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Schwerpunkt| Volume 108, ISSUE 7, P367-374, 2014

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Health economic evaluation in England

DOI:https://doi.org/10.1016/j.zefq.2014.08.019
Health economic evaluation in England
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      Summary

      The 2010 National Health Service Constitution for England specified rights and responsibilities, including health economic evaluation for the National Institute for Health and Care Excellence (NICE) and the Joint Committee on Vaccinations and Immunisations. The National Screening Committee and the Health Protection Agency also provide advice to the Government based on health economic evaluation. Each agency largely follows the methods specified by NICE.
      To distinguish the methods from neoclassical economics they have been termed “extra-welfarist”. Key differences include measurement and valuation of both benefits (QALYs) and costs (healthcare related). Policy on discounting has also changed over time and by agency. The debate over having NICE's methods align more closely with neoclassical economics has been prominent in the ongoing development of “value based pricing”.
      The political unacceptability of some decisions has led to special funding for technologies not recommended by NICE. These include the 2002 Multiple Sclerosis Risk Sharing Scheme and the 2010 Cancer Drugs Fund as well as special arrangements for technologies linked to the end of life and for innovation. Since 2009 Patient Access Schemes have made price reductions possible which sometimes enables drugs to meet NICE's cost-effectiveness thresholds. As a result, the National Health Service in England has denied few technologies on grounds of cost-effectiveness.

      Zusammenfassung

      Mit der Neuverfassung des National Health Service 2010 wurden Rechte und Zuständigkeiten konkretisiert; die Kosten-Nutzen-Bewertung wurde beim National Institute for Clinical and Social Excellence (NICE) und beim Joint Committee on Vaccinations and Immunisations (JCVI) angesiedelt. Das National Screening Committe und die Health Protection Agency können die Regierung auch auf Grundlage von Kosten-Nutzen-Bewertungen beraten. Die Behörden und Einrichtungen richten sich dabei nach den Methoden des NICE.
      Die gesundheitsökonomischen Methoden des NICE werden allgemein unter dem Begriff des Extrawelfarismus subsumiert, um sie von der neoklassischen Wohlfahrtstheorie abzugrenzen. Im Kern schlägt sich dies in unterschiedlichen Erhebungs- und Bewertungsmethoden des Nutzens (QALYs) und der Kosten (Perspektive des NHS) nieder. Zu erwähnen ist außerdem, dass sich die Diskontierung über die Zeit und zwischen den verschiedenen Einrichtungen unterschiedlich entwickelt. Im Zusammenhang mit der Einführung des Value Based Pricing wurde und wird in einer Ende Juni 2014 beendeten öffentlichen Debatte darüber gestritten, ob sich die Methoden des NICE nicht näher an die des britischen Finanzministeriums (UK Treasury) anlehnen sollten.
      Da man einige Entscheidungen des NICE zu Arzneimitteln als politisch inakzeptabel ansah, wurden besondere Budgets für Interventionen eingeführt, deren Erstattung von NICE abgelehnt wurden. Dazu gehören das Multiple Sclerosis Risk Sharing Scheme (2002) und der Cancer Drugs Fund (2010) sowie besondere Prämien für Interventionen am Ende des Lebens und für Innovationen. Seit 2009 werden über Patient Access Schemes Preissenkungen gefordert, so dass die Schwellenwerte des NICE erreicht werden. Insgesamt muss man sagen, dass der NHS in England auf der Basis von Kosteneffektivität die Erstattung von sehr wenigen Interventionen abgelehnt hat.

      Keywords

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      Article info

      Publication history

      Accepted: August 28, 2014
      Received in revised form: August 5, 2014
      Received: May 9, 2014

      Identification

      DOI: https://doi.org/10.1016/j.zefq.2014.08.019

      Copyright

      © 2014 Published by Elsevier Inc.

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