Category: CER

  • NICE’s new Severity Adjustment

    In the United Kingdom, the National Institute for Health and Care Excellence (NICE) made an update to their health technology evaluations manual in January 2022. Of particular interest, section 6.2 of the manual states that the review committee “will consider the associated absolute and proportional QALY shortfall.”  The committee defined QALY shortfall two ways: Absolute […]

  • Health Years in Total (HYT)

    Standard quality approach compares the difference in QALYs which is a function of survival and quality of life during each survival period.  Consider the comparison of treatments A and B, where treatment A is the novel treatment and treatment B is the standard of care. Under the QALY based approach this is calculated as Where […]

  • Technology assessment in rare diseases

    What is a rare disease? The definition varies across countries, but according to the European Medicines Agency (EMA) rare diseases are those with a prevalence of <5 cases per 10,000 people; ultra-rare diseases are those with <1 case per 50,000 people. In most cases, rare disease must not only be rare but also severe, often […]

  • Is the value of a QALY constant?

    Standard cost-effectiveness analysis assumes that any gain in quality-adjusted life years (QALYs) should be valued equally. This does not sound unreasonable, but is it true in practice? Consider two potential violations of constant value of QALY gains: scope insensitivity and severity independence. I define each of these below: Scope insensitivity. This assumes that individuals value […]

  • Societal vs. health system perspective: does it matter?

    Cost effectiveness analysis aims to capture identify (and monetize) all of a treatments benefits, risk and costs and then determine if the treatment is worth the money. Traditionally, however, benefits, risk and costs only related to benefits that accrue to the health care system. Many studies in the academic literature have advocated for a societal […]