Considering Severity in Health Technology Assessment

There is strong evidence that the public assign greater value to health gains to patients in relatively more severe health states. In our recently published commentary in collaboration with Biogen, we discuss how this preference is increasingly reflected in health technology assessment, with some consideration of severity incorporated by health technology assessment (HTA) bodies in, among others, The Netherlands, England and Wales, Norway, Sweden, and the United States

Many HTA bodies have adopted a more explicit consideration of severity, often using proportional shortfall, absolute shortfall or a combination of both to determine adjustments to standard cost-effectiveness thresholds. Others use a more implicit approach, such as the Institute of Clinical and Economic Review (ICER) in the US and the Common Drug Review in Canada.

We discuss the drawbacks of categorical approaches, especially discontinuities between severity categories that arguably violate concepts of vertical equity, and argue that a more continuous approach to understanding severity is needed. We also note challenges to more explicit approaches, including implications of a lower acceptable cost-effectiveness threshold for less severe conditions and the relative complexity of calculating a continuous severity adjustment.

Read the full open access commentary here: Considering Severity in Health Technology Assessment: Can We Do Better?

As part of our blog series discussing some of the key changes resulting from the recent NICE methods review, we take a deeper look into NICE’s newly proposed severity modifier which replaces their existing ‘End of Life’ criteria. The new severity modifier defines severity more broadly but one of the main areas of criticism that the EOL criteria received also applied here: namely, that there is little evidence that the modifier as currently applied reflects societal preferences.

Read the blog here: NICE’s severity modifier: a step in the right direction, but still a long way to go

OHE look forward to contributing to further research and debate in this area in the near future. Our next masterclass will explore the consideration of severity in value assessment, for more details visit our website.