The Journal asked researchers from York and Erasmus Universities to critique the paper in which wepresent the new IQWiG methods for setting a maximum reimbursement price for an intervention inGermany, and has also invited us to comment. This is, unfortunately, not likely to be productive as thecritiques simply restate the objections that were made (Institute for Quality and Efficiency in HealthCare (IQWiG), 13 October 2009), and responded to in detail (Institute for Quality and Efficiency inHealth Care (IQWiG), 16 January 2009), during the external review process. Brouwer and Ruttenwould have preferred that, despite all its faults, we had proposed the cost per QALY coupled with anassumed threshold and Sculpher and Claxton wish that the Panel had been given a broad mandate toaddress all extant issues in health economics. Both adhere closely to the belief that a normative priceexists and that cost-effectiveness calculations will reveal it and guide policymakers to decisions thatreflect societal values, respect the budget, identify the necessary trade-offs, and ensure consistency. Thisdespite abundant evidence to the contrary (see, for example: Birch and Gafni, 2006; McGregor, 2003;Nord et al., 1995) and the general failure of HTA agencies to achieve this after more than a decade oftrying. Neither commentary addresses the subject of our paper.The Panel was asked to outline a method for informing the German authorities who have to judgewhether a price demanded for an intervention in a given therapeutic area is reasonable. We maintainthat this was a clear, meaningful, and relevant mandate in the German health policy context and do notfind it fruitful to continue to discuss whether other ambitions would have been more appropriate orwhether the proposed method adheres to undefined ‘international standards’. Although some commonapproaches have developed, each country has its own procedures in accordance with its specific legaland cultural context. It seems self-evident, however, that whatever approach is taken, it is important fordecision makers to know what the existing efficiency is in a therapeutic area: what is being paid andwhat is obtained for that outlay; and that that should be a key input to decisions about price. Whetherthe benefits at that price are worth it to society is an entirely different question – one which remainsunresolved everywhere.
CARO, J.J., NORD, E., MCGUIRE, A., MCGREGOR, D.H., PUYOU DE POUVOURVILLE, G. et ATELLA, V. (2010). IQWiG Methods – A Response to Two Critiques. Health Economics, 19(10), pp. 1137-1138.