra life SMC uses Quality Adjusted Life Year or QALY to compare effect of medicine Cost per QALY compares economics
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What is a QALY? Quality Of Life 1 Perfect health 0.5 poor health 1 year @ QOL of 1 is QALY of 1 1 year @ QOL of 0.5 is QALY of 0.5 2 years @ QOL of 0.5 is QALY of 1 Cost per QALY is economic value of medicine. Cost, quality and time
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Cost per QALY Using Cost per QALY means that we can compare the economic effectiveness of medicines for different illnesses. Not perfect, but it is a useful indicator
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Reasons for non-approval No better than cheaper medicine Not shown to work Inappropriate comparator Not sufficiently strong economic case
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Inappropriate Comparator 1.Test against placebo to see if it works 2.Test against another treatment (comparator) to see if it is better 3.But can only accept if comparator is a treatment normally used in Scotland
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Not sufficiently strong economic case This is one of the most frequent reasons given for non-approval. It does not necessarily mean that it is too expensive. Doubtful use of clinical data Over-optimistic assumptions Inadequate sensitivity analysis Very high cost per QALY
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Can be a reason although very high cost medicines can be accepted. NICE and SMC decisions show that Cost/QALY<£20 000 often accepted £20-30 000 need strong case >£30 000 often rejected
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Top reasons for non-approval 1.Comparator wrong for Scotland 2.Doubtful use of clinical data 3.Over-optimistic assumptions 4.No economic evaluation 5.Failure to use final health outcome or calculate QALY (where appropriate)
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