A comparison of HAS & NICE guidelines for the economic evaluation of health technologies in the context of their respective national health care systems and cultural environments

Abstract

BackgroundHealth technology assessment (HTA) has been reinforced in France, notably with the introduction of economic evaluation in the pricing process for the most innovative and expensive treatments. Similarly to the National Institute for Clinical Excellence (NICE) in England, the National Authority for Health (HAS), which is responsible for economic evaluation of new health technologies in France, has published recommendations on the methods of economic evaluation. Since economic assessment represents a major element of HTA in England, exploring the differences between these methodological guidelines might help to comprehend both the shape and the role economic assessment is intended to have in the French health care system.MethodsMethodological guidelines for economic evaluation in France and England have been compared topic-by-topic in order to bring out key differences in the recommended methods for economic evaluation.ResultsThe analysis of both guidelines has revealed multiple similarities between France and England, although a number of differences were also noted regarding the elected methodology of analysis, the comparison of studies’ outcomes with cost-effectiveness thresholds, the study population to consider, the quality of life valuation methods, the perspective on costs, the types of resources considered and their valuation, the discount rates to apply in order to reflect the present value of interventions, etc. To account for these differences, modifications will be required in order to adapt economic models from one country to the other.ConclusionsChanges in HTA assessment methods occur in response to different challenges determined by the different philosophical and cultural considerations surrounding health and welfare as well as the political considerations regarding the role of public policies and the importance of their evaluation.

Reimbursement of licensed cell and gene therapies across the major European healthcare markets

“…The SMR is used by the Social Security Fund's health insurance (UNCAM) to set reimbursement rate, whereas the ASMR is taken into account by the pricing committee (CEPS) under the Ministry of Health, when negotiating the reimbursed ceiling price ( 9 ). Therapies with both a substantial improvements in clinical benefit (ASMR I-III) and an estimated budget impact of >€20 million also undergo a CE evaluation by the economic commission (CEESP), which is used by CEPS in price negotiations ( 10 ). The Minister of Health publishes the final P&R decision based on TC and CEPS opinions.…”

A comparative review of Haute Autorité de Santé and National Institute for Health and Care Excellence health technology assessments of Ikervis® to treat severe keratitis in adult patients with dry eye disease which has not improved despite treatment with tear substitutes

“…Therefore, one critical difference is that whereas NICE accepted the current clinical practice as a standard for comparison, HAS did not. According to Massetti et al, all potentially relevant interventions for the assessed indication should be compared, irrespective of whether they have a marketing authorization in the indication, and HAS recommends comparing the new product to current best practice and routine treatment [ 44 ].…”

Cost-Effectiveness Analysis on the Use of Parenteral Nutrition With D10-Ca Gluconate and D5 1/4ns in Normal-Weight Neonates With Respiratory Distress Syndrome

“…According to the previous studies [13], the values of the cost incurred in health programs must be adjusted each year, by 3.5% in England and 4% in France. Both countries need sensitivity analysis using alternative discounted medical cost (1.5% in England; 3% and 6% in France).…”