Nermina Ferizovic | Health Economics Expert

In a recent blog post introducing the ATMP blog series, I questioned how best to identify value elements, or contributors to value of advanced therapies. Identifying value elements for these transformative treatment options is important as it is a first key step in helping to resolve challenges these therapies have faced in achieving reimbursement. Although there are multiple ways of identifying value elements – and I will discuss these in subsequent blog posts – one way is to conduct an opportunistic thematic analysis of stakeholder responses submitted to NICE as part of reimbursement decision making. And this is exactly what I have done! 

To date, there are 17 published technology assessments (11 single technology appraisals and 6 highly specialised technology appraisals) for advanced therapies. I conducted a thematic analysis of the stakeholder comments which had been submitted for consideration by NICE as part of their decision making. A thematic analysis is a qualitative technique which enables a user to identify key themes in text. It involves reviewing and coding text (coding can be deductive (pre-defined) or inductive (based on findings in the text)) and subsequently categorising the codes into themes. Stakeholders included patients/carers, clinicians, developers, NHS and the public. 

Now, the important part. Based on the review of the stakeholder comments from the technology appraisals, there were fifteen value elements identified which were grouped into three themes: intervention factors, innovation factors and wider factors. 

• Intervention factors describe benefits of the intervention including improved survival, quality of life, one-off treatment, potential for cure, risk, uncertainty, cost, toxicity, and offer of hope. 
• Innovation factors incorporate the innovation provided by the intervention including changes in treatment pathways and provision of an alternative treatment. 
• Wider factors include life transformation, serving unmet needs and equality/equity. 

A key factor making this study possible is that there were no differences between disease areas in identified value elements which is supportive of the feasibility of a standard value assessment framework for these therapies. Value elements by stakeholder were also consistent across appraisals.