Do New Medicines Improve Population Health? Insights from NICE (2000–2020)

Huseyin Naci - Population health impact of new medicines recommended by NICE in England, 2000-2020

Health systems experience difficult trade-offs when paying for new drugs. In England, funding recommendations by the National Institute for Health and Care Excellence (NICE) for new drugs might generate health gains, but inevitably result in foregone health as the funds cannot be used for alternative treatments and services. We evaluated the population-health impact of NICE recommendations for new drugs between 2000-20. During this period, the National Health Service (NHS) coverage of new drugs displaced more population health than it generated. Our results highlight the inherent trade-offs between individuals who directly benefit from new drugs and those who forgo health due to the reallocation of resources towards new drugs.

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Comments in chat:
Nathan: Huseyn how is it plausible to even derive qalis from PFS data or single arm studies evaluating only ORR and DoR???
Leeza Osipenko: Nathan, modelling, extrapolation (surrogate to final assumptions or lack of such), and indirect comparisons (or broader application of network meta analysis) is used to build the decision-making framework for the derivation of QALYs. Sensitivity analyses are used to explore various scenarios as obviously the above steps are producing probabilistic rather than absolute results
Bobby MULROONEY: What research methodology and empirical data underpin the £15,000 GBP assessment of the Health opportunity cost - how precise or reliable is this assessment?
Leeza Osipenko: https://pubmed.ncbi.nlm.nih.gov/25692...
Bobby MULROONEY: The real cost of medicines is not just in the "cost-effective", and usually confidential, price agreed with manufacturer; there are other deductions made by the NHS - like the Budget Impact and the various rebate schemes (Voluntary scheme/Statutory scheme etc) - how have you accounted for these in your assessment of the value of the net health effect?
Woojung Lee: (1) How is the NHS opportunity cost estimated in the UK, and is it updated over time? (2) What's your sense of uncertainty around the NHS opportunity cost? (3) What are your thoughts on applying the concept of opportunity cost in the US setting?
Marcel Zwahlen: Have you dealt with inflation and/or rising overall costs over these 20 years in any way?
Kathleen Harkin: Excellent research, thanks. It looks like even HTA may have been hijacked or captured by industry ☹️
Ken Paterson: We can debate the exact threshold for opportunity cost, but I doubt anyone thinks that it is close to the current NICE acceptability levels. Your findings of health gain foregone is almost certainly true.
Ken Paterson: Can the confidentiality of actual medicines costs be justified in 2025 - surely openness and transparency dictate that actual prices are in the public domain (even if that would all help the plan of POTUS!!).
Lisa Hutchinson: And in response to John Hickman's pertinent query, this means that since many NICE-based healthcare decisions for use on NHS are made on surrogate endpoints, presumably any perceived benefits (especially in oncology) are even lower than the Huseyin Naci's study shows (or put another way, the health deficit is even more marked)!!
Sophie WINTRICH: I suspect that it may not have a huge impact on overall figures, but were broader societal savings taken into account?
Prof Ala Szczepura, Coventry University: In the NHS actually realising any opportunity cost will depend on capacity/trained staff & may require further investment/reconfiguring of services.
Laurence Woollard: Thanks so much for the presentation. Since the analysis follows the NICE reference case, which excludes wider societal impacts like reduced caregiver burden or improved productivity, how should we interpret the finding that these drugs displaced more population health than they generated? Could the conclusion be a misleading result caused by the fact that the analysis didn’t include wider societal benefits?
Ken Paterson: If you know the ICER that NICE have used and you know the health gain, why can you not work back to the drug acquisition cost?