It is becoming increasingly clear that NICE and IQWiG have very different concerns on the reimbursement front, but it is only a matter of time before IQWiG gets its teeth into cost-benefit analyses.
Differing decisions on prostate cancer therapies between the UK’s National Institute for Health and Clinical Excellence and Germany’s Institute for Quality and Efficiency in Healthcare highlight the different evidence base between the two health technology assessment authorities – but that could all change later this year when IQWiG expands its assessments to consider cost.
NICE is not likely to recommend Janssen Inc.’s Zytiga for castrate-resistant metastatic prostate cancer because it is too expensive for the NHS. In draft guidance published on Feb. 2, the institute said that the most plausible incremental cost-effectiveness ratio per quality adjusted life year (QALY) gained was £63,200 ($99,770), far outstripping its £20,000-£30,000 threshold.
NICE noted in its interim recommendation that Zytiga in combination with prednisone or prednisolone could offer patients an extra three months of life, but added that this was at the lower end of its guidance for the consideration of high-cost drugs that extend life expectancy. Furthermore, the patient population, NICE said, was too large to place Zytiga in this category, despite acknowledging that it could offer a step change in treatment because it is life-extending rather than palliative.
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