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Shah A, Dabbous F, Shah S, Ashton V, Kharat A. Assessment of clinical and economic impact of rivaroxaban plus aspirin vs. aspirin alone as a secondary prophylaxis in patients with chronic and symptomatic peripheral arterial disease in the United States. J Med Econ 2024; 27:10-15. [PMID: 38044632 DOI: 10.1080/13696998.2023.2290386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/29/2023] [Indexed: 12/05/2023]
Abstract
AIM The objective in this study was to assess the clinical and economic implications of the inclusion of rivaroxaban as a secondary prophylaxis in patients with chronic or symptomatic peripheral artery disease (PAD) in the United States (US). METHODS A cost-consequence model was adapted to evaluate the economic impact of rivaroxaban plus aspirin in a hypothetical 1-million-member health plan. The model inputs were taken from multiple sources: efficacy and safety of rivaroxaban + aspirin vs. aspirin alone were abstracted from COMPASS and VOYAGER randomized clinical trials; the prevalence of chronic and symptomatic PAD and incidence rates of clinical events (major adverse cardiac events [MACE], major adverse limb events [MALE], and major bleeding), were abstracted from the analysis of claims data; healthcare costs of clinical events and wholesale acquisition costs for rivaroxaban were abstracted from the literature and Red Book, respectively (2022 USD). One-way sensitivity analyses and subgroup analyses were also conducted. RESULTS Over one year, with a 5% uptake of rivaroxaban, the model estimated rivaroxaban + aspirin to reduce 21 MACE/MALE events in the PAD patient population. The reduction in these clinical events offsets the increased risk of major bleeding (16 additional events), demonstrating a positive health benefit of the rivaroxaban addition. These benefits led to a $0.27 incremental cost per member per month (PMPM) to a US plan. The major driver of the incremental cost was the cost of rivaroxaban. In a subgroup of patients with the presence of any high-risk factor (heart failure, diabetes, renal insufficiency, or history of vascular disease affecting two or more vascular beds), the incremental PMPM cost was $0.13. CONCLUSIONS Rivaroxaban + aspirin was found to provide positive net clinical benefit on the annual number of MACE/MALE avoided, with a modest increase in the PMPM cost.
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Carter JA, Black LK, Deering KL, Jahr JS. Budget Impact and Cost-Effectiveness of Intravenous Meloxicam to Treat Moderate-Severe Postoperative Pain. Adv Ther 2022; 39:3524-3538. [PMID: 35678995 DOI: 10.1007/s12325-022-02174-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/26/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION This study assesses the budget impact and cost-effectiveness of intravenous meloxicam (MIV) to treat moderate-severe acute postoperative pain in adults. METHODS A two-part Markov cohort model captured the pharmacoeconomic impact of MIV versus non-opioid intravenous analgesics (acetaminophen, ibuprofen, ketorolac) among a hypothetical adult cohort undergoing selected inpatient procedures and experiencing moderate-severe acute postoperative pain: Part 1 (postoperative hour 0 to discharge, cycled hourly), health states were defined by pain level. Pain transition rates, adverse event probabilities, and concomitant opioid utilization were derived from a network meta-analysis. Part 2 (discharge to week 52, cycled weekly), health states were defined by the presence/absence of pain-related readmission and opioid use disorder as determined by literature-based inputs relating to pain control outcomes. Healthcare utilization and direct medical costs were derived from an administrative claims database analysis. Primary outcomes were the incremental cost per member per month (PMPM) and cost per quality-adjusted life year (QALY) gained. Scenario, univariate, and probabilistic sensitivity analyses were conducted. The model assumed a private payer perspective in the USA (no discounting, 2019 US$). RESULTS Modeled outcomes indicated MIV was associated with lower accumulated postoperative pain, fewer adverse events, and less opioid utilization for most procedures and comparators, with longer-term outcomes also generally favoring MIV. The budget impact of MIV was - $0.028 PMPM. From a cost-effectiveness perspective, MIV had lower costs and better outcomes for all comparisons except against ketorolac in orthopedic procedures where the former was cost-effective but not cost saving ($95,925/QALY). Scenario and sensitivity analyses indicated that modeled outcomes were robust to alternative inputs and underlying input uncertainty. Differences in direct medical costs were driven by reduced costs attributable to length of stay and opioid-related adverse drug events. CONCLUSION MIV was associated with modeled clinical and economic benefits compared to commonly used non-opioid intravenous analgesics.
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Affiliation(s)
- John A Carter
- Blue Point LLC, 711 Warrenville Road, Wheaton, IL, 60189-0000, USA.
| | | | | | - Jonathan S Jahr
- Professor Emeritus of Anesthesiology, David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, USA
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Demeulemeester R, Savy N, Mounié M, Molinier L, Delpierre C, Dellamonica P, Allavena C, Pugliesse P, Cuzin L, Saint-Pierre P, Costa N. Economic impact of generic antiretrovirals in France for HIV patients' care: a simulation between 2019 and 2023. BMC Health Serv Res 2022; 22:567. [PMID: 35477443 PMCID: PMC9044646 DOI: 10.1186/s12913-022-07859-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background In a context where the economic burden of HIV is increasing as HIV patients now have a close to normal lifespan, the availability of generic antiretrovirals commonly prescribed in 2017 and the imminence of patent expiration are expected to provide substantial savings in the coming years. This article aims to assess the economic impact of these generic antiretrovirals in France and specifically over a five-year period. Methods An agent-based model was developed to simulate patient trajectories and treatment use over a five-year period. By comparing the results of costs for trajectories simulated under different predefined scenarios, a budget impact model can be created and sensitivity analyses performed on several parameters of importance. Results The potential economic savings from 2019 to 2023 generated by generic antiretrovirals range from €309 million when the penetration rate of generics is set at 10% to €1.5 billion at 70%. These savings range from €984 million to €993 million as the delay between patent and generic marketing authorisation varies from 10 to 15 years, and from €965 million to €993 million as the Negotiated Price per Unit (NPU) of generics at market-entry varies from 40 to 50% of the NPU for patents. Discussion This economic savings simulation could help decision makers to anticipate resource allocations for further innovation in antiretrovirals therapies as well as prevention, especially by funding the Pre-Exposure Prophylaxis (PrEP) or HIV screening. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07859-w.
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Affiliation(s)
- Romain Demeulemeester
- University of Toulouse III, 31330, Toulouse, France. .,Health Economics Unit, Medical Information Department, University Hospital of Toulouse, Toulouse, France. .,UMR 1295, National Institute for Health and Medical Research, Toulouse, France. .,Faculté de Médecine, Université Paul Sabatier, INSERM, UMR 1295, 37 allées Jules Guesde, 31000, Toulouse, France.
| | - Nicolas Savy
- University of Toulouse III, 31330, Toulouse, France.,CNRS UMR 5219, Toulouse Mathematics Institute, Toulouse, France
| | - Michaël Mounié
- Health Economics Unit, Medical Information Department, University Hospital of Toulouse, Toulouse, France.,UMR 1295, National Institute for Health and Medical Research, Toulouse, France
| | - Laurent Molinier
- University of Toulouse III, 31330, Toulouse, France.,Health Economics Unit, Medical Information Department, University Hospital of Toulouse, Toulouse, France.,UMR 1295, National Institute for Health and Medical Research, Toulouse, France
| | - Cyrille Delpierre
- University of Toulouse III, 31330, Toulouse, France.,UMR 1295, National Institute for Health and Medical Research, Toulouse, France
| | - Pierre Dellamonica
- Infectious Diseases Department, University of Côte d'Azur, University Hospital of Nice, Nice, France
| | - Clotilde Allavena
- Infectious Diseases Department, University Hospital of Nantes, Nantes, France
| | - Pascal Pugliesse
- Infectious Diseases Department, University of Côte d'Azur, University Hospital of Nice, Nice, France
| | - Lise Cuzin
- UMR 1295, National Institute for Health and Medical Research, Toulouse, France.,Infectious and Tropical Diseases Department, University Hospital of Martinique, Fort-de-France, France
| | - Philippe Saint-Pierre
- University of Toulouse III, 31330, Toulouse, France.,CNRS UMR 5219, Toulouse Mathematics Institute, Toulouse, France
| | - Nadège Costa
- Health Economics Unit, Medical Information Department, University Hospital of Toulouse, Toulouse, France.,UMR 1295, National Institute for Health and Medical Research, Toulouse, France
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Faleiros DR, Nunes da Silva E, Santos AC, Godman BB, Goncalves Pereira R, Guerra Junior AA. Adoption of new therapies in the treatment of Hepatitis: a verification of the accuracy of budget impact analysis to guide investment decisions. Expert Rev Pharmacoecon Outcomes Res 2022; 22:927-939. [PMID: 35320682 DOI: 10.1080/14737167.2022.2057950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES While there are good Budget Impact Analysis (BIA) guidelines, studies still register potential bias. To do this, we compared the results between theoretical and real-world evidence (RWE) expenditures for medicines for Hepatitis C: boceprevir (BOC) and telaprevir (TVR). While both are not currently recommended in treatment guidelines following recent developments, this is an emblematic case because for 4 years these medicines consumed considerable resources. METHODS Theoretical results and RWE expenditures were compared regarding the incorporation of BOC and TVR in 2013-2014 into the Brazilian Public Health System. Theoretical values were extracted from Commission for Technology Incorporation Report and RWE expenditures were extracted from the administrative data records using deterministic-probabilistic linkage. RESULTS The estimated number of patients treated (BOC+TVR) was 13,012 versus 7,641 (real). The estimated purchase price for BOC was US$6.20 versus US$11.07 (real) and for TVR was US$42.21 versus US$84.09 (average/real). The estimated budget impact was US$285.16 million versus US$128.58 million (real). CONCLUSION This study demonstrates appreciable divergence (US$156.58 million) between the theoretical budget impact and RWE expenditures due to underestimated purchase prices and overestimated populations. The greater the degree of accuracy the more reliable and usable BIAs become for decision-making.
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Affiliation(s)
- Daniel Resende Faleiros
- Nucleus Infectious and Parasitic Diseases, Tropical Medicine Centre, University of Brasilia, Brasília, Brazil
| | | | - Andreia C Santos
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Brian B Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates.,Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Ramon Goncalves Pereira
- Faculty of Pharmacy, Federal University of Minas Gerais,Belo Horizonte, Minas Gerais, Brazil
| | - Augusto A Guerra Junior
- Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais. Belo Horizonte, Minas Gerais, Brazil
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Farahbakhshian S, Inocencio TJ, Poorman G, Wright E, Pathak RR, Bullano M. The budget impact of enzyme replacement therapy in type 1 Gaucher disease in the United States. J Med Econ 2022; 25:755-761. [PMID: 35611840 DOI: 10.1080/13696998.2022.2082200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM Gaucher disease (GD) is a rare autosomal recessive condition. Type 1 GD (GD1) is the most prevalent form of GD in Western countries; enzyme replacement therapy (ERT) is a treatment option for patients with GD1. To understand the economic value of the GD1 ERT velaglucerase alfa, a budget impact model (BIM) was developed from a United States (US) payer perspective. METHODS We estimated the budget impact of velaglucerase alfa for a 10-million-member US health plan by comparing the annual total costs of therapy between a scenario using current velaglucerase alfa uptake to a projected scenario with increased velaglucerase alfa uptake. Total drug costs for both scenarios were estimated as the sum of the product of the number of eligible patients on each treatment and the annual per-patient cost of each medication. Average per-patient costs for ERTs were calculated by adding the yearly drug acquisition, drug administration, and site-of-care markup costs. The budget impact was measured over years 1-3. RESULTS An estimated 65 patients would receive velaglucerase alfa treatment in year 1, increasing to 90 patients by year 3. Across analyses, cost savings were realized with velaglucerase alfa compared with imiglucerase ($115,909) and taliglucerase alfa ($80,401). An annual total budget savings of $8.67 million could be realized for a hypothetical 10-million-member US health plan with increased velaglucerase alfa uptake. The per-member per-month costs decreased by $0.0241 across years 1-3. CONCLUSIONS BIM results show that increased velaglucerase alfa uptake for GD1 treatment is cost-saving for US health plans.
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Luo Z, Ruan Z, Yao D, Ung COL, Lai Y, Hu H. Budget Impact Analysis of Diabetes Drugs: A Systematic Literature Review. Front Public Health 2021; 9:765999. [PMID: 34869180 PMCID: PMC8639520 DOI: 10.3389/fpubh.2021.765999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/25/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Budget impact analysis (BIA) is an economic assessment that estimates the financial consequences of adopting a new intervention. BIA is used to make informed reimbursement decisions, as a supplement to cost-effectiveness analyses (CEAs). Objectives: We systematically reviewed BIA studies associated with anti-diabetic drugs and assessed the extent to which international BIA guidelines were followed in these studies. Methods: We conducted a literature search on PubMed, Web of Science, Econlit, Medline, China National Knowledge Infrastructure (CNKI), Wanfang Data knowledge Service platform from database inception to June 30, 2021. ISPOR good practice guidelines were used as a methodological standard for assessing BIAs. We extracted and compared the study characteristics outlined by the ISPOR BIA Task Force to evaluate the guideline compliance of the included BIA. Results: A total of eighteen studies on the BIA for anti-diabetic drugs were identified. More than half studies were from developed countries. Seventeen studies were based on model and one study was based on real-world data. Overall, analysis considered a payer perspective, reported potential budget impacts over 1-5 years. Assumptions were mainly made about target population size, market share uptake of new interventions, and scope of cost. The data used for analysis varied among studies and was rarely justified. Model validation and sensitivity analysis were lacking in the current BIA studies. Rebate analysis was conducted in a few studies to explore the price discount that was required for new interventions to demonstrate cost equivalence to comparators. Conclusion: Existing studies evaluating budget impact for anti-diabetic drugs vary greatly in methodology, some of which showed low compliance to good practice guidelines. In order for the BIA to be useful for assisting in health plan decision-making, it is important for future studies to optimize compliance to national or ISPOR good practice guidelines on BIA. Model validation and sensitivity analysis should also be improved in future BIA studies. Continued improvement of BIA using real-world data is necessary to ensure high-quality analyses and to provide reliable results.
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Affiliation(s)
- Zejun Luo
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR, China
| | - Zhen Ruan
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR, China
| | - Dongning Yao
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR, China.,Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR, China
| | - Yunfeng Lai
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR, China.,School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR, China.,Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR, China
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Chugh Y, De Francesco M, Prinja S. Systematic Literature Review of Guidelines on Budget Impact Analysis for Health Technology Assessment. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:825-838. [PMID: 33956308 DOI: 10.1007/s40258-021-00652-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The objective of this systematic review was to review the recommendations for the conduct of a budget impact analysis in national or organisational guidelines globally. METHODS We searched several databases including MELDINE, EMBASE, The Cochrane Library, National Guideline Clearinghouse, HTA Database (International Network of Agencies for Health Technology Assessment), Econlit and IDEAS Database (RePEc, Research Papers in Economics). The OVID platform was used to run the search in all databases simultaneously. In addition, a search of the grey literature was also conducted. The timeframe was set from 2000 to 2020 with language of publication restricted to English. RESULTS A total of 13 publications were selected. All the countries where financing of health is predominantly tax funded with public provisioning recommend a healthcare payer (government) perspective. However, countries where a healthcare payer includes a mix of federal government, communities, hospital authorities and patient communities recommend a complementary analysis with a wider societal perspective. While four guidelines prefer a simple cost calculator for costing, the rest rely on a decision modelling approach. None of the guidelines recommend discounting except the Polish guidelines, which recommend discounting at 5%. Only two countries, Belgium and Poland, mention that indirect costs, if significant, should be included in addition to direct costs. CONCLUSIONS The comparative cross-country analysis shows that a standard set of recommendations cannot be directly useful for all as there are contextual differences. Thus, budget impact analysis guidelines must be carefully contextualised in the policy environment of a country so as to reflect the dynamics of health systems.
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Affiliation(s)
- Yashika Chugh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Maria De Francesco
- International Decision Support Initiative (iDSI), Imperial College, London, United Kingdom
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
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Biskupiak J, Oderda G, Brixner D, Burgoyne D, Arondekar B, Niyazov A. Payer perceptions on the use of economic models in oncology decision making. J Manag Care Spec Pharm 2021; 27:1560-1567. [PMID: 34714111 PMCID: PMC10390914 DOI: 10.18553/jmcp.2021.27.11.1560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: To support oncology formulary decisions, especially with accelerated regulatory approvals and niche populations, payers desire data beyond what regulators review. Economic models showing financial impact of treatments may help, but data on payers' use of economic models in oncology are limited. OBJECTIVE: To assess payer perceptions regarding use of economic models in informing oncology formulary decisions. METHODS: A multidisciplinary steering committee involving health economists and payers developed a survey containing singleanswer, multiple-answer, and free-response questions. The pilot survey was tested at a mini-advisory board with 5 US payers and revised based on feedback. In February 2020, the survey was distributed to 221 US payers through the AMCP Market Insights program and 10 additional payer panelists, who were invited to discuss survey results. Results were presented primarily as frequencies of responses and evaluated by plan size, type of health plan, and geography (regional vs national). Differences in categorical data responses were compared using Pearson chi-square or Fisher's exact tests. Two-tailed values were reported and an alpha level of 0.05 or less was used to indicate statistical significance. RESULTS: Overall, 106 of 231 payers completed the survey (45.9%); 45.5% represented small plans (< 1 million lives), and 54.5% represented large plans (≥ 1 million lives). Respondents were largely pharmacists (89.9%), and 55.6% indicated that their job was pharmacy administrator. Payers indicated moderate/most interest in cost-effectiveness models (CEMs; 85.3%) and budget impact models (BIMs; 80.4%). Overall, 51.6% of respondents claimed oncology expertise on their pharmacy and therapeutics committees. Large plans were more likely to have expertise in reviewing oncology economic models than small plans (55.6% vs 31.1%, P = 0.015). The most common reasons for not reviewing economic models included "not available at time of review" (44.1%) and "potential bias" (38.2%). Overall, 43.1% of payers conduct analyses using their own data after reviewing a manufacturer-sponsored economic model. To inform formulary decisions, 62.7% of payers use BIMs and 66.7% use CEMs sometimes, often, or always. When comparing therapies with similar safety/efficacy profiles, 68.6% of payers reported economic models as helpful a moderate amount, a lot, or a great deal. Over one-third of payers (37.3%) were willing to partner with manufacturers on economic models using their plans' data. Payers valued preapproval information, data on total cost of care, and early access to models. Concerns remained regarding model transparency and assumptions. CONCLUSIONS: Most US payers reported interest in using economic models to inform oncology formulary decision making. Opportunities exist to educate payers in assessing economic models, especially among small health plans. Ensuring model availability at launch, transparency in model assumptions, and payer-manufacturer partnership in model development may increase the utility of oncology economic models among US payers. DISCLOSURES: Pfizer provided funding for this research, and Pfizer employees led the development of the survey instrument, were involved in the analysis and interpretation of the data, and contributed to the manuscript as authors. Arondekar and Niyazov are employed by Pfizer. Biskupiak, Oderda, and Brixner are managers of Millcreek Outcomes Group and were paid as consultants on this project. Burgoyne was a consultant for Pfizer on this project.
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Affiliation(s)
| | - Gary Oderda
- College of Pharmacy, University of Utah, Salt Lake City
| | - Diana Brixner
- College of Pharmacy, University of Utah, Salt Lake City
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Kossmeier M, Themanns M, Hatapoglu L, Kogler B, Keuerleber S, Lichtenecker J, Sauermann R, Bucsics A, Freissmuth M, Zebedin-Brandl E. Assessing the Accuracy of Sales Forecasts Submitted by Pharmaceutical Companies Applying for Reimbursement in Austria. Front Pharmacol 2021; 12:726758. [PMID: 34483937 PMCID: PMC8414520 DOI: 10.3389/fphar.2021.726758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/30/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives: Reimbursement decisions on new medicines require an assessment of their value. In Austria, when applying for reimbursement of new medicines, pharmaceutical companies are also obliged to submit forecasts of future sales. We systematically examined the accuracy of these pharmaceutical sales forecasts and hence the usefulness of these forecasts for reimbursement evaluations. Methods: We retrospectively analyzed reimbursement applications of 102 new drugs submitted between 2005 and 2014, which were accepted for reimbursement outside of hospitals, and for which actual reimbursed sales were available for at least 3 years. The main outcome variable was the accuracy ratio, defined as the ratio of forecasted sales submitted by pharmaceutical companies when applying for reimbursement to actual sales from reimbursement data. Results: The median accuracy ratio [95% confidence interval] was 1.33 [1.03; 1.74, range 0.15–37.5], corresponding to a median overestimation of actual sales by 33%. Forecasts of actual sales for 55.9% of all examined products either overestimated actual sales by more than 100% or underestimated them by more than 50%. The accuracy of sales forecasts did not show systematic change over the analyzed decade nor was it discernibly influenced by reimbursement status (restricted or unrestricted), the degree of therapeutic benefit, or the therapeutic area of the pharmaceutical product. Sales forecasts of drugs with a higher degree of innovation and those within a dynamic market tended to be slightly more accurate. Conclusions: The majority of sales forecasts provided by applicants for reimbursement evaluations in Austria were highly inaccurate and were on average too optimistic. This is in line with published results for other jurisdictions and highlights the need for caution when using such forecasts for reimbursement procedures.
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Affiliation(s)
| | | | | | | | | | | | | | - Anna Bucsics
- MoCA (Mechanism of Coordinated Access to Orphan Medicinal Products), Brussels, Belgium
| | - Michael Freissmuth
- Institute of Pharmacology, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Eva Zebedin-Brandl
- Institute of Pharmacology, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
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Ndikumukiza C, Yunusa I, Nkurunziza J, Chinaeke E, Alshammari FH, Abahuje E, Alsahali S. Adoption of RTS, S malaria vaccine for children younger than 5 years in Rwanda: A budget impact analysis. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 3:100063. [PMID: 35480603 PMCID: PMC9031682 DOI: 10.1016/j.rcsop.2021.100063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 08/07/2021] [Accepted: 08/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background In Rwanda, malaria affects one in six children under five years old. Despite being preventable and treatable, malaria causes substantial morbidity, mortality, and economic burden on the Rwandan government and healthcare donors. Recently, the World Health Organization (WHO) agreed to consider the new malaria vaccine (RTS, S) as an additional prevention strategy. The Global Fund, a healthcare donor, is committed to donating more than fifty million US dollars over four years (2018–2021) to fight malaria in Rwanda. We estimated the potential budget impact of the adoption of RTS, S, into the Global Fund budget (as a case study) for malaria prevention in Rwanda. Methods We developed a static budget impact model based on clinical, epidemiological, and cost (in US dollars) data from the literature, to assess the financial consequences of adding RTS, S to existing prevention strategies. Cost of treatment and prevention for the first year (without vaccine) was estimated and compared to the total cost after the fifth year (with vaccine). A one-way sensitivity analysis evaluated the robustness of the model. Results For the 283,931children under 5 years at risk of malaria in Rwanda every year, the expected budget for first year (without vaccine) was $1,328,377.71 and for the fifth year (with vaccine) was $3,837,804, yielding a potential budget impact of $2,509,427. The cost of treating un-prevented malaria for the first year was $736,959 and for the fifth year was $61,413. The annual number of malaria treatments avoided increased from 10,095 children in the first year after introduction of vaccine to 36,701 children at the fifth year. Conclusion With a potential budget impact of $2,509,427, the introduction of malaria vaccine for children under 5 years by Global Fund in Rwanda may be affordable when compared to the amount spent on treating children with malaria. Given that Malaria causes more harm than most parasitic diseases and disproportionally affects low-income populations, it is ethical to deploy all measures to control or eliminate Malaria, including vaccination.
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da Silva WC, Godman B, de Assis Acúrcio F, Cherchiglia ML, Martin A, Maruszczyk K, Izidoro JB, Portella MA, Lana AP, Campos Neto OH, Andrade EIG. The Budget Impact of Monoclonal Antibodies Used to Treat Metastatic Colorectal Cancer in Minas Gerais, Brazil. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:557-577. [PMID: 33506317 DOI: 10.1007/s40258-020-00626-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Biological medicines have increased the cost of cancer treatments, which also raises concerns about sustainability. In Brazil, three monoclonal antibodies (mAbs)-bevacizumab, cetuximab, and panitumumab-are indicated for the treatment of metastatic colorectal cancer (mCRC) but not currently funded by the Unified Health System (SUS). However, successful litigation has led to funding in some cases. OBJECTIVE Our objective was to evaluate the budgetary impact of including the mAbs bevacizumab, cetuximab, and panitumumab in standard chemotherapy for the treatment of mCRC within the SUS of Minas Gerais (MG), Brazil. METHOD A budget impact analysis of incorporating mAbs as first-line treatment of mCRC in MG was explored. The perspective taken was that of the Brazilian SUS, and a 5-year time horizon was applied. Data were collected from lawsuits undertaken between January 2009 and December 2016, and the model was populated with data from national databases and published sources. Costs are expressed in $US. RESULTS In total, 351 lawsuits resulted in funding for first-line treatment with mAbs for mCRC. The three alternative scenarios analyzed resulted in cost increases of 348-395% compared with the reference scenario. The use of panitumumab had a budgetary impact of $US103,360,980 compared with the reference scenario over a 5-year time horizon, and bevacizumab and cetuximab had budgetary impacts of $US111,334,890 and 113,772,870, respectively. The use of the anti-epidermal growth factor receptor (EGFR) mAbs (cetuximab and panitumumab) is restricted to the approximately 41% of patients with KRAS mutations, so the best cost alternative for incorporation would be the combination of panitumumab and bevacizumab, with a cost of approximately $US106 million. CONCLUSION These results highlight the appreciable costs for incorporating bevacizumab, cetuximab, and panitumumab into the SUS. Appreciable discounts are likely to be necessary before incorporation of these mAbs is approved.
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Affiliation(s)
- Wânia Cristina da Silva
- Postgraduate Program in Medicines and Pharmaceutical Services, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Francisco de Assis Acúrcio
- Postgraduate Program in Medicines and Pharmaceutical Services, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Postgraduate Program in Public Health, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Mariângela Leal Cherchiglia
- Postgraduate Program in Medicines and Pharmaceutical Services, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Postgraduate Program in Public Health, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Antony Martin
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
| | | | - Jans Bastos Izidoro
- Divisão de Medicamentos Essenciais, Departamento de Assistência Farmacêutica, Secretaria de Estado de Saúde de Minas Gerais, Belo Horizonte, Brazil
| | | | - Agner Pereira Lana
- Postgraduate Program in Public Health, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Eli Iola Gurgel Andrade
- Postgraduate Program in Medicines and Pharmaceutical Services, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Postgraduate Program in Public Health, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
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12
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Faleiros DR, Alvares-Teodoro J, Nunes da Silva E, Godman BB, Gonçalves Pereira R, Gurgel Andrade EI, de Assis Acurcio FA, Guerra Júnior AA. Budget impact analysis of medicines: estimated values versus real-world evidence and the implications. Expert Rev Pharmacoecon Outcomes Res 2021; 22:271-281. [PMID: 33971778 DOI: 10.1080/14737167.2021.1927716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objectives: Budget Impact Analyses (BIA) of medicines helps managers in promoting health systems' sustainability when assessing the role and value of new medicines. However, it is not clear whether BIAs typically underestimate or overestimate the impact on real-world budgets. This retroactive analysis seeks to compare estimated values obtained by a BIA and Real-World Evidence (RWE) to guide discussions.Methods: The estimated values were obtained through a BIA concerning the incorporation of adalimumab for the treatment of Rheumatoid Arthritis into the Brazilian Unified Health System (SUS) carried out retroactively and per international guidelines. RWE data was extracted from SUS computerized systems. We subsequently compared the number of treatments, costs, and Incremental Budget Impact (IBI).Results - The total number of treatments was underestimated by 10% (6,243) and the total expenditure was overestimated by 463% (US$ 4.7 billion). In five years, the total difference between the estimated values and real IBI reached US$ 1.1 billion. A current expenditure of US$ 1.0 was observed for every US$ 5.60 of estimated expenditure.Conclusion - The higher estimates from the BIA might cause decision makers to be more cautious with the introduction of a new medicine to reduce the opportunity costs for other interventions.
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Affiliation(s)
| | | | | | - Brian B Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | | | | | - Francisco A de Assis Acurcio
- Faculty of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil.,Faculty of Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil
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Abdallah K, Huys I, Claes K, Simoens S. Methodological Quality Assessment of Budget Impact Analyses for Orphan Drugs: A Systematic Review. Front Pharmacol 2021; 12:630949. [PMID: 33967766 PMCID: PMC8098807 DOI: 10.3389/fphar.2021.630949] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/25/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: This research aims to evaluate the methodological quality of budget impact analyses for orphan drugs and to provide suggestions for future analyses. Methods: Conference abstracts and peer-reviewed literature on budget impact analyses were collected through searches of Pubmed and Embase. ISPOR good practice guidelines were used as a methodological standard for budget impact analyses. Examined parameters encompassed: perspective, target population, data sources, intervention and comparator(s), time horizon, scope of costs, discounting, validation, assumptions and sensitivity analysis. Results: Seventy studies on individual orphan drugs and 21 studies on a combination of orphan drugs analyzing budget impact were identified. Overall, analyses considered a third-party payer perspective, reported periodic budget impacts over a one-to-five-year time horizon, and did not apply discounting. A dynamically fluctuating population and costs beyond drug costs were accounted for in 18.7% and 51.7% of studies, respectively. Input data were retrieved from published literature, clinical trials, registries, claims databases, expert opinions, historical data and market research. Assumptions were mostly made about population size and intervention/comparator(s) market uptake, but these assumptions were rarely justified and their impact was insufficiently explored through sensitivity analyses. Budget impact results were rarely validated. Conclusion: Existing budget impact analyses for orphan drugs are concise, vary greatly and are of substandard methodological quality. To eliminate possible bias in future budget impact analyses, future studies should adhere to national or ISPOR good practice guidelines on budget impact analysis.
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Affiliation(s)
- Khadidja Abdallah
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Kathleen Claes
- Department of Microbiology, Immunology and Transplantation, UZ Leuven, Leuven, Belgium
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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Roberts MH, Ferguson GT. Real-World Evidence: Bridging Gaps in Evidence to Guide Payer Decisions. PHARMACOECONOMICS - OPEN 2021; 5:3-11. [PMID: 32557235 PMCID: PMC7895868 DOI: 10.1007/s41669-020-00221-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Randomized controlled trials (RCTs) are preferred by payers for health technology assessments and coverage decisions. However, the inclusion of a highly selective patient population and the rigorously controlled conditions in RCTs may not be reflective of real-world clinical practice. Real-world evidence (RWE) obtained from an analysis of real-world data (RWD) from observational studies can bridge gaps in evidence not addressed by RCTs and is thus valuable to public and private payers for decision-making. Through a broad literature search to obtain insights into payers' experience, we found that payers have concerns about real-world studies with respect to data quality, poor internal validity, potential bias, and lack of meaningful endpoints. However, they valued RWE to fill evidence gaps not addressed by RCTs, such as high-quality, real-world, long-term effectiveness and safety data; head-to-head drug comparisons; cost analyses for tiering formulary placement; medication use and adherence patterns; identification of relevant responder and non-responder patient subpopulations; and patient-reported outcomes (PROs). RWE can be used to assess clinically meaningful endpoints and gauge the impact of interventions on the quality of healthcare. Here, we review how payers use or can use RWD on the comparative effectiveness and safety of treatments, PROs, medication adherence and persistence, prescribing patterns, healthcare resource utilization, and patient characteristics and/or biomarkers associated with treatment response when making health technology assessments and payer coverage decisions across therapeutic areas.
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Affiliation(s)
- Melissa H Roberts
- Department of Pharmacy Practice and Administrative Sciences, MSC09 5360, The University of New Mexico College of Pharmacy, University of New Mexico, Albuquerque, NM, 87131, USA.
| | - Gary T Ferguson
- Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI, 48336, USA
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15
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Michaeli T, Michaeli D. Prostate cancer follow-up costs in Germany from 2000 to 2015. J Cancer Surviv 2021; 16:86-94. [PMID: 33646503 PMCID: PMC8881276 DOI: 10.1007/s11764-021-01006-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/12/2021] [Indexed: 12/30/2022]
Abstract
Purpose The main objective of this study is to estimate and evaluate 10-year follow-up costs after prostate cancer treatment with curative (surgery, radiotherapy) and non-curative intent (hormone, androgen deprivation) per patient in Germany in 2000, 2008, and 2015. Methods Prostate cancer follow-up recommendations were extracted from the European Association of Urology guidelines from 2000 to 2015. Per patient costs were calculated with a detailed micro-costing approach considering direct and indirect medical expenses. Input parameters were derived from expert interviews, literature research, and official scales of tariffs. Costs for insurers, providers, and payers were included to estimate societal costs. Results Mean 10-year follow-up costs per patient after treatment with curative intent amounted to EUR 4415 in 2000, EUR 4224 in 2008 (p < 0.001), and EUR 5159 in 2015 (p < 0.001). Costs after hormone therapy with metastasis cumulated to EUR 10,846 in 2000, EUR 9818 in 2008 (p < 0.001), and EUR 11,978 in 2015 (p < 0.001). While insurers covered 37% of costs in 2000 (EUR 1664), only 23% of costs were reimbursed in 2015 (EUR 1195; p < 0.001). Cost sources mainly included consultations (55%), transportation (18%), and imaging (27%). Conclusion Early detection and advances in prostate cancer treatment increased 10-year survival rates beyond 80% in Germany, ultimately expanding the number of survivors requiring follow-up. Statutory insurers reacted by decreasing the reimbursement rates to reduce per patient cost by up to 46%. Consequently, the economic burden was mainly shifted to payers and providers. Implications for Cancer Survivors Equitable and effective follow-up schedules covered by insurance funds are necessary to care for prostate cancer patients.
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Affiliation(s)
- Thomas Michaeli
- Fifth Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Michaeli
- Fifth Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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16
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Stargardter M, McBride A, Tosh J, Sachdev R, Yang M, Ambavane A, Mittal M, Vioix H, Liu FX. Budget impact of tepotinib in the treatment of adult patients with metastatic non-small cell lung cancer harboring METex14 skipping alterations in the United States. J Med Econ 2021; 24:816-827. [PMID: 34126842 DOI: 10.1080/13696998.2021.1942017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIMS To estimate the budget impact of adding tepotinib to United States (US) health plans for treating adult patients with metastatic non-small cell lung cancer (mNSCLC) harboring mesenchymal-epithelial transition exon 14 (METex14) skipping alterations. METHODS The base-case analysis was conducted from the perspective of a hypothetical Medicare plan of 1 million members. Scenarios were analysed for other US health plans. Treatments included tepotinib, capmatinib, crizotinib, and standard of care (SoC). Patients eligible for tepotinib were estimated from published epidemiological data and literature, and real-world evidence. Clinical inputs were derived from the phase II VISION trial, US prescribing information, and published literature. Tepotinib uptake and projected testing rates for METex14 skipping alterations were based on market research. Unit costs (2020 US dollars (USD)) and resource utilization associated with drug acquisition and administration, treatment monitoring, disease and adverse event (AE) management, and subsequent treatment were derived primarily from public sources. RESULTS In the base-case, 38-65 patients were eligible for tepotinib each year over the three-year time horizon. The cumulative net budgetary impact of tepotinib was -$692,541 (-2.6%); $26,531,670 in the scenario without tepotinib and $25,839,129 in the scenario with tepotinib. A negligible net budget impact was observed per member per month (PMPM) at $0.2457 and $0.2393, respectively, before and after tepotinib's introduction. Results were most sensitive to variability in unit costs of capmatinib and tepotinib and their corresponding median treatment durations. Sensitivity and scenario analyses support the conclusion that introducing tepotinib will have minimal budgetary impact for Medicare health plans. Similar results were obtained for other US health plans. LIMITATIONS Assumptions and expert opinion were applied to address data gaps in key model inputs. CONCLUSIONS The estimated budgetary impact of tepotinib for the treatment of adult patients with mNSCLC harboring METex14 skipping alterations is minimal from the perspective of US health plans.
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Affiliation(s)
| | - Ali McBride
- The University of Arizona College of Pharmacy - Tucson, Tucson, AZ, USA
| | - Jon Tosh
- Evidera, Evidence Synthesis, Modeling, & Communication, London, UK
| | - Rameet Sachdev
- Evidera, Evidence Synthesis, Modeling, & Communication, Bethesda, MD, USA
| | - Mo Yang
- EMD Serono, Rockland, MA, USA
| | - Apoorva Ambavane
- Evidera, Evidence Synthesis, Modeling, & Communication, Bethesda, MD, USA
| | - Madhav Mittal
- Evidera, Evidence Synthesis, Modeling, & Communication, Bethesda, MD, USA
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Han L, Zhang X, Fu WQ, Sun CY, Zhao XM, Zhou LR, Liu GX. A systematic review of the budget impact analyses for antitumor drugs of lung cancer. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2020; 18:55. [PMID: 33292288 PMCID: PMC7706257 DOI: 10.1186/s12962-020-00253-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/24/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Budget impact analyses (BIAs) are used for reimbursement decisions and drug access medical insurance, as a supplement to cost-effectiveness analyses (CEAs). OBJECTIVES We systematically reviewed BIAs for antitumor drugs of lung cancer to provide reference for high-value drug budget impact analyses and decision making. METHODS We conducted a literature search on PubMed, EMbase, The Cochrane Library, China National Knowledge Infrastructure and Wanfang Data Knowledge Service Platform from 2010 to 2019. The methodological indicators and result information of the budget impact analyses were extracted and evaluated for quality. RESULTS A total of 14 studies on the budget impact for antitumor drugs of lung cancer were included, and the overall quality was good. Half of studies were from developed countries. Nine of the studies were designed using the BIA cost calculation model, and two were simulated using the Markov model Monte Carlo model. From all studies, only 14.3% reported model validation. The budget impact results of the same drug in different countries were inconsistent. CONCLUSIONS Included studies evaluating budget impact analyses for anti-tumor drugs of lung cancer showed variability in the methodological framework for BIAs. The budget impact analyses of high-value drugs need to be more stringent to ensure the accuracy of the parameters, and should provide reliable results based on real data to decision-making departments, which should carefully consider access to lung cancer drugs.
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Affiliation(s)
- Lu Han
- School of Health Management/Public Health, Harbin Medical University, Harbin, 150081, China
| | - Xin Zhang
- School of Health Management/Public Health, Harbin Medical University, Harbin, 150081, China
| | - Wen-Qi Fu
- School of Health Management/Public Health, Harbin Medical University, Harbin, 150081, China
| | - Cheng-Yao Sun
- School of Health Management/Public Health, Harbin Medical University, Harbin, 150081, China
| | - Xian-Ming Zhao
- Tumor Radiotherapy Center, Harbin the First Hospital, Harbin, 150010, China
| | - Liang-Ru Zhou
- School of Health Management/Public Health, Harbin Medical University, Harbin, 150081, China
| | - Guo-Xiang Liu
- School of Health Management/Public Health, Harbin Medical University, Harbin, 150081, China.
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Patterson BJ, Herring WL, Van Oorschot D, Curran D, Carrico J, Zhang Y, Ackerson BK, Bruxvoort K, Sy LS, Tseng HF. Incremental clinical and economic impact of recombinant zoster vaccination: real-world data in a budget impact model. J Manag Care Spec Pharm 2020; 26:1567-1575. [PMID: 33043821 PMCID: PMC10391059 DOI: 10.18553/jmcp.2020.20251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In 2017, the FDA approved the adjuvanted recombinant zoster vaccine (RZV) for the prevention of herpes zoster (HZ) in immunocompetent adults aged 50 years and older. RZV joined zoster vaccine live (ZVL) as U.S.-marketed vaccines against HZ. The Advisory Committee on Immunization Practices preferentially recommended use of RZV over ZVL. In order to inform population-based decision makers (PBDMs) about the incremental clinical and economic impact of RZV adoption, budget impact (BI) models may be used. Populating such models with national data can inform PBDMs about the incremental value of RZV adoption nationally; however, heterogeneity across health plans requires the inclusion of plan-specific data to ensure the relevance of modeling outcomes for plan-specific decision makers. OBJECTIVE To investigate the clinical and economic outcomes associated with the adoption of RZV in nationally representative populations with commercial and Medicare coverage and to demonstrate the effect of the heterogeneity of health plans using real-world data from a large, integrated delivery network (IDN). METHODS We used a publicly available BI model. The model accounts for national and IDN-collected population characteristics (size, age distribution) and epidemiological data (incidence of HZ and complications, HZ recurrence rate), vaccine characteristics from randomized controlled trials and observational studies (efficacy, waning, second dose compliance for RZV, adverse event rate), national costs (vaccine, direct medical for HZ, complications, and vaccine adverse events), and current and anticipated vaccine coverage. We assessed incremental clinical (HZ cases and complications) and economic (per-member-per-month [PMPM] costs) impact at 5-year to 15-year time horizons, comparing scenarios where RZV is solely implemented with one where only ZVL is utilized. RESULTS Following the adoption of RZV, the incremental HZ cases avoided over 5 and 15 years were estimated to be 1,800 and 15,000 for a commercial plan, 3,800 and 21,000 for a Medicare plan, and 8,600 and 71,000 for a specific IDN. The incremental PMPM budget impact over the same time horizons was estimated to be $0.42 and $0.31, respectively, for a commercial plan, $0.35 and $0.10 for a Medicare plan, and $0.39 and $0.25 for a specific IDN. The differences in results across plans resulted from the population age distribution, the vaccine copay (applied in the Medicare scenario only), the vaccine coverage in the plan, and other plan-specific factors affecting disease epidemiology and costs per case of HZ. CONCLUSIONS Model projections indicated that RZV adoption avoided HZ cases and related complications, with the PMPM budget impact dependent on plan-specific factors. As health gains increased over time, the incremental costs incurred were found to decrease as the shorter-term costs of adopting the new vaccine were increasingly offset by the longer-term benefits of vaccination. DISCLOSURES GlaxoSmithKline Biologicals SA funded this study (GSK study identifier: HO-17-18378) and was involved in all stages of study conduct, including analysis of the data. GlaxoSmithKline Biologicals SA also paid all costs associated with the development and publication of this manuscript. Patterson, Van Oorschot, and Curran are employees of the GSK group of companies and hold shares in the GSK group of companies. Herring, Carrico, and Zhang are employees of RTI Health Solutions, which received funding via a contractual agreement with the GSK group of companies to perform the work contributing to this research. Ackerson, Bruxvoort, Sy, and Tseng are employees of Kaiser Permanente Southern California, which was contracted by the GSK group of companies for the conduct of this study and were members of the KPSC study team. Ackerson, Bruxvoort, Sy, and Tseng report research contracts with the following pharmaceutical companies unrelated to this study: Dynavax (Ackerson, Bruxvoort, and Sy); the GSK group of companies (Ackerson, Bruxvoort, Sy, and Tseng); Novavax (Ackerson, Sy, and Tseng); and Seqirus (Ackerson, Bruxvoort, Sy, and Tseng). Tseng reports having served as a paid consultant for the GSK group of companies. The authors declare no other financial and nonfinancial relationships and activities. Findings from this study were presented at AMCP Nexus 2019; October 29-November 1, 2019; National Harbor, MD.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lina S Sy
- Kaiser Permanente Southern California, Pasadena
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Stakeholders' feedback on the proposed recommendations for updating the patented medicine prices review board (pmprb) budget impact analysis guidelines. JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY 2020; 27:e1-e24. [PMID: 31922700 DOI: 10.15586/jptcp.v27i1.651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/11/2019] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The present study aimed to obtain Canadian stakeholders' feedback on a list of proposed recommendations for updating the Patented Medicine Prices Review Board (PMPRB)'s 2007 budget impact analysis (BIA) guidelines. METHODS A mixed-methods study was designed to obtain feedback from two stakeholder perspectives-(public and private) payers and manufacturers-on the proposed BIA recommendations. We obtained policymakers' opinion through one-on-one interviews and collected feedback from manufacturers and their consultants using a survey. The interview guide and the survey were developed based on the list of recommendations related to BIA key elements, which were either not discussed or addressed differently in the PMPRB 2007 BIA guidelines. The list was derived from 16 Canadian or other national and transnational BIA guidelines. A thematic analysis was applied for analysis of the qualitative (interview) data. RESULTS Thirty-five policymakers and manufacturers participated in the study. Stakeholders supported the inclusion of 56% of the proposed recommendations into the guidelines pertaining to the use of expert opinions, data extrapolated from the payers' database, scenario analysis, and dynamic population. Inclusion of indirect costs, and cost transfers from other jurisdictions, were not approved. There was no consensus regarding the inclusion of patients' adherence/compliance and cost offsets. CONCLUSIONS The present study has provided sufficient insights to enable the creation of a penultimate version for updating the PMPRB BIA guidelines. This penultimate version will be subject to a broader consultation among stakeholders prior to a final revision and approval. Further Canadian stakeholder feedback is required for reaching consensus on inconclusive recommendations.
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Castañeda-Orjuela C, García-Molina M, De la Hoz-Restrepo F. Is There Something Else Beyond Cost-Effectiveness Analysis for Public Health Decision Making? Value Health Reg Issues 2019; 23:1-5. [PMID: 31881441 DOI: 10.1016/j.vhri.2019.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 08/13/2019] [Accepted: 09/09/2019] [Indexed: 10/25/2022]
Abstract
Healthcare costs are a concern for the sustainability of health systems in both rich and poor countries. Achieving a balance between the aspirations of payers and the manufacturers of new technologies is a challenge for democratic societies. Evidence about the efficacy and effectiveness of a new intervention is a fundamental aspect for its inclusion, but additional information about organization, implementation, and feasibility is required. Economic evaluations, especially cost-effectiveness analyses (CEA), help inform the choice of a particular health intervention, but they are not the only input for decision making (DM). Use of CEA is relatively recent but has quickly become widespread. CEA techniques have evolved into increasingly complex and sophisticated methods intended to reflect reality closely but, at the same time, their results have become more difficult to verify and validate. In developed countries, CEA results have generated intense debates, but in developing countries, these reflections are still weak due to lack of technical capacity. Competing perspectives on CEAs exist and can heavily influence the DM process. The use of CEAs and the interpretation of their results requires critical analysis, especially when public funds are to be invested. Here, we present a perspective on the use of CEAs for DM that arises from our experience of its use in developing countries and requires the consideration of other rationalities, in addition to the economic one, for DM.
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Affiliation(s)
- Carlos Castañeda-Orjuela
- Epidemiology and Public Health Evaluation Group, Public Health Department, Universidad Nacional de Colombia, Bogotá, Colombia; Colombian National Health Observatory, Instituto Nacional de Salud, Bogotá, Colombia.
| | | | - Fernando De la Hoz-Restrepo
- Epidemiology and Public Health Evaluation Group, Public Health Department, Universidad Nacional de Colombia, Bogotá, Colombia
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Graham J, Wolfson LJ, Kyle J, Bolde-Villarreal CP, Guarneros-DeRegil DB, Monsanto H, Pillsbury M, Talbird S, Daniels VJ. Budget impact analysis of multiple varicella vaccination strategies: a Mexico perspective. Hum Vaccin Immunother 2019; 16:886-894. [PMID: 31567045 PMCID: PMC7227656 DOI: 10.1080/21645515.2019.1672491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
A number of live-attenuated varicella vaccines are produced globally that provide protection against the varicella zoster virus. In Mexico, varicella vaccination is not included in the national immunization program and is recommended for use only in high-risk subgroups. We developed a budget impact model to estimate the impact of universal childhood immunization against varicella on the national payer system in Mexico. A scenario of no varicella vaccination was compared to scenarios with vaccination with a single dose at 13 months of age, in alignment with the existing program of immunization with the measles-mumps-rubella vaccine. Nine different vaccination scenarios were envisioned, differing by vaccine type and by coverage. Varicella cases and treatment costs of each scenario were computed in a dynamic transmission model of varicella epidemiology, calibrated to the population of Mexico. Unit costs were based on Mexico sources or were from the literature. The results indicated that each of the three vaccine types increased vaccine acquisition and administration expenditures but produced overall cost savings in each of the first 10 years of the program, due to fewer cases and reduced varicella treatment costs. A highly effective vaccine at 95% coverage produced the greatest cost savings.
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Affiliation(s)
- Jonathan Graham
- Health Economics, Research Triangle Park, RTI Health Solutions, NC, USA
| | - Lara J Wolfson
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc, Kenilworth, NJ, USA
| | - Jeffrey Kyle
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc, Kenilworth, NJ, USA
| | | | | | | | - Matthew Pillsbury
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc, Kenilworth, NJ, USA
| | - Sandra Talbird
- Health Economics, Research Triangle Park, RTI Health Solutions, NC, USA
| | - Vincent J Daniels
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc, Kenilworth, NJ, USA
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Pandolfino J, Lipham J, Chawla A, Ferko N, Hogan A, Qadeer RA. A budget impact analysis of a magnetic sphincter augmentation device for the treatment of medication-refractory mechanical gastroesophageal reflux disease: a United States payer perspective. Surg Endosc 2019; 34:1561-1572. [PMID: 31559575 DOI: 10.1007/s00464-019-06916-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/12/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Medication-refractory gastroesophageal reflux disease (GERD) is sometimes treated with laparoscopic Nissen fundoplication (LNF); however, this is a non-reversible procedure associated with important side effects and the need for repeat surgery. Removable magnetic sphincter augmentation (MSA) devices are an alternative, effective, and safe treatment option for such patients who have some lower esophageal sphincter function. The objective of this study was to assess the economic impact of introducing MSA technology (i.e., LINX Reflux Management System) into current practice from a US-payer perspective. METHODS An economic budget impact model was developed over a 1-year time horizon that compared current treatment of GERD patients who are medically managed (but refractory) or receiving LNF to future treatment of GERD patients that included a mix of patients treated with medical management only, LNF, or MSA. Resources included within the analyses were index procedures (inpatient and outpatient use), reoperations (revisions and removals), readmissions, healthcare visits, diagnostic tests, procedures, and medications. Medicare payment rates were typically used to inform unit costs. RESULTS Assuming a hypothetical commercial insurance population of 1 million members, the base-case analysis estimated a net cost savings of $111,367 with introduction of the MSA. This translates to a savings of $0.01 per member per month. Results were largely driven by avoided inpatient procedures with use of the MSA device. Alternative analyses exploring the potential impact of increasing surgical volumes predicted that results would remain cost saving if the proportion of MSA market share taken from LNF was ≥ 90%. CONCLUSIONS This study predicts that the introduction of the MSA device would lead to favorable budget impact results for the treatment of medication-refractory mechanical GERD for commercial payers. Future analyses will benefit from inclusion of middle-ground treatments as well as longer time horizons.
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Affiliation(s)
- John Pandolfino
- Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Chicago, IL, 60611, USA.
| | - John Lipham
- Department of Surgery, Keck Medical Center of USC, University of Southern California, Los Angeles, CA, USA
| | | | - Nicole Ferko
- Cornerstone Research Group Inc, Burlington, ON, Canada
| | - Andrew Hogan
- Cornerstone Research Group Inc, Burlington, ON, Canada
| | - Rana A Qadeer
- Cornerstone Research Group Inc, Burlington, ON, Canada
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Jahn B, Todorovic J, Bundo M, Sroczynski G, Conrads-Frank A, Rochau U, Endel G, Wilbacher I, Malbaski N, Popper N, Chhatwal J, Greenberg D, Mauskopf J, Siebert U. Budget Impact Analysis of Cancer Screening: A Methodological Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:493-511. [PMID: 31016686 DOI: 10.1007/s40258-019-00475-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Budget impact analyses (BIAs) describe changes in intervention- and disease-related costs of new technologies. Evidence on the quality of BIAs for cancer screening is lacking. OBJECTIVES We systematically reviewed the literature and methods to assess how closely BIA guidelines are followed when BIAs are performed for cancer-screening programs. DATA SOURCES Systematic searches were conducted in MEDLINE, EMBASE, EconLit, CRD (Centre for Reviews and Dissemination, University of York), and CEA registry of the Tufts Medical Center. STUDY ELIGIBILITY CRITERIA Eligible studies were BIAs evaluating cancer-screening programs published in English, 2010-2018. SYNTHESIS METHODS Standardized evidence tables were generated to extract and compare study characteristics outlined by the ISPOR BIA Task Force. RESULTS Nineteen studies were identified evaluating screening for breast (5), colorectal (6), cervical (3), lung (1), prostate (3), and skin (1) cancers. Model designs included decision-analytic models (13) and simple cost calculators (6). From all studies, only 53% reported costs for a minimum of 3 years, 58% compared to a mix of screening options, 42% reported model validation, and 37% reported uncertainty analysis for participation rates. The quality of studies appeared to be independent of cancer site. LIMITATIONS "Gray" literature was not searched, misinterpretation is possible due to limited information in publications, and focus was on international methodological guidelines rather than regional guidelines. CONCLUSIONS Our review highlights considerable variability in the extent to which BIAs evaluating cancer-screening programs followed recommended guidelines. The annual budget impact at least over the next 3-5 years should be estimated. Validation and uncertainty analysis should always be conducted. Continued dissemination efforts of existing best-practice guidelines are necessary to ensure high-quality analyses.
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Affiliation(s)
- Beate Jahn
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tyrol, Austria
| | - Jovan Todorovic
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tyrol, Austria
| | - Marvin Bundo
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tyrol, Austria
| | - Gaby Sroczynski
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tyrol, Austria
| | - Annette Conrads-Frank
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tyrol, Austria
| | - Ursula Rochau
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tyrol, Austria
| | - Gottfried Endel
- Evidence-based Health Care, Main Association of Austrian Social Insurance Institutions, Haidingergasse 1, 1030, Vienna, Austria
| | - Ingrid Wilbacher
- Evidence-based Health Care, Main Association of Austrian Social Insurance Institutions, Haidingergasse 1, 1030, Vienna, Austria
| | - Nikoletta Malbaski
- Evidence-based Health Care, Main Association of Austrian Social Insurance Institutions, Haidingergasse 1, 1030, Vienna, Austria
| | - Niki Popper
- DWH Simulation Services, DEXHELPP, Neustiftgasse 57-59, 1070, Vienna, Austria
- TU Wien, Information and Software Engineering Group (ifs - E194-01), Favoritenstraße 9-11/194-01, 1040, Vienna, Austria
| | - Jagpreet Chhatwal
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St, Boston, MA, 02114, USA
| | - Dan Greenberg
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Josephine Mauskopf
- RTI Health Solutions, RTI International, 3040 Cornwallis Rd, Durham, NC, 27709, USA
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tyrol, Austria.
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St, Boston, MA, 02114, USA.
- Division of Health Technology Assessment, ONCOTYROL-Center for Personalized Cancer Medicine, Karl-Kapferer-Straße 5, 6020, Innsbruck, Austria.
- Department of Health Policy and Management, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, Boston, MA, 02115, USA.
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Hung A, Mullins CD, Slejko JF, Haines ST, Shaya F, Lugo A. Using a Budget Impact Model Framework to Evaluate Antidiabetic Formulary Changes and Utilization Management Tools. J Manag Care Spec Pharm 2019; 25:342-349. [PMID: 30816818 PMCID: PMC7210727 DOI: 10.18553/jmcp.2019.25.3.342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Traditional budget impact models predict the financial consequences of a new drug entering the market. This study provides an example of applying the budget impact framework to a new research question of interest to managed care organizations-what is the budget impact of our formulary and utilization management (UM) policy changes? OBJECTIVE To predict the 3-year annual budgetary impact of TRICARE's antidiabetic formulary and UM policy changes using TRICARE claims data. METHODS A budget impact model was built in Microsoft Excel using health plan claims data for a 3-year time horizon. Model outcomes included spending on antidiabetic medications and medications used for side effect treatment. In sensitivity analyses, medical costs from inpatient, outpatient, and emergency room visits were also estimated. Model inputs included health plan antidiabetic medication utilization, as well as publicly available drug cost, rebate, dispensing fee, and patient cost-sharing estimates. Type of enrollee and pharmacy were also incorporated into the model. Sensitivity analyses varied estimates for utilization switch rates between preferred and nonpreferred agents, drug costs, rebates, and dispensing fees, as well as predicted impact from implementation delays. RESULTS For the 623,827 affected by the formulary and UM policy changes, the model predicted annual savings that increased from $24 million in the first year to $43 million in the third year after the changes. The majority of savings came from drug acquisition costs, as opposed to rebates, copays, and dispensing fees. Sensitivity analyses found savings across all varied parameters and scenarios except an unlikely scenario when 0% of utilization switched from nonpreferred to preferred agents. The model also predicted that the formulary and UM policy changes would lead to $529,439 in savings from medical visit costs in Year 3. CONCLUSIONS This budget impact model predicted cost savings from the payer's formulary and UM policy changes. DISCLOSURES This project was supported by grant number F32HS024857 from the Agency for Healthcare Research and Quality (AHRQ), which contracted with the University of Maryland School of Pharmacy to conduct this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ, which had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or design to submit the manuscript for publication. The findings discussed in this manuscript represent the views of the authors and do not necessarily reflect the views of the Department of Defense, the Defense Health Agency, nor the Departments of the Army, Navy, and Air Force. Hung reports a grant from the AHRQ, during the conduct of the study, and personal fees from CVS Health and BlueCross BlueShield Association, outside the submitted work. Mullins reports grants and personal fees from Bayer and Pfizer and personal fees from Boehringer-Ingelheim, Janssen/J&J, Regeneron, and Sanofi, outside the submitted work. Mullins, Slejko, and Shaya are employed by the University of Maryland School of Pharmacy. Haines and Lugo have nothing to disclose. Part of this content was previously presented as a poster at the 2017 AMCP Managed Care & Specialty Pharmacy Annual Meeting; March 27-30, 2017; Denver, CO, and as poster and oral presentations at the 2017 AMCP Nexus Meeting; October 16-19, 2017; Dallas, TX. Part of this content was published as Hung's PhD dissertation.
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Affiliation(s)
- Anna Hung
- Duke Clinical Research Institute, Durham, North Carolina
| | | | | | | | - Fadia Shaya
- University of Maryland School of Pharmacy, Baltimore
| | - Amy Lugo
- Defense Health Agency, San Antonio, Texas
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25
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Use of economic predictions to make formulary decisions. Am J Health Syst Pharm 2019; 76:S15-S20. [DOI: 10.1093/ajhp/zxy024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Foroutan N, Tarride JE, Xie F, Levine M. A methodological review of national and transnational pharmaceutical budget impact analysis guidelines for new drug submissions. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:821-854. [PMID: 30538513 PMCID: PMC6263295 DOI: 10.2147/ceor.s178825] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Budget impact analysis (BIA) in health care, sometimes referred to as resource impact, is the financial change in the use of health resources associated with adding a new drug to a formulary or the adoption of a new health technology. Several national and transnational organizations worldwide have updated their BIA guidelines in the past 4 years. The aim of the present review was to provide a comprehensive list of the key recommendations of BIA guidelines from different countries that may be of interest for those who wish to build or to update BIA guidelines. METHODS National and transnational BIA guidelines were searched in databases including MEDLINE, EMBASE, Cochrane, EconLit, CINAHL, Business Source Premier, HealthSTAR, and the gray literature including regulatory agency websites. Data were reviewed and abstracted based on key elements in a standard BIA model (analytical model structure, input and data sources, and reporting format). RESULTS Eight national (Australia, UK, Belgium, Ireland, France, Poland, Brazil, and Canada) and one transnational (International Society for Pharmacoeconomics and Outcomes Research) BIA guidelines were included in this review, and a comprehensive list of BIA recommendations was identified. The review showed that certain recommendations such as patient population assessment, drug-related direct costs, discounting, and disaggregated results were common across the various jurisdictions. BIA guidelines differed from each other in terms of the number and scope of recommendations, the terminology used (eg, the definition of comparators or cost offsets) and the direction of the recommendations (ie, to include or not to include with respect to such items as off-label indications, indirect costs, clinical outcomes, and resource utilization). CONCLUSION While there was a common purpose for all of the BIA guidelines that were identified, substantial differences did occur in the specific recommendations. The pharmaceutical financing system structure might explain why guidelines from the UK, Australia, and Canada have more country-specific recommendations. The desire to be consistent with adopted economic evaluation assumptions might be another reason for some observed differences between countries. Further research is required to assess the source of the heterogeneity between BIA recommendations are identified in different guidelines.
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Affiliation(s)
- Naghmeh Foroutan
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada,
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada,
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada,
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada,
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada,
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada
- Program for Health Economics and Outcome Measures (PHENOM), Hamilton, ON, Canada
| | - Mitchell Levine
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada,
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada,
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada
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Lorenzoni V, Triulzi I, Turchetti G. Budget impact analysis of the use of extended half-life recombinant factor VIII (efmoroctocog alfa) for the treatment of congenital haemophilia a: the Italian National Health System perspective. BMC Health Serv Res 2018; 18:596. [PMID: 30071878 PMCID: PMC6090904 DOI: 10.1186/s12913-018-3398-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 07/15/2018] [Indexed: 01/11/2023] Open
Abstract
Background Congenital haemophilia A (HA) is a rare, inherited, life-long bleeding disorder characterised by prolonged or spontaneous bleeding due to the lack of clotting factor VIII (FVIII) in the body. Treatment for HA involves FVIII replacement therapy and poses great economic burden to National Health Systems and to society. Availability of novel products as extended half-life clotting factor products might change treatment approches and their economic evaluation is essential for an informed treatment choice. Accordingly the objective of the present work is to analyse the economic impact of using efmoroctocog alfa (recombinant factor VIII-Fc fusion protein, rFVIIIFc) for the treatment of children and adults with severe congenital haemophilia A (HA). Methods A budget impact analysis was performed to estimate the economic impact of the introduction of rFVIIIFc in the market-mix of products for the treatment of HA. The analysis condidered a 3-year time horizon and the Italian National Health System (INHS) perspective. The model estimated drug costs associated with the treatment of HA in the current scenario - representing the marketplace forecast for the time period of interest assuming that rFVIIFc is not introduced - and a new scenario, assuming that rFVIIIFc is available in the market. The size of the target population was calculated using epidemiological national data. Univariate one-way sensitivity analyses and scenario analyses were performed. Results Overall 3-year costs of treating the HA population in the current scenario were 555,277,691 Euro for the INHS. With the introduction of rFVIIIFc, the costs were reduced to 541,897,466 Euro suggesting potential savings to the INHS of 13,380,255 Euro. Results were consistent at variation of most of the model’s parameters; only in case of lower dosage of conventional products and higher dosage of rFVIIIFc, costs for the INHS increased, in both cases, of about 20 million Euro. Conclusions The use of rFVIIIFc for the treatment of HA has been recently approved by the Italian Medicines Agency (AIFA) and this is the first study estimating the financial impact of this new therapeutic alternative in the Italian context. The analysis suggests that rFVIIIFc use does not result in higher expenditure for the INHS.
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Affiliation(s)
- Valentina Lorenzoni
- Institute of Management, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà n. 33, Pisa, Italy
| | - Isotta Triulzi
- Institute of Management, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà n. 33, Pisa, Italy
| | - Giuseppe Turchetti
- Institute of Management, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà n. 33, Pisa, Italy.
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Ghabri S, Autin E, Poullié AI, Josselin JM. The French National Authority for Health (HAS) Guidelines for Conducting Budget Impact Analyses (BIA). PHARMACOECONOMICS 2018; 36:407-417. [PMID: 29247437 DOI: 10.1007/s40273-017-0602-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Budget impact analysis (BIA) provides short- and medium-term estimates on changes in budgets and health outcomes resulting from the adoption of new health interventions. OBJECTIVE The purpose of this study is to present the newly developed French National Authority for Health (HAS) guidelines on budget impact analysis as follows: process, literature review, recommendations and comparisons with other guidelines. METHODS The development process of the HAS guidelines included a literature review (search dates: January 2000 to June 2016), a retrospective investigation of BIA previously submitted to HAS, a public consultation, international expert reviews and approval from the HAS Board and the Economic and Public Health Evaluation Committee of HAS. RESULTS Documents identified in the literature review included 12 national guidelines, 5 recommendations for good practices developed by national and international society of health economics and 14 methodological publications including recommendations for conducting BIA. Based on its research findings, HAS developed its first BIA guidelines, which include recommendations on the following topics: BIA definition, perspective, populations, time horizon, compared scenarios, budget impact models, costing, discounting, choice of clinical data, reporting of results and uncertainty exploration. CONCLUSION It is expected that the HAS BIA guidelines will enhance the usefulness, quality and transparency of BIA submitted by drug manufacturers to HAS. BIA is becoming an essential part of a comprehensive economic assessment of healthcare interventions in France, which also includes cost-effectiveness analysis and equity of access to healthcare.
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Affiliation(s)
- Salah Ghabri
- Department of Economic and Public Health Evaluation, French National Authority for Health (Haute Autorité de Santé, HAS), 5 Avenue du Stade de France, 93218, Saint-Denis La Plaine cedex, France.
| | - Erwan Autin
- Department of Economic and Public Health Evaluation, French National Authority for Health (Haute Autorité de Santé, HAS), 5 Avenue du Stade de France, 93218, Saint-Denis La Plaine cedex, France
| | - Anne-Isabelle Poullié
- Department of Economic and Public Health Evaluation, French National Authority for Health (Haute Autorité de Santé, HAS), 5 Avenue du Stade de France, 93218, Saint-Denis La Plaine cedex, France
| | - Jean Michel Josselin
- Faculty of Economics, University of Rennes 1, CREM-CNRS, 35065, Rennes Cedex, France
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Ghabri S, Mauskopf J. The use of budget impact analysis in the economic evaluation of new medicines in Australia, England, France and the United States: relationship to cost-effectiveness analysis and methodological challenges. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:173-175. [PMID: 29032482 DOI: 10.1007/s10198-017-0933-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 09/27/2017] [Indexed: 05/24/2023]
Affiliation(s)
- Salah Ghabri
- Department of Economic and Public Health Evaluation, French National Authority for Health (Haute Autorité de Santé, HAS), 5 Avenue du Stade de France, 93218, Saint-Denis La Plaine Cedex, France.
| | - Josephine Mauskopf
- RTI Health Solutions, RTI International, Research Triangle Park, NC, USA
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30
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Carvalho N, Jit M, Cox S, Yoong J, Hutubessy RCW. Capturing Budget Impact Considerations Within Economic Evaluations: A Systematic Review of Economic Evaluations of Rotavirus Vaccine in Low- and Middle-Income Countries and a Proposed Assessment Framework. PHARMACOECONOMICS 2018; 36:79-90. [PMID: 28905279 PMCID: PMC5775390 DOI: 10.1007/s40273-017-0569-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND In low- and middle-income countries, budget impact is an important criterion for funding new interventions, particularly for large public health investments such as new vaccines. However, budget impact analyses remain less frequently conducted and less well researched than cost-effectiveness analyses. OBJECTIVE The objective of this study was to fill the gap in research on budget impact analyses by assessing (1) the quality of stand-alone budget impact analyses, and (2) the feasibility of extending cost-effectiveness analyses to capture budget impact. METHODS We developed a budget impact analysis checklist and scoring system for budget impact analyses, which we then adapted for cost-effectiveness analyses, based on current International Society for Pharmacoeconomics and Outcomes Research Task Force recommendations. We applied both budget impact analysis and cost-effectiveness analysis checklists and scoring systems to examine the extent to which existing economic evaluations provide sufficient evidence about budget impact to enable decision making. We used rotavirus vaccination as an illustrative case in which low- and middle-income countries uptake has been limited despite demonstrated cost effectiveness. A systematic literature review was conducted to identify economic evaluations of rotavirus vaccine in low- and middle-income countries published between January 2000 and February 2017. We critically appraised the quality of budget impact analyses, and assessed the extension of cost-effectiveness analyses to provide useful budget impact information. RESULTS Six budget impact analyses and 60 cost-effectiveness analyses were identified. Budget impact analyses adhered to most International Society for Pharmacoeconomics and Outcomes Research recommendations, with key exceptions being provision of undiscounted financial streams for each budget period and model validation. Most cost-effectiveness analyses could not be extended to provide useful budget impact information; cost-effectiveness analyses also rarely presented undiscounted annual costs, or estimated financial streams during the first years of programme scale-up. CONCLUSIONS Cost-effectiveness analyses vastly outnumber budget impact analyses of rotavirus vaccination, despite both being critical for policy decision making. Straightforward changes to the presentation of cost-effectiveness analyses results could facilitate their adaptation into budget impact analyses.
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Affiliation(s)
- Natalie Carvalho
- Centre for Health Policy and Global Burden of Disease Group, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Modelling and Economics Unit, Public Health England, London, UK
| | - Sarah Cox
- Initiative for Vaccine Research, World Health Organization, Program in Applied Vaccine Experiences Scholar, Geneva, Switzerland
| | - Joanne Yoong
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
- Saw Swee Hock School of Public Health, National University of Singapore and National University Hospital System, Singapore, Singapore
| | - Raymond C W Hutubessy
- Initiative for Vaccine Research, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland.
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