1
|
Del Prato S, Giorgino F, Szafranski K, Poon Y. Cost-utility analysis of a flash continuous glucose monitoring system in the management of people with type 2 diabetes mellitus on basal insulin therapy-An Italian healthcare system perspective. Diabetes Obes Metab 2024; 26:3633-3641. [PMID: 38853717 DOI: 10.1111/dom.15703] [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: 02/26/2024] [Revised: 05/13/2024] [Accepted: 05/24/2024] [Indexed: 06/11/2024]
Abstract
AIMS To assess the cost-utility of the FreeStyle Libre flash continuous glucose monitoring (CGM) system from an Italian healthcare system perspective, when compared with self-monitoring of blood glucose (SMBG) in people living with type 2 diabetes mellitus (T2DM) receiving basal insulin. MATERIALS AND METHODS A patient-level microsimulation model was run using Microsoft Excel for 10 000 patients over a lifetime horizon, with 3.0% discounting for costs and utilities. Inputs were based on clinical trials and real-world evidence, with patient characteristics reflecting Italian population data. The effect of flash CGM was modelled as a persistent 0.8% reduction in glycated haemoglobin versus SMBG. Costs (€ 2023) and disutilities were applied to glucose monitoring, diabetes complications, severe hypoglycaemia, and diabetic ketoacidosis. The health outcome was measured as quality-adjusted life-years (QALYs). RESULTS Direct costs were €5338 higher with flash CGM than with SMBG. Flash CGM was associated with 0.51 more QALYs than SMBG, giving an incremental cost-effectiveness ratio (ICER) of €10 556/QALY. Scenario analysis ICERs ranged from €3825/QALY to €26 737/QALY. In probabilistic analysis, flash CGM was 100% likely to be cost effective at willingness-to-pay thresholds > €20 000/QALY. CONCLUSIONS From an Italian healthcare system perspective, flash CGM is cost effective compared with SMBG for people living with T2DM on basal insulin.
Collapse
Affiliation(s)
- Stefano Del Prato
- Interdisciplinary Research Center "Health Science" of the Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Francesco Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | | | - Yeesha Poon
- Abbott Diabetes Care, Alameda, California, USA
| |
Collapse
|
2
|
Salcedo J, Hill-McManus D, Hardern C, Opeifa O, Viti R, Siviero L, Roscini AS, Di Martino G. Cost-Effectiveness of Vedolizumab as a First-Line Advanced Therapy Versus Adalimumab Treatment Sequences for Ulcerative Colitis in Italy. PHARMACOECONOMICS - OPEN 2024:10.1007/s41669-024-00497-4. [PMID: 38858333 DOI: 10.1007/s41669-024-00497-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Today, there are many treatment options available for the management of ulcerative colitis, creating challenges in selecting the most efficacious and cost-effective treatment sequences. Treatments in the anti-tumor necrosis factor alpha (TNFα) therapeutic class, as well as vedolizumab, are widely used and endorsed as first-line options according to treatment guidelines. The aim of this study was to compare treatment sequences involving vedolizumab and the anti-TNFα treatment adalimumab in terms of cost-effectiveness in the treatment of moderately to severely active ulcerative colitis in Italy. METHODS A cost-effectiveness model comparing treatment sequences within the Italian National Health Service in terms of costs and quality-adjusted life years (QALYs) with a lifetime horizon was developed. The analysis focused on the relative positioning of vedolizumab and adalimumab, leveraging the results of the landmark head-to-head VARSITY clinical trial as key inputs. The robustness of the results was investigated through a range of sensitivity and scenario analyses. RESULTS The strategy of vedolizumab as a first-line advanced therapy followed by adalimumab was associated with higher costs and health benefits compared with first-line adalimumab followed by vedolizumab. The incremental cost-effectiveness ratio was €16,146/QALY, which was found to be robust to changes to inputs associated with areas of high uncertainty. CONCLUSION This economic evaluation estimated a 94% probability that vedolizumab as a first-line advanced therapy is cost-effective at a threshold of €33,004/QALY when compared with first-line adalimumab sequences. Using clinical trial evidence to inform the efficacy of second-line treatments estimated that the effectiveness of anti-TNFα treatments is not substantially reduced by vedolizumab exposure.
Collapse
Affiliation(s)
- Jonathan Salcedo
- Takeda Pharmaceuticals U.S.A., Inc., 40 Landsdowne Street, Cambridge, MA, 02139, USA.
| | | | | | | | | | | | | | | |
Collapse
|
3
|
Zozaya N, Villaseca J, Fernández I, Abdalla F, Cadenas-Noreña B, Calleja MÁ, Gómez-Pajuelo P, Mestre-Ferrándiz J, Oliva-Moreno J, Trillo JL, Hidalgo-Vega Á. A Review of Current Approaches to Evaluating and Reimbursing New Medicines in a Subset of OECD Countries. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:297-313. [PMID: 38214848 DOI: 10.1007/s40258-023-00867-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVES The aim of this study was to review the current evaluation and funding processes for new drugs in different developed countries, to provide a comparative framework with detailed, homogeneous, and up-to-date information. METHODS Scientific publications, reports and websites were reviewed between July and December 2021 using PubMed, Google Scholar, and grey literature sources. The main items searched were actors and processes, including timelines, characteristics of clinical and economic evaluations, participation of stakeholders, elements of price and reimbursement decisions, cost-effectiveness thresholds and specific funds. The analysed 13 countries were Australia, Canada, England, France, Germany, Italy, Japan, the Netherlands, Portugal, Scotland, South Korea, Spain and Sweden. RESULTS Eight countries perform the assessment process separated from the pricing decision. Countries measure each drug's added therapeutic value through multi-attribute value scales, algorithms, non-prescriptive lists of criteria, or quality-adjusted life years (QALYs). Health technology assessment (HTA) methodologies differ in their outcome measures, elicitation techniques, comparators, and perspectives. The criteria used for pricing and reimbursement include humanistic, clinical, and economic aspects. Only Scotland, England, the Netherlands, Canada and Portugal use explicit efficiency thresholds. Health care professionals participate in all assessment committees, and patients are becoming increasingly involved in most countries. The official time from marketing authorisation to the completion of the evaluation and pricing processes varied from 126 to 540 days. CONCLUSIONS Most analysed countries show a trend towards value-based approaches that consider value for money to society, but also other economic, clinical, and humanistic criteria. Good practices included robustness, transparency, independence, and participation.
Collapse
Affiliation(s)
- Néboa Zozaya
- Department of Health Economics, Weber, C/Moreto 17, 5D, 28014, Madrid, Spain.
- Department of Quantitative Methods in Economics and Management, Faculty of Economics, Business and Tourism, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - Javier Villaseca
- Department of Health Economics, Weber, C/Moreto 17, 5D, 28014, Madrid, Spain
| | - Irene Fernández
- Department of Health Economics, Weber, C/Moreto 17, 5D, 28014, Madrid, Spain
| | - Fernando Abdalla
- Department of Health Economics, Weber, C/Moreto 17, 5D, 28014, Madrid, Spain
| | | | | | | | | | - Juan Oliva-Moreno
- Department of Economic Analysis and Finance, University of Castilla-La Mancha, Toledo, Spain
| | - José Luis Trillo
- Department of Pharmacy, Health Area of the Malvarrosa Valencia Clinical Department, Valencia, Spain
| | - Álvaro Hidalgo-Vega
- Department of Economic Analysis and Finance, University of Castilla-La Mancha, Toledo, Spain
- Weber Foundation, Madrid, Spain
| |
Collapse
|
4
|
Fagereng GL, Morvik AM, Reinvik Ulimoen S, Ringerud AM, Dahlen Syversen I, Sagdahl E. The impact of level of documentation on the accessibility and affordability of new drugs in Norway. Front Pharmacol 2024; 15:1338541. [PMID: 38420198 PMCID: PMC10899517 DOI: 10.3389/fphar.2024.1338541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction: Over the preceding decade, an increasing number of drugs have been approved by the European Medicines Agency (EMA) with limited knowledge of their relative efficacy. This is due to the utilization of non-randomized, single-arm studies, surrogate endpoints, and shorter follow-up time. The impact of this trend on the accessibility and affordability of newly approved drugs in Europe remains uncertain. The primary objective of this study is to provide insights into the issues of accessibility and affordability of new drugs in the Norwegian healthcare system. Method: The presented study entails an analysis of all reimbursement decisions for hospital drugs in Norway spanning 2021-2022. The included drugs were approved by the EMA between 2014 and 2022, with the majority (91%) receiving approval between 2018 and 2022. The drugs were categorized based on the level of documentation of relative efficacy. Approval rates and costs (confidential net-prices) were compared. Results: A total of 35% (70/199) of the reimbursement decisions were characterized by limited certainty regarding relative efficacy and as a consequence the Norwegian Health Technology Assessment (HTA) body did not present an incremental cost-effectiveness ratio (ICER) in the HTA report. Within this category, a lower percentage of drugs (47%) gained reimbursement approval compared to those with a higher certainty level, which were presented with an ICER (58%). On average, drugs with an established relative efficacy were accepted with a 4.4-fold higher cost (confidential net-prices). These trends persisted when specifically examining oncology drugs. Conclusion: Our study underscores that a substantial number of recently introduced drugs receive reimbursement regardless of the level of certainty concerning relative efficacy. However, the results suggest that payers prioritize documented over potential efficacy. Given that updated information on relative efficacy may emerge post-market access, a potential solution to address challenges related to accessibility and affordability in Europe could involve an increased adoption of market entry agreements. These agreements could allow for price adjustments after the presentation of new knowledge regarding relative efficacy, potentially resolving some of the current challenges.
Collapse
Affiliation(s)
- Gro Live Fagereng
- The Pharmaceutical Division, The Norwegian Hospital Procurement Trust, Vadsø, Norway
- Institute for Cancer Research, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Sara Reinvik Ulimoen
- The Pharmaceutical Division, The Norwegian Hospital Procurement Trust, Vadsø, Norway
- South-Eastern Norway Regional Health Authority, Hamar, Norway
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Anne Marthe Ringerud
- The Pharmaceutical Division, The Norwegian Hospital Procurement Trust, Vadsø, Norway
| | | | - Erik Sagdahl
- The Pharmaceutical Division, The Norwegian Hospital Procurement Trust, Vadsø, Norway
- Department of Pharmacy, The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
5
|
Basile M, Valentini I, Attanasio R, Cozzi R, Persichetti A, Samperi I, Scoppola A, Auriemma RS, De Menis E, Esposito F, Ferrante E, Iatì G, Mazzatenta D, Poggi M, Rudà R, Tortora F, Cruciani F, Mitrova Z, Saulle R, Vecchi S, Cappabianca P, Paoletta A, Bozzao A, Caputo M, Doglietto F, Ferraù F, Lania AG, Laureti S, Lello S, Locatelli D, Maffei P, Minniti G, Peri A, Ruini C, Settanni F, Silvani A, Veronese N, Grimaldi F, Papini E, Cicchetti A. A pharmacoeconomic analysis from Italian guidelines for the management of prolactinomas. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2024; 11:1-16. [PMID: 38230389 PMCID: PMC10788683 DOI: 10.33393/grhta.2024.2601] [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: 05/08/2023] [Accepted: 11/22/2023] [Indexed: 01/18/2024] Open
Abstract
Background Prolactinoma, the most common pituitary adenoma, is usually treated with dopamine agonist (DA) therapy like cabergoline. Surgery is second-line therapy, and radiotherapy is used if surgical treatment fails or in relapsing macroprolactinoma. Objective This study aimed to provide economic evidence for the management of prolactinoma in Italy, using a cost-of-illness and cost-utility analysis that considered various treatment options, including cabergoline, bromocriptine, temozolomide, radiation therapy, and surgical strategies. Methods The researchers conducted a systematic literature review for each research question on scientific databases and surveyed a panel of experts for each therapeutic procedure's specific drivers that contributed to its total cost. Results The average cost of the first year of treatment was €2,558.91 and €3,287.40 for subjects with microprolactinoma and macroprolactinoma, respectively. Follow-up costs from the second to the fifth year after initial treatment were €798.13 and €1,084.59 per year in both groups. Cabergoline had an adequate cost-utility profile, with an incremental cost-effectiveness ratio (ICER) of €3,201.15 compared to bromocriptine, based on a willingness-to-pay of €40,000 per quality-adjusted life year (QALY) in the reference economy. Endoscopic surgery was more cost-effective than cabergoline, with an ICER of €44,846.64. Considering a willingness-to-pay of €40,000/QALY, the baseline findings show cabergoline to have high cost utility and endoscopic surgery just a tad above that. Conclusions Due to the favorable cost-utility profile and safety of surgical treatment, pituitary surgery should be considered more frequently as the initial therapeutic approach. This management choice could lead to better outcomes and an appropriate allocation of healthcare resources.
Collapse
Affiliation(s)
- Michele Basile
- High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome
| | - Ilaria Valentini
- High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome
| | | | - Renato Cozzi
- ASST Grande Ospedale Metropolitano Niguarda, Endocrinology Department, Milan
| | - Agnese Persichetti
- Ministry of Interior, Department of Firefighters, Public Rescue and Civil Defense, Rome
| | | | | | - Renata Simona Auriemma
- Department of Clinical Medicine and Surgery, Endocrinology Section, ‘Federico II’ University of Naples, Naples
| | - Ernesto De Menis
- Internal Medicine 2, Treviso Hospital, Treviso and Functional Department of Endocrinology and Metabolism, AULSS 2 Veneto
| | - Felice Esposito
- Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II’ University of Naples, Naples
| | - Emanuele Ferrante
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan
| | - Giuseppe Iatì
- Department of Radiation Oncology, University of Messina, Messina
| | - Diego Mazzatenta
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna
| | - Maurizio Poggi
- Endocrinology, Department of Clinical and Molecular Medicine, S. Andrea Hospital, Sapienza University of Rome, Rome
| | - Roberta Rudà
- Division of Neurology, Castelfranco Veneto and Treviso Hospital, Treviso Division of Neuro-Oncology, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin
| | - Fabio Tortora
- Radiology Unit, Department of Advanced Biomedical Sciences, University “Federico II”, Naples
| | - Fabio Cruciani
- Department of Epidemiology, Lazio Region Health Service, Rome
| | - Zuzana Mitrova
- Department of Epidemiology, Lazio Region Health Service, Rome
| | - Rosella Saulle
- Department of Epidemiology, Lazio Region Health Service, Rome
| | - Simona Vecchi
- Department of Epidemiology, Lazio Region Health Service, Rome
| | - Paolo Cappabianca
- Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II’ University of Naples, Naples
| | | | - Alessandro Bozzao
- Neuroradiology, S. Andrea Hospital, NESMOS Department (Neuroscience, Mental Health, Sensorial Organs), Sapienza University of Rome, Rome
| | - Marco Caputo
- Laboratorio Analisi Cliniche e Microbiologia, Synlab SRL, Calenzano (FI)
| | | | - Francesco Ferraù
- Department of Human Pathology of Adulthood and Childhood ‘G. Barresi’, University of Messina, Messina
| | - Andrea Gerardo Lania
- Department of Biomedical Sciences, Endocrinology Unit, Humanitas Clinical and Research Center IRCCS, Humanitas University, Rozzano (MI)
| | | | - Stefano Lello
- Department of Woman and Child Health and Public Health, Institute of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
| | - Davide Locatelli
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Varese
| | - Pietro Maffei
- Department of Medicine (DIMED), 3rd Medical Clinic, Padua University, Padua
| | - Giuseppe Minniti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena
| | - Alessandro Peri
- Pituitary Diseases and Sodium Alterations Unit, AOU Careggi, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence
| | - Chiara Ruini
- Department of Psychology, University of Bologna, Bologna
| | - Fabio Settanni
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin
| | - Antonio Silvani
- Department of Neuro-Oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano
| | - Nadia Veronese
- ASST Grande Ospedale Metropolitano Niguarda, Endocrinology Department, Milan
| | | | - Enrico Papini
- Endocrinology, Ospedale Regina Apostolorum, Albano Laziale (RM) - Italy
| | - Americo Cicchetti
- High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome
| |
Collapse
|
6
|
The Value of Tucatinib in Metastatic HER2-Positive Breast Cancer Patients: An Italian Cost-Effectiveness Analysis. Cancers (Basel) 2023; 15:cancers15041175. [PMID: 36831518 PMCID: PMC9953803 DOI: 10.3390/cancers15041175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/02/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND This study was aimed at estimating the appropriate price of tucatinib plus trastuzumab and capecitabine (TXC), as third-line treatment, in HER2+ breast cancer (BC) patients from the Italian National Health System (NHS) perspective. METHODS A partitioned survival model with three mutually exclusive health states (i.e., progression-free survival (PFS), progressive disease (PD), and death) was used to estimate the price of tucatinib vs trastuzumab emtansine (TDM-1), considering a willingness to pay (WTP) of 60,000 EUR. Data from the HER2CLIMB trial, the Italian population, and the literature were used as input. The model also estimated the total costs and the life-years (LY) of TXC and TDM1. Deterministic and probabilistic (PSA) sensitivity analyses were conducted to evaluate the robustness of the model. RESULTS In the base case scenario, the appropriate price of tucatinib was 4828.44 EUR per cycle. The TXC resulted in +0.28 LYs and +16,628 EUR compared with TDM-1. Results were mainly sensitive to therapy intensity variation. In PSA analysis, TXC resulted cost-effective in 53% of the simulations. Assuming a WTP ranging 20,000-80,000 EUR, the tucatinib price ranged from 4090.60 to 5197.41 EUR. CONCLUSIONS This study estimated the appropriate price for tucatinib according to different WTP in order to help healthcare decision makers to better understand the treatment value.
Collapse
|
7
|
Canali B, Candelora L, Fiorentino F, Halmos T, La Malfa P, Massara F, Vassallo C, Urbinati D. COVID-19 impact on the decision process of the Italian Medicine Agency: a quantitative assessment. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2023; 10:46-52. [PMID: 37275270 PMCID: PMC10238912 DOI: 10.33393/grhta.2023.2560] [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: 01/05/2023] [Accepted: 04/04/2023] [Indexed: 06/07/2023] Open
Abstract
Background Since the COVID-19 pandemic has placed more attention on drugs' approval process and the importance of rapid decision-making in the healthcare sector, it is crucial to assess how time to market (TTM) of drugs varied. Objective To estimate the impact of the COVID-19 pandemic on TTM of drugs in Italy. Methods An IQVIA database was used to retrieve information on drugs that obtained positive opinion from the Committee for Medicinal Products for Human Use between January 2015 and December 2021. The available observations were divided into three groups (Pre COVID, Partially COVID, and Fully COVID) according to the timing of their negotiation process. Differences in average TTM among the three groups were analyzed in three steps: (1) descriptive statistics; (2) univariate analysis; (3) multivariate analysis, using a matching estimator. Results A total of 363 unique combinations of molecule and indication met the inclusion criteria: 174 in the Pre COVID group, 69 in the Partially COVID group, and 123 in the Fully COVID group. Descriptive statistics and univariate analysis found a statistically significant difference in TTM among the three periods, with average TTM increasing during the pandemic (+136 days, p = 0.00) and then decreasing afterward (-23 days, p = 0.09). In the matching analysis, results for the Partially COVID period were confirmed (+108 days, p = 0.00) while results for the Fully COVID period lost significance but maintained a negative sign. Conclusions The results suggest that after an adjustment phase in the Partially COVID period, a return to the status quo was reached.
Collapse
Affiliation(s)
- Beatrice Canali
- Real World Solutions, IQVIA Solutions S.r.l., Milano - Italy
| | - Laura Candelora
- Real World Solutions, IQVIA Solutions S.r.l., Milano - Italy
| | | | | | - Paola La Malfa
- Real World Solutions, IQVIA Solutions S.r.l., Milano - Italy
| | | | - Chiara Vassallo
- Real World Solutions, IQVIA Solutions S.r.l., Milano - Italy
| | - Duccio Urbinati
- Real World Solutions, IQVIA Solutions S.r.l., Milano - Italy
| |
Collapse
|