Is there Evidence of a Difference Between Willingness to Pay and Willingness to Accept Thresholds? A Review of Nice Technology Appraisals

• Published in: Value in health 2016, Vol.19 (7), p.A492-A493
• Main Authors: Minacori, R, Geale, K
• Format: Article
• Language: English
• Subjects: Internal Medicine
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2016.09.843

Objectives: The willingness to pay (WTP) threshold accepted by National Institute for Health and Care Excellence (NICE) for the reimbursement of a drug is £20,000-£30,000 per quality adjusted life year (QALY). It is relevant to consider WTP when the new technology offers relative improvements in health at a higher cost, i.e. when the incremental cost-effectiveness ratio (ICER) is placed in the north-east (NE) quadrant of the cost-effectiveness acceptability plane (CEAP) or for losses in health accompanied by cost-savings (south-west [SW] quadrant). The WTP for a gain in health is generally less than the willingness to accept (WTA) a loss in health which implies that the slope of the WTA curve is steeper than in the WTP curve. The objective of this study was to evaluate whether there is evidence that NICE considers a WTA threshold in the SW quadrant that differs from the WTP threshold in the NE quadrant. Methods: NICE technology appraisal (TA) guidance documents published June 2013-June 2016 were reviewed. Appraisal documents presenting results in the SW quadrant by the manufacturer or the Evidence Review Group (ERG) were collected and SW ICERs were extracted. The number of, and opinions related to the SW quadrant results were reviewed and summarised. Results: Manufacturer submitted SW ICERs were found in one base-case and three scenario analyses. The ERG presented SW ICERs as scenario analyses in three TAs and once after correcting errors found in one manufacturer’s model. NICE did not consider SW ICERs of £18,300/QALY and £21,100 to 39,100/QALY to be cost-effective, while £250,000/QALY was considered cost-effective. Conclusions: Evidence of a divergence between the WTP and WTA thresholds used by NICE was not found. The slope of the WTA threshold may be slightly steeper than WTP. Based on available evidence, the NICE WTA threshold may be between £21,100 per QALY and £250,000 per QALY.