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Reimbursement Decisions of the All Wales Medicines Strategy Group

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  • Warren Linley
  • Dyfrig Hughes

Abstract

Background: There have been several explorations of factors influencing the reimbursement decisions of the National Institute for Health and Clinical Excellence (NICE) but not of other UK-based health technology assessment (HTA) organizations. Objective: This study aimed to explore the factors influencing the recommendations of the All Wales Medicines Strategy Group (AWMSG) on the use of new medicines in Wales. Methods: Based on public data, logistic regression models were developed to evaluate the influence of cost effectiveness, the quality and quantity of clinical evidence, disease characteristics (including rarity), budget impact, and a range of other factors on the recommendations of AWMSG and its subcommittee, the New Medicines Group (NMG). Results Multivariate analyses of 47 AWMSG appraisals between 2007–9 correctly predicted 87% of decisions. The results are suggestive of a positive influence on recommendations of the presence of probabilistic sensitivity analyses (PSAs) but, counter-intuitively, a statistically significant negative influence of evidence from high-quality randomized controlled trials (RCTs) [odds ratio 0.059; 95% CI 0.005, 0.699]. This latter observation may be attributed to our strict definition of high quality, which excluded the use of surrogate endpoints. Putative explanatory variables, including cost effectiveness, budget impact, underlying disease characteristics and ‘ultra’-orphan drug status were not statistically significant predictors of final AWMSG decisions based on our dataset. Univariate analyses indicate that medicines with negative recommendations had significantly higher incremental cost-effectiveness ratios than those with positive recommendations, consistent with the pursuit of economic efficiency. There is also evidence that AWMSG considers equity issues via an ultra-orphan drugs policy. Conclusions Consideration of decision uncertainty via PSA appears to positively influence the reimbursement decisions of AWMSG. The significant negative impact of the presence of high-quality RCTs, and the lack of a significant positive impact of other expected factors, may reflect issues in the plausibility of supporting evidence for medicines that received negative recommendations. Furthermore, it serves to emphasize the difficulties in applying the usual hierarchies of evidence to the HTA process, and in particular to the appraisal of high-cost specialist medicines close to market launch. Copyright Springer International Publishing AG 2012

Suggested Citation

  • Warren Linley & Dyfrig Hughes, 2012. "Reimbursement Decisions of the All Wales Medicines Strategy Group," PharmacoEconomics, Springer, vol. 30(9), pages 779-794, September.
    • Handle: RePEc:spr:pharme:v:30:y:2012:i:9:p:779-794
    DOI: 10.2165/11591530-000000000-00000
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    References listed on IDEAS

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    1. Lesley Chim & Patrick Kelly & Glenn Salkeld & Martin Stockler, 2010. "Are Cancer Drugs Less Likely to be Recommended for Listing by the Pharmaceutical Benefits Advisory Committee in Australia?," PharmacoEconomics, Springer, vol. 28(6), pages 463-475, June.
    2. Nancy Devlin & David Parkin, 2004. "Does NICE have a cost‐effectiveness threshold and what other factors influence its decisions? A binary choice analysis," Health Economics, John Wiley & Sons, Ltd., vol. 13(5), pages 437-452, May.
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    Cited by:

    1. Degtiar, Irina, 2017. "A review of international coverage and pricing strategies for personalized medicine and orphan drugs," Health Policy, Elsevier, vol. 121(12), pages 1240-1248.
    2. Wranik, Wiesława Dominika & Gambold, Liesl & Peacock, Stuart, 2021. "Uncertainty tolerance among experts involved in drug reimbursement recommendations: Qualitative evidence from HTA committees in Canada and Poland," Health Policy, Elsevier, vol. 125(3), pages 307-319.
    3. Helen Dakin & Nancy Devlin & Yan Feng & Nigel Rice & Phill O'Neill & David Parkin, 2015. "The Influence of Cost‐Effectiveness and Other Factors on Nice Decisions," Health Economics, John Wiley & Sons, Ltd., vol. 24(10), pages 1256-1271, October.
    4. Warren G. Linley & Dyfrig A. Hughes, 2013. "Societal Views On Nice, Cancer Drugs Fund And Value‐Based Pricing Criteria For Prioritising Medicines: A Cross‐Sectional Survey Of 4118 Adults In Great Britain," Health Economics, John Wiley & Sons, Ltd., vol. 22(8), pages 948-964, August.
    5. Kisser, Agnes & Tüchler, Heinz & Erdös, Judit & Wild, Claudia, 2016. "Factors influencing coverage decisions on medical devices: A retrospective analysis of 78 medical device appraisals for the Austrian hospital benefit catalogue 2008–2015," Health Policy, Elsevier, vol. 120(8), pages 903-912.
    6. Malinowski, Krzysztof Piotr & Kawalec, Paweł & Trąbka, Wojciech, 2016. "Impact of patient outcomes and cost aspects on reimbursement recommendations in Poland in 2012–2014," Health Policy, Elsevier, vol. 120(11), pages 1249-1255.

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