Call for new restrictions on UK vaccine prices

New proposals on evaluating the cost effectiveness of vaccines suggest the government should drive a harder bargain on prices.

The government’s Joint Committee on Vaccination and Immunisation (JCVI) makes its decisions on vaccines separately from NICE, which looks at other medicines, and operates a slightly different health economic rating.

It current cost-effectiveness threshold is set at £20,000 per Quality Adjusted Life Year (QALY) but a new report suggests this should be lowered to £15,000 per QALY.

The new recommendations have their roots in the sad case a two-year old girl Faye Burdett, who died of meningitis B in 2016. She had fallen outside the age range to receive immunisation against the infection, and media coverage of her death prompted 820,000 people to sign a petition calling for all children to receive the meningitis B vaccine.

Use of GlaxoSmithKline’s Bexsero meningitis B vaccine is restricted to children aged under six months for cost-effectiveness reasons.

Since 2014 a separate body known as the Cost Effectiveness Methodology for Immunisation Programmes and Procurement (CEMIPP) group has been reviewing how the JCVI makes its decisions, prompted by the controversy around the meningitis B vaccine.

The government has now launched a consultation on the CEMIPP recommendations, which include lowering the threshold below which vaccines, and perhaps all other drugs, are considered good value for money.

If its recommendation of lowering the threshold to £15,000 per QALY is implemented, it will drive down the price the NHS pays for any vaccine – although manufacturers may be able to persuade the JCVI by showing the long-term benefits of vaccination.

The CEMIPP has recommended lowering the discount rate for health impacts from 3.5% per year to 1.5% per year – a lower rate implies that greater weight is given to costs and benefits further into the future.

There is a catch to this too – there will be an indefinite period of time over which impacts of a vaccine are considered, and a ‘sensitivity test’ on the future health impacts of a vaccine in the future.

Lower threshold for medicines too?

And in a section titled “wider implications of CEMIPP's recommendations’, the working group also suggests there may be implications beyond vaccines.

It says the government might also consider stricter thresholds for all drugs going through the conventional NICE assessment process.

Authors wrote: “Implementing the recommendations of the CEMIPP review in such a broad sense would bring all appraisal methodology close in line with (Department of Health and Social Care) practice and likely confer health and economic benefits through improved allocation of resources across the health system.”

While the government has publicly backed pharma and life sciences as an industry key to the UK's growth, it has driven a hard bargain when it comes to drug pricing and has required the NHS to meet tough cost-saving targets.

On top of NICE’s threshold of £30,000 per QALY, the government requires pharma companies to renegotiate on price if a drug costs the NHS more than £20 million in any of its first three years on market.

Nearly every NICE recommendation is now accompanied by a separate price discount negotiated with the Department of Health.

Vinny Smith, chief executive of the Meningitis Research Foundation charity, said: “We are taking time to review the report in full but are concerned that some recommendations would be detrimental to future vaccines and could reduce our chances of preventing serious and fatal illnesses.”

The consultation is open until May and can be read in full here.