Es mostren els missatges amb l'etiqueta de comentaris QALYs. Mostrar tots els missatges
Es mostren els missatges amb l'etiqueta de comentaris QALYs. Mostrar tots els missatges

05 de febrer 2013

Overvaluing expensive drugs

A research from University of York has concluded that NICE is overvaluing expensive treatments because its cost threshold - the price at which a treatment is deemed good value for the NHS - is set too high. The threshold value per quality-adjusted life year (QALY) - a measure of the health benefits of a treatment - should be lowered from £30,000 to just £18,317, their analysis found. It suggests the NHS may be wasting money on treatments that are not as good value as first thought. Professor Sculped said:
It is crucial that the cost effectiveness threshold is seen as representing health forgone as the additional costs of new technologies are imposed on the fixed budgets of local commissioners. For decisions made by NICE and many policy options considered by the NHS and DH, this is the key to establishing the value for money of new services.
This is a strong criticism against QALYs, let's see if it has some impact in the near future. Fortunately, the British have the opportunity to debate on it. Nearer here, the press is saying now that 30% of drugs requested for approval were rejected (7 out of 24). No details available, no website, no transparent process. That's alleged democracy, southern style. NTA=Nothing to add.

PS. If you don't want to read the article, have a look at this presentation. I suggest you save it, it may be useful for the future.

PS. As you can see from my blog, in one week, two officials have said different numbers of rejected drugs for public funding (2 vs 7). Does this make any sense? Is there anybody asking for an explanation in Parliament?

PS. Follow the controversy on DSM-5 at BBC News.

PS. Check here how our drug prices have converged to the european average.

PS. Must read: Uwe Reinhardt blog.

PS. Interesting article on 20 years of economic evaluations of cancer.

17 de febrer 2011

Equitat d'oportunitats

Quan l'Alan Williams va formular l'argument del "Fair Innings" va agafar a més d'un amb el pas canviat. L'Adam Oliver ens recorda que va ser en Harris qui va establir el concepte:
The essence of the basic ‘intergenerational’ fair innings argument outlined by Harris (1985) is that people who have achieved old age would not have their lives further prolonged if this was undertaken at the expense of those who had not yet realized their fair innings, presumably to give as many people as possible the opportunity to fulfil their ambitions and potential. Harris was concerned with a fair innings defined in terms of life-expectancy, which, according to Williams (1997) is tied in with the view that people generally feel that everyone is entitled to a ‘normal’ span of life
En Williams anava més lluny que en Harris, resumint molt:
Williams therefore believed that when prioritising people (or groups of people) for health care treatment, consideration of differences in post-treatment QALY gains (an efficiency argument) should be accompanied by consideration of differences in QALE (an equity argument).
Ens va deixar quan encara buscava una regla d'aplicació del principi d'equitat d'oportunitats, una forma de reconciliar l'equitat integeneracional i afegir esperança de vida de qualitat a aquells que més s'en poden beneficiar. I la qüestió esdevé encara oberta a hores d'ara. La lectura del treball d'Oliver i la reflexió  d'Ezequiel, Wertheimer i Persad són per a mi encara els referents del moment.
Ara que vivim perillosament moments de retallades indiscriminades, ara ens cal més que mai la prudència que acompanyen tota decisió d'assignació de recursos. La forma com establim prioritats condiciona l'esdevenidor.

PD. Un repàs als materials de la darrera conferència sobre el tema hauria de ser d'utilitat per a més d'un.

PD. Just avui l'Adam em diu que al Setembre fan unes jornades a LSE sobre el tema. El títol de la ponència més provocador és el de Gwyn Bevan : “If cost/QALY is the answer, what is the question?”. Haurem de fer un forat a l'agenda.

14 d’octubre 2010

En Weinstein carrega fort

Legislating against Use of Cost-Effectiveness Information

En Weinstein i en Neumann publiquen a NEJM un article suggerent. Expliquen com la llei norteamericana ha prohibit l'ús dels QALYs com a llindar.
El resum en un paràgraf:
"To be sure, there are legitimate debates about the role of QALYs as the sole benchmark of health gains for purposes of allocating society’s resources. However, acknowledging the measure’s limitations, panels in the United States and Britain and at the World Health Organization have found QALYs preferable to alternative measures of health improvement."

Malgrat que em preocupen els llindars i qui els fixa, em preocupa també que no hi hagi mesures i que seguim conduint mirant el retrovisor.
Per aquí el vent bufa i s'ho emporta tot, fins i tot el que diuen les lleis, que cal avaluar la utilitat terapèutica dels medicaments. Encara no han prohibit els QALYs perquè no interessa establir prioritats, el cafè per a tots és més gratificant però potser és cosa de dies.