Developing a framework to explore how treatment pathway modelling can be mapped to decisions and guidance

Project theme: Applied economic evaluation and policy analysis

The National Institute for Health and Care Excellence (NICE) is currently piloting a ‘Pathways’ approach to the evaluation of new technologies. This involves developing a single economic model for a disease and using this model to inform recommendations for several treatments within a treatment pathway. Two pilot studies are being undertaken to develop pathways models that will allow the clinical and cost-effectiveness of treatments to be appraised at different treatment stages. The first is in renal cell carcinoma(1) and the second in non-small cell lung cancer.(2)

This has highlighted some challenges in using the type of information provided by these assessments within decision-making. Firstly, cost-effectiveness analysis identifies a single cost-effective treatment option and doesn’t account for the trade-offs associated with recommending multiple treatment options. Secondly, a range of ‘events’ (e.g. new products becoming available, changing evidence, evolving drug prices) may modify cost effectiveness, and although it would be impractical to respond to every such event with a reassessment, there is a question of the appropriate policy responses to these events.

References

1. National Institute for Health and Care Excellence. Renal cell carcinoma Pathways Pilot [ID6186]. https://www.nice.org.uk/guidance/indevelopment/gid-ta11186. Accessed 11th July 2023. 

2. National Institute for Health and Care Excellence. Treatments for non-small-cell lung cancer [ID6234]. https://www.nice.org.uk/guidance/indevelopment/gid-ta11289. Accessed 21st July 2023. 

Aims 

A scoping project will be undertaken with the objectives of: 

• Describing available health economics literature that addresses considerations when translating cost-effectiveness analysis results to clinical guidance. 

• Conducting a workshop with relevant stakeholders to understand the current processes for translating NICE guidance to local prescribing decisions; challenges with existing processes and potential policy responses. Invitees will include representatives of NICE, NHSE, DHSC and individuals with a detailed knowledge of drivers of local prescribing decisions. 

• Producing a manuscript describing the review and workshop findings, their implications for relevant stakeholders, and areas where more research may be beneficial. 

Project Team

Beth Woods , Alfredo Palacios, Mark Sculpher , Allan Wailoo , Karl Claxton 

Contact

Beth Woods  beth.woods@york.ac.uk

Publications

• Woods, B., Palacios, A. & Sculpher, M. A Framework for Using Cost-effectiveness Analysis to Support Pricing and Reimbursement Decisions for New Pharmaceuticals in a Context of Evolving Treatments, Prices, and Evidence. PharmacoEconomics (2024). https://doi.org/10.1007/s40273-024-01450-3