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Lee M, Larose H, Gräbeldinger M, Williams J, Baird AM, Brown S, Bruns J, Clark R, Cortes J, Curigliano G, Ferris A, Garrison LP, Gupta Y, Kanesvaran R, Lyman G, Pani L, Pemberton-Whiteley Z, Salmonson T, Sawicki P, Stein B, Suh DC, Velikova G, Grueger J. The evolving value assessment of cancer therapies: Results from a modified Delphi study. HEALTH POLICY OPEN 2024; 6:100116. [PMID: 38464704 PMCID: PMC10924144 DOI: 10.1016/j.hpopen.2024.100116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/22/2024] [Accepted: 02/29/2024] [Indexed: 03/12/2024] Open
Abstract
The move toward early detection and treatment of cancer presents challenges for value assessment using traditional endpoints. Current cancer management rarely considers the full economic and societal benefits of therapies. Our study used a modified Delphi process to develop principles for defining and assessing value of cancer therapies that aligns with the current trajectory of oncology research and reflects broader notions of value. 24 experts participated in consensus-building activities across 5 months (16 took part in structured interactions, including a survey, plenary sessions, interviews, and off-line discussions, while 8 participated in interviews). Discussion focused on: 1) which oncology-relevant endpoints should be used for assessing treatments for early-stage cancer and access decisions for early-stage treatments, and 2) the importance of additional value components and how these can be integrated in value assessments. The expert group reached consensus on 4 principles in relation to the first area (consider oncology-relevant endpoints other than overall survival; build evidence for endpoints that provide earlier indication of efficacy; develop evidence for the next generation of predictive measures; use managed entry agreements supported by ongoing evidence collection to address decision-maker evidence needs) and 3 principles in relation to the second (routinely use patient reported outcomes in value assessments; assess broad economic impact of new medicines; consider other value aspects of relevance to patients and society).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Giuseppe Curigliano
- Department of Oncology and Hemato-Oncology, University of Milan, Division of Early Drug Development, European Institute of Oncology, IRCCS, Italy
| | | | | | - Y.K. Gupta
- All India Institute of Medical Science Bhopal, India
| | | | - Gary Lyman
- Fred Hutchinson Cancer Research Center, USA
| | - Luca Pani
- University of Miami, Università di Modena e Reggio Emilia, Italy
| | - Zack Pemberton-Whiteley
- Leukaemia Care, UK, Acute Leukemia Advocates Network (ALAN), Switzerland, Blood Cancer Alliance (BCA), UK
| | | | | | | | - Dong-Churl Suh
- Chung-Ang University, South Korea; Rutgers, The State University of New Jersey, USA
| | | | - Jens Grueger
- Boston Consulting Group, Switzerland, Zurich, University of Washington, DC, USA
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Towse A, Fenwick E. It Takes 2 to Tango. Setting Out the Conditions in Which Performance-Based Risk-Sharing Arrangements Work for Both Parties. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:1058-1065. [PMID: 38615938 DOI: 10.1016/j.jval.2024.03.2196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES Faster regulatory approval processes often fail to achieve faster patient access. We seek an approach, using performance-based risk-sharing arrangements, to address uncertainty for payers regarding the relative effectiveness and value for money of products launched through accelerated approval schemes. One important reason for risk sharing is to resolve differences of opinion between innovators and payers about a technology's underlying value. To date, there has been no formal attempt to set out the circumstances in which risk sharing can address these differences. METHODS We use a value of information framework to understand what a performance-based risk-sharing arrangements can, in principle, add to a reimbursement scheme, separating payer perspectives on cost-effectiveness and the value of research from those of the innovator. We find 16 scenarios, developing 5 rules to analyze these 16 scenarios, identifying cases in which risk sharing adds value for both parties. RESULTS We find that risk sharing provides an improved solution in 9 out of 16 combinations of payer and innovator expectations about treatment outcome and the value of further research. Among our assumptions, who pays for research and scheme administration costs are key. CONCLUSIONS Steps should be undertaken to make risk sharing more practical, ensuring that payers consider it an option. This requires additional costs to the health system falling on the innovator in an efficient way that aligns incentives for product development for global markets. Health systems benefits are earlier patient access to cost-effective treatments and payers with higher confidence of not wasting money. Innovators get greater returns while conducting research.
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Affiliation(s)
- Adrian Towse
- Senior Visiting Fellow, Office of Health Economics, London, UK.
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Ardito V, Cavallaro L, Drummond M, Ciani O. Mapping Payment and Pricing Schemes for Health Innovation: Protocol of a Scoping Literature Review. PHARMACOECONOMICS - OPEN 2024:10.1007/s41669-024-00496-5. [PMID: 38773050 DOI: 10.1007/s41669-024-00496-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 05/23/2024]
Abstract
INTRODUCTION Innovative pricing and payment/reimbursement schemes have been proposed as one part of the solution to the problem of patient access to new health technologies or to the uncertainty about their long-term effectiveness. As part of a Horizon Europe research project on health innovation next generation pricing and payment models (HI-PRIX), this protocol illustrates the conceptual and methodological steps related to a scoping review aiming at investigating nature and scope of pricing and payment/reimbursement schemes applied to, or proposed for, existing or new health technologies. METHODS A scoping review of literature will be performed according to the PRISMA guidelines for scoping reviews (PRISMA-ScR) guidelines. The search will be conducted in three scientific databases (i.e., PubMed, Web of Science, and Scopus), over a 2010-2023 timeframe. The search strategy is structured around two blocks of keywords, namely "pricing and payment/reimbursement schemes," and "innovativeness" (of the scheme type or scheme use). A simplified search will be replicated in the gray literature. Studies illustrating pricing and payment/reimbursement schemes with a sufficient level of details to explain their characteristics and functioning will be deemed eligible to be considered for data synthesis. Pricing and payment/reimbursement schemes will be classified according to several criteria, such as their purpose, nature, governance, data collection needs, and foreseen distribution of risk. The results will populate a publicly available online tool, the Pay-for-Innovation Observatory. DISCUSSION The findings of this review have the potential to offer a comprehensive toolkit with a variety of pricing and payment schemes to policymakers and manufacturers facing reimbursement and access decisions.
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Affiliation(s)
- Vittoria Ardito
- Center for Research on Health and Social Care Management, SDA Bocconi School of Management, Via Sarfatti, 10, 20136, Milan, MI, Italy.
| | - Ludovico Cavallaro
- Center for Research on Health and Social Care Management, SDA Bocconi School of Management, Via Sarfatti, 10, 20136, Milan, MI, Italy
| | - Michael Drummond
- Center for Research on Health and Social Care Management, SDA Bocconi School of Management, Via Sarfatti, 10, 20136, Milan, MI, Italy
- Centre for Health Economics, University of York, York, UK
| | - Oriana Ciani
- Center for Research on Health and Social Care Management, SDA Bocconi School of Management, Via Sarfatti, 10, 20136, Milan, MI, Italy
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Corral J, Borras JM, Lievens Y. Utilisation of radiotherapy in lung cancer: A scoping narrative literature review with a focus on the introduction of evidence-based therapeutic approaches in Europe. Clin Transl Radiat Oncol 2024; 45:100717. [PMID: 38226026 PMCID: PMC10788411 DOI: 10.1016/j.ctro.2023.100717] [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: 11/13/2023] [Accepted: 12/16/2023] [Indexed: 01/17/2024] Open
Abstract
Background and purpose The aim of this study was to review the published studies on the utilisation of radiotherapy in lung cancer (both small and non-small cell lung cancer, SCLC and NSCLC) patients in European countries with a population-based perspective. Material and methods A literature search since January 2000 until December 2022 was carried out. Only English-published papers were included, and only European data was considered. PRISMA guidelines were followed. A scoping narrative review was undertaken due to the hetereogeneity of the published papers. Results 38 papers were included in the analysis, with the majority from the Netherlands (52.6%) and the UK (18.4%). Large variability is observed in the reported radiotherapy utilisation, around 40% for NSCLC in general and between 26 and 42% in stage I NSCLC. Stereotactic body radiotherapy (SBRT) shows a wide range of utilisation across countries and over time, from 8 to 63%. Similary, in stage III lung cancer, chemoradiotherapy (CRT) utilisation varied considerably (11-70%). Eleven studies compared radiotherapy utilisation between older and younger age-groups, showing that younger patients receive more CRT, while the opposite applies for SBRT. An widespreadlack of data on relevant covariates such as comorbidty and health-services related variables is observed. Conclusion The actual utilisation of radiotherapy for lung cancer reported in patterns-of-care studies (POCs) is notably lower than the evidence-based optimal utilisation. Important variability is observed by country, time period, stage at diagnosis and age. A wider use of POCs should be promoted to improve our knowledge on the actual application of evidence-based treatment recommendations.
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Affiliation(s)
- Julieta Corral
- Catalonian Cancer Plan, Department of Health, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet, Barcelona, Spain
| | - Josep M. Borras
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, Spain
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Dayer VW, Drummond MF, Dabbous O, Toumi M, Neumann P, Tunis S, Teich N, Saleh S, Persson U, von der Schulenburg JMG, Malone DC, Salimullah T, Sullivan SD. Real-world evidence for coverage determination of treatments for rare diseases. Orphanet J Rare Dis 2024; 19:47. [PMID: 38326894 PMCID: PMC10848432 DOI: 10.1186/s13023-024-03041-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/19/2024] [Indexed: 02/09/2024] Open
Abstract
Health technology assessment (HTA) decisions for pharmaceuticals are complex and evolving. New rare disease treatments are often approved more quickly through accelerated approval schemes, creating more uncertainties about clinical evidence and budget impact at the time of market entry. The use of real-world evidence (RWE), including early coverage with evidence development, has been suggested as a means to support HTA decisions for rare disease treatments. However, the collection and use of RWE poses substantial challenges. These challenges are compounded when considered in the context of treatments for rare diseases. In this paper, we describe the methodological challenges to developing and using prospective and retrospective RWE for HTA decisions, for rare diseases in particular. We focus attention on key elements of study design and analyses, including patient selection and recruitment, appropriate adjustment for confounding and other sources of bias, outcome selection, and data quality monitoring. We conclude by offering suggestions to help address some of the most vexing challenges. The role of RWE in coverage and pricing determination will grow. It is, therefore, necessary for researchers, manufacturers, HTA agencies, and payers to ensure that rigorous and appropriate scientific principles are followed when using RWE as part of decision-making.
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Affiliation(s)
- Victoria W Dayer
- CHOICE Institute, School of Pharmacy, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | | | - Omar Dabbous
- Novartis Gene Therapies, Inc., Bannockburn, IL, USA
| | - Mondher Toumi
- Faculty of Medicine, Public Health Department, Aix-Marseille University, Marseille, France
| | | | | | | | - Shadi Saleh
- American University of Beirut, Beirut, Lebanon
| | - Ulf Persson
- The Swedish Institute for Health Economics, Lund, Sweden
| | | | - Daniel C Malone
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA
| | | | - Sean D Sullivan
- CHOICE Institute, School of Pharmacy, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
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Hogervorst MA, Vreman R, Heikkinen I, Oortwijn W. Response to uncertainty management in regulatory and health technology assessment decision-making on drugs: guidance of the HTAi-DIA Working Group - author's reply. Int J Technol Assess Health Care 2023; 40:e1. [PMID: 38108142 PMCID: PMC10859829 DOI: 10.1017/s0266462323002817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Milou Amber Hogervorst
- Utrecht University, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht, The Netherlands
| | - Rick Vreman
- Utrecht University, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht, The Netherlands
| | | | - Wija Oortwijn
- Radboud University Medical Centre, Department for Health Evidence, Nijmegen, The Netherlands
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7
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Weymann D, Pollard S, Lam H, Krebs E, Regier DA. Toward Best Practices for Economic Evaluations of Tumor-Agnostic Therapies: A Review of Current Barriers and Solutions. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1608-1617. [PMID: 37543205 DOI: 10.1016/j.jval.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/28/2023] [Accepted: 07/26/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVES Cancer therapies targeting tumor-agnostic biomarkers are challenging traditional health technology assessment (HTA) frameworks. The high prevalence of nonrandomized single-arm trials, heterogeneity, and small benefiting populations are driving outcomes uncertainty, challenging healthcare decision making. We conducted a structured literature review to identify barriers and prioritize solutions to generating economic evidence for tumor-agnostic therapies. METHODS We searched MEDLINE and Embase for English-language studies conducting economic evaluations of tumor-agnostic treatments or exploring related challenges and solutions. We included studies published by December 2022 and supplemented our review with Canadian Agency for Drugs and Technologies in Health and National Institute for Health and Care Excellence technical reports for approved tumor-agnostic therapies. Three reviewers abstracted and summarized key methodological and empirical study characteristics. Challenges and solutions were identified through authors' statements and categorized using directed content analysis. RESULTS Twenty-six studies met our inclusion criteria. Studies spanned economic evaluations (n = 5), reimbursement reviews (n = 4), qualitative research (n = 1), methods validations (n = 3), and commentaries or literature reviews (n = 13). Challenges encountered related to (1) the treatment setting and clinical trial designs, (2) a lack of data or low-quality data on clinical and cost parameters, and (3) an inability to produce evidence that meets HTA guidelines. Although attempted solutions centered on analytic approaches for managing missing data, proposed solutions highlighted the need for real-world evidence combined with life-cycle HTA to reduce future evidentiary uncertainty. CONCLUSIONS Therapeutic innovation outpaces HTA evidence generation and the methods that support it. Existing HTA frameworks must be adapted for tumor-agnostic treatments to support future economic evaluations enabling timely patient access.
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Affiliation(s)
| | | | - Halina Lam
- Cancer Control Research, BC Cancer, Vancouver, Canada
| | - Emanuel Krebs
- Cancer Control Research, BC Cancer, Vancouver, Canada
| | - Dean A Regier
- Cancer Control Research, BC Cancer, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada.
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Grimm SE, Pouwels XGLV, Ramaekers BLT, Wijnen B, Grutters J, Joore MA. Response to "UNCERTAINTY MANAGEMENT IN REGULATORY AND HEALTH TECHNOLOGY ASSESSMENT DECISION-MAKING ON DRUGS: GUIDANCE OF THE HTAi-DIA WORKING GROUP". Int J Technol Assess Health Care 2023; 39:e70. [PMID: 37822085 DOI: 10.1017/s026646232300260x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- Sabine Elisabeth Grimm
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre and Maastricht Health Economics and Technology Assessment Centre, School for Public Health and Primary Care (CAPHRI), Maastricht, The Netherlands
| | - Xavier G L V Pouwels
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Bram L T Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre and Maastricht Health Economics and Technology Assessment Centre, School for Public Health and Primary Care (CAPHRI), Maastricht, The Netherlands
| | - Ben Wijnen
- Trimbos-instituut, Utrecht, The Netherlands
| | - Janneke Grutters
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre and Maastricht Health Economics and Technology Assessment Centre, School for Public Health and Primary Care (CAPHRI), Maastricht, The Netherlands
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Goldhaber-Fiebert JD, Cipriano LE. Pricing Treatments Cost-Effectively when They Have Multiple Indications: Not Just a Simple Threshold Analysis. Med Decis Making 2023; 43:914-929. [PMID: 37698120 PMCID: PMC10625719 DOI: 10.1177/0272989x231197772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/19/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Economic evaluations of treatments increasingly employ price-threshold analyses. When a treatment has multiple indications, standard price-threshold analyses can be overly simplistic. We examine how rules governing indication-specific prices and reimbursement decisions affect value-based price analyses. METHODS We analyze a 2-stage game between 2 players: the therapy's manufacturer and the payer purchasing it for patients. First, the manufacturer selects a price(s) that may be indication specific. Then, the payer decides whether to provide reimbursement at the offered price(s). We assume known indication-specific demand. The manufacturer seeks to maximize profit. The payer seeks to maximize total population incremental net monetary benefit and will not pay more than their willingness-to-pay threshold. We consider game variants defined by constraints on the manufacturer's ability to price and payer's ability to provide reimbursement differentially by indication. RESULTS When both the manufacturer and payer can make indication-specific decisions, the problem simplifies to multiple single-indication price-threshold analyses, and the manufacturer captures all the consumer surplus. When the manufacturer is restricted to one price and the payer must make an all-or-nothing reimbursement decision, the selected price is a weighted average of indication-specific threshold prices such that reimbursement of more valuable indications subsidizes reimbursement of less valuable indications. With a single price and indication-specific coverage decisions, the manufacturer may select a high price where fewer patients receive treatment because the payer restricts reimbursement to the set of indications providing value commensurate with the high price. However, the manufacturer may select a low price, resulting in reimbursement for more indications and positive consumer surplus. CONCLUSIONS When treatments have multiple indications, economic evaluations including price-threshold analyses should carefully consider jurisdiction-specific rules regarding pricing and reimbursement decisions. HIGHLIGHTS With treatment prices rising, economic evaluations increasingly employ price-threshold analyses to identify value-based prices. Standard price-threshold analyses can be overly simplistic when treatments have multiple indications.Jurisdiction-specific rules governing indication-specific prices and reimbursement decisions affect value-based price analyses.When the manufacturer is restricted to one price for all indications and the payer must make an all-or-nothing reimbursement decision, the selected price is a weighted average of indication-specific threshold prices such that reimbursement of the more valuable indications subsidize reimbursement of the less valuable indications.With a single price and indication-specific coverage decisions, the manufacturer may select a high price with fewer patients treated than in the first-best solution. There are also cases in which the manufacturer selects a lower price, resulting in reimbursement for more indications and positive consumer surplus.
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Affiliation(s)
- Jeremy D. Goldhaber-Fiebert
- Department of Health Policy and Center for Health Policy, Stanford School of Medicine and Freeman Spogli Institute, Stanford University, Stanford, CA, USA
| | - Lauren E. Cipriano
- Ivey Business School and Departments of Epidemiology & Biostatistics and Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
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Myung JE, Strachan L, Shin J, Yim J, Lee SS. Reimbursement Coverage Decision Making for Digital Health Technologies in South Korea: Does It Fit the Value Framework Used in Traditional Medical Technologies? Value Health Reg Issues 2023; 36:27-33. [PMID: 37019064 DOI: 10.1016/j.vhri.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 01/02/2023] [Accepted: 02/22/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES The introduction of digital health technologies (DHTs) that have the potential to improve health outcomes and lower the costs of healthcare services has seen an explosion in recent years. Indeed, the expectation that these innovative technologies can ultimately fill a gap in the patient-healthcare provider model of care with the hope of bending the continuously increasing healthcare expenditure curve has not yet been realized in many countries including South Korea (from herein referred to as Korea). We examine reimbursement coverage decision making status for DHTs in South Korea. METHODS We examine the regulatory landscape, health technology assessment process, and reimbursement coverage determination for DHTs in Korea. RESULTS We identified the specific challenges and opportunities for reimbursement coverage of DHTs. CONCLUSIONS To ensure DHTs can be used effectively in medical practice, a more flexible and nontraditional approach to assessment, reimbursement, and payment determination is required.
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Kim S, Lee JY, Cho SH, Shin EJ, Kim M, Lee JH. An Industry Survey on Unmet Needs in South Korea's New Drug Listing System. Ther Innov Regul Sci 2023; 57:759-768. [PMID: 37183236 DOI: 10.1007/s43441-023-00531-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/28/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Since introducing the positive listing system in 2007, the South Korean government has undergone multiple changes in its drug listing system. As there is a lack of studies that evaluate the system from an industry perspective, this paper examined South Korea's new drug listing system from the suppliers' perspective. METHODS We surveyed members of the three main pharmaceutical industry associations online. The survey (a 5-point Likert scale) covered their satisfactory levels, demands, and updates on the current new drug listing system, especially pharmacoeconomic evaluation, pharmacoeconomic evaluation exemption, and risk-sharing agreement. RESULTS A total of 56 respondents participated in the survey. The self-reported satisfaction level for value recognition of new drugs was 1.6 (± 0.7) points (5 points = very satisfied). The most highly demanded reforms for PE, RSA, and PEE were incremental cost-effectiveness ratio threshold (92.9%), reimbursement scope expansion (91.1%), and eligible disease (83.9%). Lastly, they also claimed that the indication-based pricing system must be introduced (83.9%). CONCLUSIONS Pricing and reimbursement policies need to improve in such a way that would enable better access to new drugs while still facilitating their development. Given the nature of the current system, some innovative rare disease treatments and anticancer drugs remain unreimbursed, resulting in low satisfaction levels across the pharmaceutical industry. Hence, pathways to speed up the reimbursement assessment process and expand the range of reimbursable diseases are required. Pharmaceutical companies are also important stakeholders, like in the case of clinicians and patients, and their opinions should also be considered in the process of pricing and reimbursement policy reforms.
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Affiliation(s)
- Sungju Kim
- Healthcare Group, Lee & Ko, Seoul, 04532, Republic of Korea
| | - Ji Yeon Lee
- Healthcare Group, Lee & Ko, Seoul, 04532, Republic of Korea
| | - Seong Ha Cho
- College of Pharmacy, Chung-Ang University, Seoul, 06974, Republic of Korea
| | - Eileen J Shin
- Healthcare Group, Lee & Ko, Seoul, 04532, Republic of Korea
| | - Minyoung Kim
- College of Pharmacy, Chung-Ang University, Seoul, 06974, Republic of Korea
| | - Jong Hyuk Lee
- College of Pharmacy, Chung-Ang University, Seoul, 06974, Republic of Korea.
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Healthcare Systems across Europe and the US: The Managed Entry Agreements Experience. Healthcare (Basel) 2023; 11:healthcare11030447. [PMID: 36767022 PMCID: PMC9914690 DOI: 10.3390/healthcare11030447] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/27/2022] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
This systematic study aims at analyzing the differences between the approach of the European healthcare systems to the pharmaceutical market and the American one. This paper highlights the opportunities and the limitations given by the application of managed entry agreements (MEAs) in European countries as opposed to the American market, which does not regulate pharmaceutical prices. Data were collected from the Organisation for Economic Co-operation and Development (OECD), the European Medicines Agency, and the national healthcare agencies of US and European countries. A literature review was undertaken in PubMed, Scopus, MEDLINE, and Google for a period ten years (2010-2019). The period 2020-2021 was considered to compare health expenditure before and after the SARS-CoV-2 pandemic. Scarce information from national agencies has been given in terms of MEAs related to the COVID-19 pandemic. The comparison between the United States approach and the European one shows the importance of a market access regulation to reduce the cost of therapies, increasing the efficiency of national healthcare systems and the advantages in terms of quality and accessibility to the final users: patients. Nevertheless, it seems that the golden age of MEAs for Europe was during the examined period. Except for Italy, countries will move to other forms of reimbursements to obtain higher benefits, reducing the costs of an inefficient implementation and outcomes in the medium term.
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13
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Drummond M, Federici C, Reckers‐Droog V, Torbica A, Blankart CR, Ciani O, Kaló Z, Kovács S, Brouwer W. Coverage with evidence development for medical devices in Europe: Can practice meet theory? HEALTH ECONOMICS 2022; 31 Suppl 1:179-194. [PMID: 35220644 PMCID: PMC9545598 DOI: 10.1002/hec.4478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/26/2021] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Abstract
Health economists have written extensively on the design and implementation of coverage with evidence development (CED) schemes and have proposed theoretical frameworks based on cost-effectiveness modeling and value of information analysis. CED may aid decision-makers when there is uncertainty about the (cost-)effectiveness of a new health technology at the time of reimbursement. Medical devices are potential candidates for CED schemes, as regulatory regimes do not usually require the same level of efficacy and safety data normally needed for pharmaceuticals. The purpose of this research is to assess whether the actual practice of CED for medical devices in Europe meets the theoretical principles proposed by health economists and whether theory and practice can be more closely aligned. Based on decision-makers' perceptions of the challenges associated with CED schemes, plus examples from the schemes themselves, we discuss a series of proposals for assessing the desirability of schemes, their design, implementation, and evaluation. These proposals, while reflecting the practical challenges with developing CED programs, embody many of the principles suggested by economists and should support decision-makers in dealing with uncertainty about the real-world performance of devices.
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Affiliation(s)
| | - Carlo Federici
- Centre for Research on Health and Social Care Management (CERGAS)Universitá BocconiMilanItaly
- School of EngineeringUniversity of WarwickCoventryUK
| | - Vivian Reckers‐Droog
- Erasmus School of Health Policy & ManagementErasmus UniversityRotterdamThe Netherlands
| | - Aleksandra Torbica
- Centre for Research on Health and Social Care Management (CERGAS)Universitá BocconiMilanItaly
| | - Carl Rudolf Blankart
- Kompetenzzentrum für Public ManagementUniversität BernBernSwitzerland
- Swiss Institute for Translational and Entrepreneurial MedicineBernSwitzerland
| | - Oriana Ciani
- Centre for Research on Health and Social Care Management (CERGAS)Universitá BocconiMilanItaly
| | - Zoltán Kaló
- Syreon Research InstituteBudapestHungary
- Centre for Health Technology AssessmentSemmelweis UniversityBudapestHungary
| | | | - Werner Brouwer
- Erasmus School of Health Policy & ManagementErasmus UniversityRotterdamThe Netherlands
- Erasmus School of EconomicsErasmus University RotterdamRotterdamThe Netherlands
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Jackson CH, Baio G, Heath A, Strong M, Welton NJ, Wilson EC. Value of Information Analysis in Models to Inform Health Policy. ANNUAL REVIEW OF STATISTICS AND ITS APPLICATION 2022; 9:95-118. [PMID: 35415193 PMCID: PMC7612603 DOI: 10.1146/annurev-statistics-040120-010730] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Value of information (VoI) is a decision-theoretic approach to estimating the expected benefits from collecting further information of different kinds, in scientific problems based on combining one or more sources of data. VoI methods can assess the sensitivity of models to different sources of uncertainty and help to set priorities for further data collection. They have been widely applied in healthcare policy making, but the ideas are general to a range of evidence synthesis and decision problems. This article gives a broad overview of VoI methods, explaining the principles behind them, the range of problems that can be tackled with them, and how they can be implemented, and discusses the ongoing challenges in the area.
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Affiliation(s)
| | - Gianluca Baio
- Department of Statistical Science, University College London, London WC1E 6BT, United Kingdom
| | - Anna Heath
- The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Mark Strong
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, United Kingdom
| | - Nicky J. Welton
- Bristol Medical School (PHS), University of Bristol, Bristol BS8 1QU, United Kingdom
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15
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Richter BI, Parent B, Lonze BE. The Moral Necessity to Increase Access to HCV+ Transplants With Early Treatment for HCV-naive Patients. Transplantation 2022; 106:236-238. [PMID: 34342960 DOI: 10.1097/tp.0000000000003898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Benjamin I Richter
- Department of Internal Medicine, New York University Grossman School of Medicine, New York, NY
| | - Brendan Parent
- Division of Medical Ethics, Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Bonnie E Lonze
- Transplant Institute, New York University Langone Health, New York, NY
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16
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Kierkegaard P, Hicks T, Allen AJ, Yang Y, Hayward G, Glogowska M, Nicholson BD, Buckle P. Strategies to implement SARS-CoV-2 point-of-care testing into primary care settings: a qualitative secondary analysis guided by the Behaviour Change Wheel. Implement Sci Commun 2021; 2:139. [PMID: 34922624 PMCID: PMC8684208 DOI: 10.1186/s43058-021-00242-6] [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: 05/19/2021] [Accepted: 11/17/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The purpose of this study is to develop a theory-driven understanding of the barriers and facilitators underpinning physicians' attitudes and capabilities to implementing SARS-CoV-2 point-of-care (POC) testing into primary care practices. METHODS We used a secondary qualitative analysis approach to re-analyse data from a qualitative, interview study of 22 primary care physicians from 21 primary care practices across three regions in England. We followed the three-step method based on the Behaviour Change Wheel to identify the barriers to implementing SARS-CoV-2 POC testing and identified strategies to address these challenges. RESULTS Several factors underpinned primary care physicians' attitudes and capabilities to implement SARS-CoV-2 POC testing into practice. First, limited knowledge of the SARS-CoV-2 POC testing landscape and a demanding workload affected physicians' willingness to use the tests. Second, there was scepticism about the insufficient evidence pertaining to the clinical efficacy and utility of POC tests, which affected physicians' confidence in the accuracy of tests. Third, physicians would adopt POC tests if they were prescribed and recommended by authorities. Fourth, physicians required professional education and training to increase their confidence in using POC tests but also suggested that healthcare assistants should administer the tests. Fifth, physicians expressed concerns about their limited workload capacity and that extra resources are needed to accommodate any anticipated changes. Sixth, information sharing across practices shaped perceptions of POC tests and the quality of information influenced physician perceptions. Seventh, financial incentives could motivate physicians and were also needed to cover the associated costs of testing. Eighth, physicians were worried that society will view primary care as an alternative to community testing centres, which would change perceptions around their professional identity. Ninth, physicians' perception of assurance/risk influenced their willingness to use POC testing if it could help identify infectious individuals, but they were also concerned about the risk of occupational exposure and potentially losing staff members who would need to self-isolate. CONCLUSIONS Improving primary care physicians' knowledgebase of SARS-CoV-2 POC tests, introducing policies to embed testing into practice, and providing resources to meet the anticipated demands of testing are critical to implementing testing into practice.
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Affiliation(s)
- Patrick Kierkegaard
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
- CRUK Convergence Science Center, Institute for Cancer Research & Imperial College London, Roderic Hill Building, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK.
| | - Timothy Hicks
- NIHR Newcastle In Vitro Diagnostics Co-Operative, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
- Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - A Joy Allen
- NIHR Newcastle In Vitro Diagnostics Co-Operative, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
- Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Yaling Yang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
- NIHR Community Healthcare MedTech and In-Vitro Diagnostics Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
- NIHR Community Healthcare MedTech and In-Vitro Diagnostics Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Peter Buckle
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK
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17
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Grimm SE, Pouwels X, Ramaekers BLT, Wijnen B, Otten T, Grutters J, Joore MA. State of the ART? Two New Tools for Risk Communication in Health Technology Assessments. PHARMACOECONOMICS 2021; 39:1185-1196. [PMID: 34278550 PMCID: PMC8476369 DOI: 10.1007/s40273-021-01060-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 05/22/2023]
Abstract
PURPOSE Outcomes of health technology assessments (HTA) are uncertain, and decision-making is associated with a risk. This risk, consisting of the probability of making a wrong decision and its impact, is rarely considered in HTA. This hampers transparent and consistent risk assessment and management. The aim of this study was to develop risk communication tools in the context of health technology decision-making under uncertainty. METHODS We performed a scoping review of tools for uncertainty and risk communication within HTA using citation pearl-growing. We developed two tools, drawing on existing publications on risk and uncertainty communication for inspiration. Individual semi-structured interviews with HTA stakeholders were performed to identify potential improvements in usefulness, user-friendliness, and information adequacy. Tools were amended and further evaluated in a real-world HTA and workshop with HTA stakeholders. RESULTS The identified risk communication tools did not include non-quantified uncertainties, and did not link to risk management strategies. We developed two tools: the Assessment of Risk Table (ART), for a summary of quantified and non-quantified uncertainties and the resulting risk assessment, and the Appraisal of Risk Chart (ARCH), for linking net benefit and risk outcomes to appropriate risk management strategies. Stakeholders appreciated the usefulness of the tools. They also highlighted that more information on local policy options was required for optimal risk management use, and HTA processes may need adapting. CONCLUSION The risk communication tools presented here can help assess risk, facilitate communication between analysts and decision-makers, and guide the appropriate use of available risk management strategies.
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Affiliation(s)
- Sabine E Grimm
- Department of Clinical Epidemiology and Medical Technology Assessment, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Xavier Pouwels
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, University of Twente, P.O. box 217, 7500 AE, Enschede, The Netherlands
| | - Bram L T Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Ben Wijnen
- Department of Clinical Epidemiology and Medical Technology Assessment, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Thomas Otten
- Department of Clinical Epidemiology and Medical Technology Assessment, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Janneke Grutters
- Department for Health Evidence, Radboud University Medical Centre, Post 133, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
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Lee B, Bae EY, Bae S, Choi HJ, Son KB, Lee YS, Jang S, Lee TJ. How can we improve patients' access to new drugs under uncertainties? : South Korea's experience with risk sharing arrangements. BMC Health Serv Res 2021; 21:967. [PMID: 34521408 PMCID: PMC8442279 DOI: 10.1186/s12913-021-06919-x] [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: 02/17/2021] [Accepted: 08/19/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND New drugs including cancer drugs and orphan drugs are becoming increasingly more expensive. Risk sharing arrangements (RSAs) could manage the risk based on both financial impact and the health outcome of new drugs if reimbursed. To improve patients' access to new drugs under uncertainties, many developed countries have adopted RSAs. In this study, we aimed to understand the effects of RSAs in South Korea on patients' access. METHODS We reviewed current status of RSA drugs in South Korea. The number of appraisals and time gap between market approval and reimbursement per RSA drug were considered to quantify improvement of patients' access as they showed how rapidly decisions on reimbursement of RSA drugs were derived. Then, we applied a comparative analysis to determine whether the RSA drugs in South Korea were reimbursed in the UK, Italy, and Australia. Most data for this study were obtained from websites of the governmental department/agencies responsible for appraisal of drug reimbursement in each country. And literatures related to RSAs were investigated as well. RESULTS The eligibility for Korean RSAs had two key components - drugs for cancer and rare diseases and not having other alternative treatments. As of the first half of 2019, there were 39 RSA drugs reimbursed in South Korea, the majority of which were financial-based schemes. Refund and expenditure cap were the representative types (89.7%). After introduction of RSAs, the time gap and number of appraisals were decreased. Based on the indications of RSA drugs, the level of drug coverage in South Korea was found lower than Italy, similar to the UK, and higher than Australia. CONCLUSIONS RSAs in South Korea significantly enhanced patients' access to new drugs and led to the alleviation of patients' out-of-pocket expenses. The drug coverage of South Korea had a level comparable to that of other countries. This study provides implications for countries that have a dual mission of containing pharmaceutical expenditure and improving access to new drugs.
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Affiliation(s)
- Boram Lee
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Eun-Young Bae
- College of Pharmacy, Gyeongsang National University, Jinju, South Korea
| | - SeungJin Bae
- College of Pharmacy, Ewha Womans University, Seoul, South Korea
| | - Hyun-Jin Choi
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Kyung-Bok Son
- College of Pharmacy, Ewha Womans University, Seoul, South Korea
| | - Young-Sil Lee
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Suhyun Jang
- College of Pharmacy, Gachon University, Incheon, South Korea.,Institute of Pharmaceutical Sciences, Gachon University, Incheon, South Korea
| | - Tae-Jin Lee
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea. .,Institute of Health and Environment, Seoul National University, Seoul, South Korea.
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Borras JM, Corral J, Aggarwal A, Audisio R, Espinas JA, Figueras J, Naredi P, Panteli D, Pourel N, Prades J, Lievens Y. Innovation, value and reimbursement in radiation and complex surgical oncology: Time to rethink. Eur J Surg Oncol 2021; 48:967-977. [PMID: 34479744 DOI: 10.1016/j.ejso.2021.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND PURPOSE Complex surgery and radiotherapy are the central pillars of loco-regional oncology treatment. This paper describes the reimbursement schemes used in radiation and complex surgical oncology, reports on literature and policy reviews. MATERIAL AND METHODS A systematic review of the literature of the reimbursement models has been carried out separately for radiotherapy and complex cancer surgery based on PRISMA guidelines. Using searches of PubMed and grey literature, we identified articles from scientific journals and reports published since 2000 on provider payment or reimbursement systems currently used in radiation oncology and complex cancer surgery, also including policy models. RESULTS Most European health systems reimburse radiotherapy using a budget-based, fee-for-service or fraction-based system; while few reimburse services according to an episode-based model. Also, the reimbursement models for cancer surgery are mostly restricted to differences embedded in the DRG system and adjustments applied to the fees, based on the complexity of each surgical procedure. There is an enormous variability in reimbursement across countries, resulting in different incentives and different amounts paid for the same therapeutic strategy. CONCLUSION A reimbursement policy, based on the episode of care as the basic payment unit, is advocated for. Innovation should be tackled in a two-tier approach: one defining the common criteria for reimbursement of proven evidence-based interventions; another for financing emerging innovation with uncertain definitive value. Relevant clinical and economic data, also collected real-life, should support reimbursement systems that mirror the actual cost of evidence-based practice.
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Affiliation(s)
- Josep M Borras
- University of Barcelona, Spain; Catalonian Cancer Plan, Department of Health, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
| | - Julieta Corral
- Catalonian Cancer Plan, Department of Health, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Ajay Aggarwal
- Guy's and St. Thomas' Hospital NHS Trust, United Kingdom
| | - Riccardo Audisio
- Department of Surgery, Sahlgrenska University Hospital, University of Gothenburg, Sweden
| | - Josep Alfons Espinas
- Catalonian Cancer Plan, Department of Health, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Josep Figueras
- European Observatory on Health Systems and Policies, Belgium
| | - Peter Naredi
- Department of Surgery, Sahlgrenska University Hospital, University of Gothenburg, Sweden
| | - Dimitra Panteli
- Department of Health Care Management, Technische Universität Berlin, Germany
| | | | - Joan Prades
- Catalonian Cancer Plan, Department of Health, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital & Ghent University, Belgium
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20
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Innovation, value and reimbursement in radiation and complex surgical oncology: time to rethink. Radiother Oncol 2021; 169:114-123. [PMID: 34461186 DOI: 10.1016/j.radonc.2021.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE Complex surgery and radiotherapy are the central pillars of loco-regional oncology treatment. This paper describes the reimbursement schemes used in radiation and complex surgical oncology, reports on literature and policy reviews. MATERIAL AND METHODS A systematic review of the literature of the reimbursement models has been carried out separately for radiotherapy and complex cancer surgery based on PRISMA guidelines. Using searches of PubMed and grey literature, we identified articles from scientific journals and reports published since 2000 on provider payment or reimbursement systems currently used in radiation oncology and complex cancer surgery, also including policy models. RESULTS Most European health systems reimburse radiotherapy using a budget-based, fee-for-service or fraction-based system; while few reimburse services according to an episode-based model. Also, the reimbursement models for cancer surgery are mostly restricted to differences embedded in the DRG system and adjustments applied to the fees, based on the complexity of each surgical procedure. There is an enormous variability in reimbursement across countries, resulting in different incentives and different amounts paid for the same therapeutic strategy. CONCLUSION A reimbursement policy, based on the episode of care as the basic payment unit, is advocated for. Innovation should be tackled in a two-tier approach: one defining the common criteria for reimbursement of proven evidence-based interventions; another for financing emerging innovation with uncertain definitive value. Relevant clinical and economic data, also collected real-life, should support reimbursement systems that mirror the actual cost of evidence-based practice.
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21
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Grimm SE, Pouwels X, Ramaekers BLT, van Ravesteyn NT, Sankatsing VDV, Grutters J, Joore MA. Implementation Barriers to Value of Information Analysis in Health Technology Decision Making: Results From a Process Evaluation. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1126-1136. [PMID: 34372978 DOI: 10.1016/j.jval.2021.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/10/2021] [Accepted: 03/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Value of information (VOI) analysis can support health technology assessment decision making, but it is a long way from being standard use. The objective of this study was to understand barriers to the implementation of VOI analysis and propose actions to overcome these. METHODS We performed a process evaluation of VOI analysis use within decision making on tomosynthesis versus digital mammography for use in the Dutch breast cancer population screening. Based on steering committee meeting attendance and regular meetings with analysts, we developed a list of barriers to VOI use, which were analyzed using an established diffusion model. We proposed actions to address these barriers. Barriers and actions were discussed and validated in a workshop with stakeholders representing patients, clinicians, regulators, policy advisors, researchers, and the industry. RESULTS Consensus was reached on groups of barriers, which included characteristics of VOI analysis itself, stakeholder's attitudes, analysts' and policy makers' skills and knowledge, system readiness, and implementation in the organization. Observed barriers did not only pertain to VOI analysis itself but also to formulating the objective of the assessment, economic modeling, and broader aspects of uncertainty assessment. Actions to overcome these barriers related to organizational changes, knowledge transfer, cultural change, and tools. CONCLUSIONS This in-depth analysis of barriers to implementation of VOI analysis and resulting actions and tools may be useful to health technology assessment organizations that wish to implement VOI analysis in technology assessment and research prioritization. Further research should focus on application and evaluation of the proposed actions in real-world assessment processes.
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Affiliation(s)
- Sabine E Grimm
- Department of Clinical Epidemiology and Medical Technology Assessment, School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Xavier Pouwels
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands
| | - Bram L T Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment, School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Valérie D V Sankatsing
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Janneke Grutters
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
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Walker S, Fox A, Altunkaya J, Colbourn T, Drummond M, Griffin S, Gutacker N, Revill P, Sculpher M. Program Evaluation of Population- and System-Level Policies: Evidence for Decision Making. Med Decis Making 2021; 42:17-27. [PMID: 34041992 DOI: 10.1177/0272989x211016427] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Policy evaluations often focus on ex post estimation of causal effects on short-term surrogate outcomes. The value of such information is limited for decision making, as the failure to reflect policy-relevant outcomes and disregard for opportunity costs prohibits the assessment of value for money. Further, these evaluations do not always consider all relevant evidence, other courses of action, or decision uncertainty. METHODS In this article, we explore how policy evaluation could better meet the needs of decision making. We begin by defining the evidence required to inform decision making. We then conduct a literature review of challenges in evaluating policies. Finally, we highlight potential methods available to help address these challenges. RESULTS The evidence required to inform decision making includes the impacts on the policy-relevant outcomes, the costs and associated opportunity costs, and the consequences of uncertainty. Challenges in evaluating health policies are described using 8 categories: 1) valuation space; 2) comparators; 3) time of evaluation; 4) mechanisms of action; 5) effects; 6) resources, constraints, and opportunity costs; 7) fidelity, adaptation, and level of implementation; and 8) generalizability and external validity. Methods from a broad set of disciplines are available to improve policy evaluation, relating to causal inference, decision-analytic modeling, theory of change, realist evaluation, and structured expert elicitation. LIMITATIONS The targeted review may not identify all possible challenges, and the methods covered are not exhaustive. CONCLUSIONS Evaluations should provide appropriate evidence to inform decision making. There are challenges in evaluating policies, but methods from multiple disciplines are available to address these challenges. IMPLICATIONS Evaluators need to carefully consider the decision being informed, the necessary evidence to inform it, and the appropriate methods.[Box: see text].
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Affiliation(s)
- Simon Walker
- Centre for Health Economics, University of York, York, UK
| | - Aimee Fox
- Adelphi Values, Bollington, Cheshire, UK
| | - James Altunkaya
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Tim Colbourn
- Institute for Global Health, University College London, London, UK
| | - Mike Drummond
- Centre for Health Economics, University of York, York, UK
| | - Susan Griffin
- Centre for Health Economics, University of York, York, UK
| | - Nils Gutacker
- Centre for Health Economics, University of York, York, UK
| | - Paul Revill
- Centre for Health Economics, University of York, York, UK
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
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Thomson S, Witzke N, Gyawali B, Delos Santos S, Udayakumar S, Cardone C, Cheung MC, Chan KKW. Assessing the benefit of cancer drugs approved by the European Medicines Agency using the European Society for Medical Oncology Magnitude of Clinical Benefit Scale over time. Eur J Cancer 2021; 150:203-210. [PMID: 33932727 DOI: 10.1016/j.ejca.2021.03.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/20/2021] [Accepted: 03/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Increasingly, cancer drugs are being approved based on surrogate measurements of efficacy. Clinically meaningful data, such as overall survival (OS) and quality of life, are often only presented in subsequent publications. We examined if the clinical benefit of cancer drugs, as measured by the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS), improves post-European Medicines Agency (EMA) approval as more data emerges. METHODS Cancer drug indications approved by the EMA from January 2006 to December 2016 were reviewed and trials cited for efficacy were identified. Primary and subsequent publications (up to December 2019) of scorable trials were included. Changes in benefit over time were measured using ESMO-MCBS thresholds for non-curative (≥4 for substantial, =3 for intermediate and ≤2 for low benefit) and curative intent (A or B for major benefit) scoring. RESULTS Fifty-five non-curative and two curative intent trials were included. At approval, 29.1% of non-curative trials were substantial, 45.5% intermediate and 25.5% low benefit. For curative intent trials, one displayed major benefit and one displayed no major benefit. We identified 82 subsequent publications for reassessment. A change in ESMO-MCBS classification was seen in 34.5% of non-curative trials (11 raised and 8 lowered). At 3-year reassessment, 36.4% of non-curative trials were substantial, 34.5% intermediate and 29.1% low benefit. Both curative trials showed no major benefit at reassessment. CONCLUSION As over a third of trials changed classification, in either direction, reassessing the ESMO-MCBS score of approved cancer drugs may help to inform patients and ensure ongoing relevance of regulatory and reimbursement decisions.
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Affiliation(s)
- Sasha Thomson
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Noah Witzke
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Bishal Gyawali
- Department of Oncology, Department of Public Health Sciences and Division of Cancer Care and Epidemiology, Queen's University, Kingston, Ontario, Canada
| | - Seanthel Delos Santos
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Suji Udayakumar
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Claudia Cardone
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Napoli, Italy
| | - Matthew C Cheung
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Evaluative Clinical Sciences, Odette Cancer Centre Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada.
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Grimm SE, Pouwels X, Ramaekers BLT, Wijnen B, Knies S, Grutters J, Joore MA. Building a trusted framework for uncertainty assessment in rare diseases: suggestions for improvement (Response to "TRUST4RD: tool for reducing uncertainties in the evidence generation for specialised treatments for rare diseases"). Orphanet J Rare Dis 2021; 16:62. [PMID: 33522936 PMCID: PMC7849113 DOI: 10.1186/s13023-020-01666-4] [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: 08/19/2020] [Accepted: 12/22/2020] [Indexed: 01/21/2023] Open
Abstract
The aim of this letter to the editor is to provide a comprehensive summary of uncertainty assessment in Health Technology Assessment, with a focus on transferability to the setting of rare diseases. The authors of "TRUST4RD: tool for reducing uncertainties in the evidence generation for specialised treatments for rare diseases" presented recommendations for reducing uncertainty in rare diseases. Their article is of great importance but unfortunately suffers from a lack of references to the wider uncertainty in Health Technology Assessment and research prioritisation literature and consequently fails to provide a trusted framework for decision-making in rare diseases. In this letter to the editor we critique the authors' tool and provide pointers as to how their proposal can be strengthened. We present references to the literature, including our own tool for uncertainty assessment (TRUST; unrelated to the authors' research), apply TRUST to two assessments of orphan drugs in rare diseases and provide a broader perspective on uncertainty and risk management in rare diseases, including a detailed research agenda.
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Affiliation(s)
- Sabine E Grimm
- Department of Clinical Epidemiology and Medical Technology Assessment, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, Netherlands.
| | - Xavier Pouwels
- University of Twente, Hallenweg 5, 7522 NH, Enschede, Netherlands
| | - Bram L T Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, Netherlands
| | - Ben Wijnen
- Department of Clinical Epidemiology and Medical Technology Assessment, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, Netherlands
| | - Saskia Knies
- Zorginstituut Nederland, Eekholt 4, 1112 XH, Diemen, Netherlands
| | - Janneke Grutters
- Department for Health Evidence, Radboud University Medical Centre, Post 133, PO Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, Netherlands
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Kim AE, Choi DH, Chang J, Kim SH. Performance-Based Risk-Sharing Arrangements (PBRSA): Is it a Solution to Increase Bang for the Buck for Pharmaceutical Reimbursement Strategy for Our Nation and Around the World? Clin Drug Investig 2020; 40:1107-1113. [PMID: 33037566 PMCID: PMC7546145 DOI: 10.1007/s40261-020-00972-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2020] [Indexed: 12/05/2022]
Abstract
Due to the risks involved in not achieving desired health outcomes for the dollar spent on drugs, healthcare decision makers, including payers, providers, drug manufacturers, and patients, need a mechanism to share this financial risk among the involved parties. Performance-based risk-sharing arrangements (PBRSAs) are agreements that can potentially reduce the ‘drug lag’ in which patients wait for an unknown amount of time until a particular drug is covered under their health plan. In addition, PBRSAs can mitigate the risk of investing heavily in drugs that are ineffective or do not deliver good value or “bang for the buck”. This review describes and evaluates PBRSAs for drugs in the USA and juxtaposes to other developed nations (i.e. Germany) that adopted PBRSAs in their healthcare model. There are different types of outcomes-based health schemes, namely conditional coverage, which can be further broken down into coverage with evidence development (CED), conditional treatment continuation (CTC), and performance-linked reimbursement, which includes outcomes guarantees. Both CED and CTC are ‘conditional’ on the collected evidence of the new drug’s effectiveness, offering discount only if the drug delivers desirable results. The outcomes guarantee scheme offers discount or even a full refund if the outcome is less than expected, forcing the drug to meet the expected effectiveness. The USA can follow the German reference pricing model in which the assessment of new drugs is centralized and done collectively by representatives from a group of healthcare decision makers. In any shape or form, PBRSA is a clever mechanism to cope with uncertainty if drug price is scaled appropriately based on value.
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Affiliation(s)
- Andy Eunwoo Kim
- Shenandoah University Bernard J. Dunn School of Pharmacy, 1775 North Sector Ct, Winchester, VA, 22601, USA
| | - David Hohyun Choi
- Torrid Inc., 18501 East San Jose Ave, City of Industry, CA, 91748, USA
| | - Jongwha Chang
- University of Texas at El Paso School of Pharmacy, 500 West University Avenue, El Paso, TX, 79968, USA
| | - Sean Hyungwoo Kim
- Shenandoah University Bernard J. Dunn School of Pharmacy, 1775 North Sector Ct, Winchester, VA, 22601, USA.
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International experience with performance-based risk-sharing arrangements: implications for the Chinese innovative pharmaceutical market. Int J Technol Assess Health Care 2020; 36:486-491. [PMID: 32962784 DOI: 10.1017/s0266462320000653] [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: 11/06/2022]
Abstract
OBJECTIVES Various forms of outcomes-based or risk-sharing agreements have been implemented since early 2000s as a way of access to innovative medicinal products. This study aims to summarize the international experience of performance-based risk-sharing arrangements (PBRSAs) and identify the preconditions for a successful implementation of such schemes. Their implications for the Chinese healthcare market are discussed. METHODS A systematic literature review (in PubMed) was conducted to review the evidence on the nature and performance of PBRSAs in the past 10 years. Grey literature was searched for reports in government websites of the countries in scope. RESULTS The search identifies 463 records from PubMed and 3 additional records from other sources. Thirty-one publications are included in the final review. The following preconditions were identified to support a successful implementation of PBRSAs: (1) Identify meaningful and feasible outcome measurements; (2) Establish an effective and efficient data collection infrastructure; (3) Control of the implementation costs; (4) Develop governance and administrative infrastructure to allow delisting and rebate/refund; (5) Clarify personal data protection issues. CONCLUSIONS The implementation of PBRSAs has proven to be challenging. Although the Chinese healthcare system is not yet well equipped to implement such schemes, some recent changes may pave the way to successful PBRSAs for particular innovative products.
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Kim S, Lee JH. Price-Cutting Trends in New Drugs after Listing in South Korea: The Effect of the Reimbursement Review Pathway on Price Reduction. Healthcare (Basel) 2020; 8:healthcare8030233. [PMID: 32722530 PMCID: PMC7551345 DOI: 10.3390/healthcare8030233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 01/29/2023] Open
Abstract
This study aims to analyze the trends of post-listing price changes for new drugs listed from 2007, when the health technology assessment (HTA) was introduced in South Korea, until 2017. We analyzed 135 products that have undergone price cuts. These products were analyzed by their respective review pathways, namely, pharmaco-economic study (PE), weighted average price (WAP), and the without a cost-effectiveness (CE) pathway. Prices were discounted faster in PE than in WAP (p = 0.002 in a comparison between PE and WAP). In addition, the median discount rate of the first price cut was 5.0% (range: 0.1–20.0) for PE, 3.0% (range: <0.1–30.0) for WAP, and 5.0% (range: 0.6–10.9) without a CE pathway. The median cumulative discount rate of PE and WAP showed that the PE pathway products’ discount rates were higher: 10.4% for PE and 6.0% for WAP (p = 0.025 for comparison between PE and WAP). It is necessary to discuss the practical effects of the price-cutting system from a myriad of perspectives, including insurance finance, the value of new drugs, and the accessibility of new drugs to patients.
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Affiliation(s)
- Sungju Kim
- Healthcare Group, Lee & Ko, Seoul 04532, Korea;
| | - Jong Hyuk Lee
- Department of Pharmaceutical Engineering, College of Life and Health Sciences, Hoseo University, Asan 31499, Korea
- Correspondence: ; Tel.: +82-41-540-9814
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Al-Omar HA, Alghannam HH, Aljuffali IA. Exploring the status and views of managed entry agreements in Saudi Arabia: mixed-methods approach. Expert Rev Pharmacoecon Outcomes Res 2020; 21:837-845. [DOI: 10.1080/14737167.2020.1792295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Hussain Abdulrahman Al-Omar
- Assistant Professor of Pharmacoeconomics and HCPs Behavior, Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Advisor for Health Technology Assessment Initiative, Vision Realization Office, Ministry of Health, Riyadh, Saudi Arabia
| | - Hawra Hussain Alghannam
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Abdulrahman Aljuffali
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Advisor to the Minister of Health for Pharmaceutical Sector Development, Chief Strategic Purchasing Officer, Program for Health Assurance and Purchasing of Health Services (PHAP), Ministry of Health, Riyadh, Saudi Arabia
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Challenges with coverage with evidence development schemes for medical devices: A systematic review. HEALTH POLICY AND TECHNOLOGY 2020. [DOI: 10.1016/j.hlpt.2020.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lorgelly PK, Adler A. Impact of a Global Pandemic on Health Technology Assessment. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:339-343. [PMID: 32377982 PMCID: PMC7202921 DOI: 10.1007/s40258-020-00590-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Affiliation(s)
- Paula K Lorgelly
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Amanda Adler
- Diabetes Trial Unit, University of Oxford, Oxford, UK
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Dabbous M, Chachoua L, Caban A, Toumi M. Managed Entry Agreements: Policy Analysis From the European Perspective. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:425-433. [PMID: 32327159 DOI: 10.1016/j.jval.2019.12.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/05/2019] [Accepted: 12/27/2019] [Indexed: 05/05/2023]
Abstract
BACKGROUND Mounting pressures on the healthcare system, such as budget constraints and new, costly health technologies reaching the market, have pushed payers and manufacturers to engage in managed entry agreements (MEAs) to address uncertainty and facilitate market access. OBJECTIVES This study was conducted to illustrate the current landscape of MEAs in Europe and to analyze the main hurdles they face in implementation, providing a policy perspective. METHODS We conducted a health policy analysis based on a literature review and described the emergence, classification, current use, and implementation obstacles of MEAs in Europe. RESULTS Throughout Europe, uncertainty and high prices of health technologies have pushed stakeholders towards MEAs. Two main types of MEAs were applied heavily, finance-based agreements (FBAs) and performance-based agreements, including individual performance-based agreements and coverage with evidence development (CED). Service-based agreements have not been as heavily considered so far, yet are increasingly used. Many European countries are turning to CEDs to address uncertainty and facilitate market access while negotiating the pricing and reimbursement rates of products. Despite the interest in CEDs, European countries have moved toward FBAs due to the complexities and burdens associated with PBAs. CONCLUSIONS Ultimately, in Europe, with the exception of Italy, where MEAs have proven to be inefficient, MEAs are predominantly FBAs dedicated to addressing cost containment from payers' perspective and external reference pricing from the manufacturers' perspective. It has been speculated that MEAs will disappear in the medium-term as they are counterproductive for extending patient access and emergence of innovation. To inform value-based decision making and allow early access to innovative medicines, CEDs should be revisited.
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Cipriani A, Ioannidis JPA, Rothwell PM, Glasziou P, Li T, Hernandez AF, Tomlinson A, Simes J, Naci H. Generating comparative evidence on new drugs and devices after approval. Lancet 2020; 395:998-1010. [PMID: 32199487 DOI: 10.1016/s0140-6736(19)33177-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/11/2019] [Accepted: 12/17/2019] [Indexed: 01/19/2023]
Abstract
Certain limitations of evidence available on drugs and devices at the time of market approval often persist in the post-marketing period. Often, post-marketing research landscape is fragmented. When regulatory agencies require pharmaceutical and device manufacturers to conduct studies in the post-marketing period, these studies might remain incomplete many years after approval. Even when completed, many post-marketing studies lack meaningful active comparators, have observational designs, and might not collect patient-relevant outcomes. Regulators, in collaboration with the industry and patients, ought to ensure that the key questions unanswered at the time of drug and device approval are resolved in a timely fashion during the post-marketing phase. We propose a set of seven key guiding principles that we believe will provide the necessary incentives for pharmaceutical and device manufacturers to generate comparative data in the post-marketing period. First, regulators (for drugs and devices), notified bodies (for devices in Europe), health technology assessment organisations, and payers should develop customised evidence generation plans, ensuring that future post-approval studies address any limitations of the data available at the time of market entry impacting the benefit-risk profiles of drugs and devices. Second, post-marketing studies should be designed hierarchically: priority should be given to efforts aimed at evaluating a product's net clinical benefit in randomised trials compared with current known effective therapy, whenever possible, to address common decisional dilemmas. Third, post-marketing studies should incorporate active comparators as appropriate. Fourth, use of non-randomised studies for the evaluation of clinical benefit in the post-marketing period should be limited to instances when the magnitude of effect is deemed to be large or when it is possible to reasonably infer the comparative benefits or risks in settings, in which doing a randomised trial is not feasible. Fifth, efficiency of randomised trials should be improved by streamlining patient recruitment and data collection through innovative design elements. Sixth, governments should directly support and facilitate the production of comparative post-marketing data by investing in the development of collaborative research networks and data systems that reduce the complexity, cost, and waste of rigorous post-marketing research efforts. Last, financial incentives and penalties should be developed or more actively reinforced.
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Affiliation(s)
- Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
| | - John P A Ioannidis
- Meta-Research Innovation Center at Stanford, and Departments of Medicine, Departments of Health Research and Policy, Departments of Biomedical Data Science, and Departments of Statistics, Stanford University, Palo Alto, CA, USA
| | - Peter M Rothwell
- Centre for the Prevention of Stroke and Dementia, University of Oxford, Oxford, UK
| | - Paul Glasziou
- Centre for Research in Evidence-Based Practice, University of Bond, Queensland, Australia
| | - Tianjing Li
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Anneka Tomlinson
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - John Simes
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, UK
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Fenwick E, Steuten L, Knies S, Ghabri S, Basu A, Murray JF, Koffijberg HE, Strong M, Sanders Schmidler GD, Rothery C. Value of Information Analysis for Research Decisions-An Introduction: Report 1 of the ISPOR Value of Information Analysis Emerging Good Practices Task Force. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:139-150. [PMID: 32113617 DOI: 10.1016/j.jval.2020.01.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/05/2020] [Indexed: 05/22/2023]
Abstract
Healthcare resource allocation decisions made under conditions of uncertainty may turn out to be suboptimal. In a resource constrained system in which there is a fixed budget, these suboptimal decisions will result in health loss. Consequently, there may be value in reducing uncertainty, through the collection of new evidence, to make better resource allocation decisions. This value can be quantified using a value of information (VOI) analysis. This report, from the ISPOR VOI Task Force, introduces VOI analysis, defines key concepts and terminology, and outlines the role of VOI for supporting decision making, including the steps involved in undertaking and interpreting VOI analyses. The report is specifically aimed at those tasked with making decisions about the adoption of healthcare or the funding of healthcare research. The report provides a number of recommendations for good practice when planning, undertaking, or reviewing the results of VOI analyses.
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Affiliation(s)
| | | | - Saskia Knies
- National Health Care Institute (Zorginstituut Nederland), Diemen, The Netherlands
| | - Salah Ghabri
- French National Authority for Health, Paris, France
| | - Anirban Basu
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - James F Murray
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Indianapolis, IN, USA
| | - Hendrik Erik Koffijberg
- Department of Health Technology & Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Mark Strong
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - Gillian D Sanders Schmidler
- Duke-Margolis Center for Health Policy, Duke Clinical Research Institute and Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Claire Rothery
- Centre for Health Economics, University of York, York, England, UK
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McCabe C, Paulden M, Awotwe I, Sutton A, Hall P. One-Way Sensitivity Analysis for Probabilistic Cost-Effectiveness Analysis: Conditional Expected Incremental Net Benefit. PHARMACOECONOMICS 2020; 38:135-141. [PMID: 31840216 PMCID: PMC6977148 DOI: 10.1007/s40273-019-00869-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Although probabilistic analysis has become the accepted standard for decision analytic cost-effectiveness models, deterministic one-way sensitivity analysis continues to be used to meet the need of decision makers to understand the impact that changing the value taken by one specific parameter has on the results of the analysis. The value of a probabilistic form of one-way sensitivity analysis has been recognised, but the proposed methods are computationally intensive. Deterministic one-way sensitivity analysis provides decision makers with biased and incomplete information whereas, in contrast, probabilistic one-way sensitivity analysis (POSA) can overcome these limitations, an observation supported in this study by results obtained when these methods were applied to a previously published cost-effectiveness analysis to produce a conditional incremental expected net benefit curve. The application of POSA will provide decision makers with unbiased information on how the expected net benefit is affected by a parameter taking on a specific value and the probability that the specific value will be observed.
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Affiliation(s)
- Christopher McCabe
- Institute of Health Economics, 1200, 10405 Jasper Avenue, Edmonton, AB, Canada
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Mike Paulden
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Isaac Awotwe
- Department of Economics, University of Alberta, Edmonton, AB, Canada
| | - Andrew Sutton
- Institute of Health Economics, 1200, 10405 Jasper Avenue, Edmonton, AB, Canada.
| | - Peter Hall
- Department of Oncology, University of Edinburgh, Edinburgh, UK
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Triki N, Ash N, Porath A, Birnbaum Y, Greenberg D, Hammerman A. Risk sharing or risk shifting? On the development of patient access schemes in the process of updating the national list of health services in Israel. Expert Rev Pharmacoecon Outcomes Res 2019; 19:749-753. [PMID: 31825682 DOI: 10.1080/14737167.2019.1702525] [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] [Indexed: 10/25/2022]
Abstract
Background: Agreements between payers and pharmaceutical/medical device companies are widely implemented to address financial and clinical uncertainties. We analyzed the main characteristics of these agreements in Israel from 2011-2018.Research design and methods: We reviewed all agreements implemented during the study period. Information regarding the type of agreement, therapeutic indications, its time frame and the total budget involved are presented.Results: A total of 56 agreements were signed since 2011, of which 53 (95%) were financial-based and 50 (89%) referred to pharmaceuticals. The annual number of agreements increased from one in 2011 to 21 in 2018. The main therapeutic areas covered were: oncology (41%), hepatitis C (16%), neurology (11%), respiratory (9%), and cardiovascular (7%). The proportion of the annual budget allocated subject to these agreements increased accordingly from 3% in 2011 to 73% in 2018. The majority (63%) of the agreements were signed for 5 years, 9% were shorter-term and 20% have no time-limit. In 14 (44%) of the financial-based agreements implemented through 2017, the actual utilization exceeded the pre-specified threshold and the companies reimbursed the health-plans accordingly.Conclusions: The number of agreements and the allocated budget subject to these agreements increased substantially in recent years. Most agreements are financial-based that, in many cases, shifted the short-term financial risk from health-plans to the industry.
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Affiliation(s)
- Noa Triki
- Department of Health Technology Policy, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Nachman Ash
- Medical Division, Maccabi Healthcare Services, Tel-Aviv, Israel.,The Department of Health Systems Management, Ariel University, Ariel, Israel
| | - Avi Porath
- Department of Public Health, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Yair Birnbaum
- Clalit Health Services Headquarters, Tel-Aviv, Israel
| | - 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
| | - Ariel Hammerman
- Department of Pharmaceutical Technology Assessment, Clalit Health Services Headquarters, Tel-Aviv, Israel
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Antonanzas F, Juárez-Castelló C, Lorente R, Rodríguez-Ibeas R. The Use of Risk-Sharing Contracts in Healthcare: Theoretical and Empirical Assessments. PHARMACOECONOMICS 2019; 37:1469-1483. [PMID: 31535280 DOI: 10.1007/s40273-019-00838-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The aim of this review is to provide a summary of the literature on risk-sharing agreements, including conceptual, theoretical and empirical (number of agreements and their achievements) perspectives, and stakeholders' perceptions. METHODS We conducted a systematic literature search in MEDLINE from 2000 to April 2019, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology, and completed it with a manual search of other publications (mainly grey literature). The search was restricted to publications with English abstracts; the initial identification of articles was restricted to the title, abstract and key words fields. The geographical scope was not restricted. RESULTS Over 20 studies proposed different taxonomies of risk-sharing contracts, which can be summarised as financial and paying-for-performance agreements. Theoretical studies modelling the incentives to implement risk-sharing agreements are scarce; they addressed different types of contracts and regulatory contexts, characterizing the drug prices and the optimal strategies of the involved agents. Empirical studies describing specific agreements are abundant and referred to different geographical contexts; however, few articles showed the economic results and assessed the value of such contracts. Stakeholders' perceptions of risk-sharing contracting were favourable, but little is known about the economic and clinical advantages of specific agreements. Whether risk-sharing contracts have yielded the desired results for healthcare systems remains uncertain. CONCLUSION Risk-sharing contracts are increasingly used, although the lack of transparency and aggregated registries makes it difficult to learn from these experiences and assess their impact on healthcare systems.
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Affiliation(s)
| | | | - Reyes Lorente
- Department of Economics, University of La Rioja, Logroño, Spain
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Grimm SE, Fayter D, Ramaekers BLT, Petersohn S, Riemsma R, Armstrong N, Pouwels X, Witlox W, Noake C, Worthy G, Kleijnen J, Joore MA. Pembrolizumab for Treating Relapsed or Refractory Classical Hodgkin Lymphoma: An Evidence Review Group Perspective of a NICE Single Technology Appraisal. PHARMACOECONOMICS 2019; 37:1195-1207. [PMID: 30895564 PMCID: PMC6713293 DOI: 10.1007/s40273-019-00792-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
As part of its Single Technology Appraisal (STA) process, the National Institute for Health and Care Excellence (NICE) invited the manufacturer (Merck Sharp & Dohme; MSD) of pembrolizumab (Keytruda®) to submit evidence of its clinical and cost effectiveness for the treatment of patients with relapsed or refractory classical Hodgkin lymphoma (RRcHL) who did not respond to treatment with brentuximab vedotin. Kleijnen Systematic Reviews Ltd, in collaboration with Maastricht University Medical Centre+, was commissioned to act as the independent Evidence Review Group (ERG). The ERG produced a detailed review of the evidence for the clinical and cost effectiveness of the technology, based on the company's submission to NICE. According to the NICE scope, pembrolizumab was compared with single or combination chemotherapy. Comparisons were undertaken in two populations: patients who did and did not receive prior autologous stem cell transplant (autoSCT; populations 1 and 2, respectively). Despite it having been recommended by NICE in population 1 at the time the ERG received the company submission, nivolumab was not included as a comparator. No studies directly comparing pembrolizumab and its comparators were identified. One ongoing, single-arm study of the efficacy and safety of pembrolizumab (KEYNOTE-087) and one comparative observational study (Cheah et al., 2016) were used to inform the comparative effectiveness of pembrolizumab and standard of care (SoC), using indirect comparisons in both populations. Almost all analyses showed significant PFS and overall response rate benefits for pembrolizumab versus SoC, but due to being based on indirect comparison, were likely to contain systematic error. The economic evaluation therefore suffered from substantial uncertainty in any estimates of cost effectiveness. Furthermore, there was a lack of evidence on the uptake and timing of allogeneic stem cell transplant, and alternative assumptions had a significant impact on cost effectiveness. Immature survival data from KEYNOTE-087 exacerbated this issue and necessitated the use of alternative data sources for longer-term extrapolation of survival. Some issues identified in the company's analyses were amended by the ERG. The revised ERG deterministic base-case incremental cost-effectiveness ratios based on the company's second Appraisal Consultation Document response for pembrolizumab versus SoC (with a commercial access agreement) for populations 1 and 2 were £54,325 and £62,527 per quality-adjusted life-year gained, respectively. There was substantial uncertainty around these ICERs, especially in population 2. NICE did not recommend pembrolizumab as an option for treating RRcHL in population 1, but recommended pembrolizumab for use within the Cancer Drugs Fund in population 2.
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MESH Headings
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/economics
- Antineoplastic Agents, Immunological/administration & dosage
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/economics
- Cost-Benefit Analysis
- Hodgkin Disease/drug therapy
- Hodgkin Disease/economics
- Humans
- Quality-Adjusted Life Years
- Technology Assessment, Biomedical
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Affiliation(s)
- Sabine E Grimm
- Department of Clinical Epidemiology and Medical Technology Assessment, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Debra Fayter
- Kleijnen Systematic Reviews Ltd, 6 Escrick Business Park, Riccall Road, York, YO19 6FD, UK
| | - Bram L T Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Svenja Petersohn
- Department of Clinical Epidemiology and Medical Technology Assessment, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Rob Riemsma
- Kleijnen Systematic Reviews Ltd, 6 Escrick Business Park, Riccall Road, York, YO19 6FD, UK
| | - Nigel Armstrong
- Kleijnen Systematic Reviews Ltd, 6 Escrick Business Park, Riccall Road, York, YO19 6FD, UK
| | - Xavier Pouwels
- Department of Clinical Epidemiology and Medical Technology Assessment, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Willem Witlox
- Department of Clinical Epidemiology and Medical Technology Assessment, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Caro Noake
- Kleijnen Systematic Reviews Ltd, 6 Escrick Business Park, Riccall Road, York, YO19 6FD, UK
| | - Gillian Worthy
- Kleijnen Systematic Reviews Ltd, 6 Escrick Business Park, Riccall Road, York, YO19 6FD, UK
| | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, 6 Escrick Business Park, Riccall Road, York, YO19 6FD, UK
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
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Gao L, Moodie M, Li SC. The cost-effectiveness of omega-3 polyunsaturated fatty acids - The Australian healthcare perspective. Eur J Intern Med 2019; 67:70-76. [PMID: 31285124 DOI: 10.1016/j.ejim.2019.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To examine the cost-effectiveness of a triglyceride lowering medication-icosapent ethyl added on to statin from Australian healthcare system perspective. METHODS A Markov-model was developed using data from the pivotal trial of icosapent ethyl in a secondary prevention population. Probabilities of CVD events were derived and extrapolated from the published Kaplan-Meier curve using a valid algorithm. Management cost of CVD, health-related quality of life, and background non-CVD mortality were extracted from publicly available sources. Acquisition cost of icosapent ethyl from the United States was used in the current analysis. Australian patients with histories of CVD were modelled for a 25 year time horizon and costs and benefits were discounted. Sensitivity analyses (SA) were undertaken. Value of perfect information (VPI) was quantified. RESULTS Treatment with icosapent ethyl was associated with both higher costs and benefits (i.e. quality-adjusted life year [QALY] and life year [LY]), resulting in an incremental cost-effectiveness ratio (ICER) of AUD59,036/QALY or AUD54,358/LY. Using the often quoted willingness-to-pay (WTP)/QALY of AUD50,000/QALY, icosapent ethyl was not considered cost-effective. SA showed that time horizon, drug cost, and discount rate were the key drivers of the ICER. Total monetary VPI for icosapent ethyl was over AUD15 million over 5 years. CONCLUSIONS Patients with established CVD in whom level of triglycerides is high would benefit from the treatment using icosapent ethyl, however, it is not a cost-effective from an Australian healthcare system perspective. The government may consider subsidising this medication given the clinical need but at a discounted acquisition cost.
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Affiliation(s)
- Lan Gao
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia; Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia; School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia.
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia; Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Shu-Chuen Li
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia
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Carter D, Merlin T, Hunter D. An Ethical Analysis of Coverage With Evidence Development. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:878-883. [PMID: 31426928 DOI: 10.1016/j.jval.2019.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 02/14/2019] [Accepted: 02/27/2019] [Indexed: 06/10/2023]
Abstract
Sometimes a government or other payer is called on to fund a new health technology even when the evidence leaves a lot of uncertainty. One option is for the payer to provisionally fund the technology and reduce uncertainty by developing evidence. This is called coverage with evidence development (CED). Only-in-research CED, when the payer funds the technology only for patients who participate in the evidence development, raises the sharpest ethical questions. Is the patient coerced or induced into participating? If so, under what circumstances, if any, is this ethically justified? Building on work by Miller and Pearson, we argue that patients have a right to funding for a technology only when the payer can be confident that the technology provides reasonable value for money. Technologies are candidates for CED precisely because serious questions remain about value for money, and therefore patients have no right to technologies under a CED arrangement. This is why CED induces rather than coerces. The separate question of whether the inducement is ethically justified remains. We argue that CED does pose risks to patients, and the worse these risks are, the harder it is to justify the inducement. Finally, we propose conditions under which the inducement could be ethically justified and means of avoiding inducement altogether. We draw on the Australian context, and so our conclusions apply most directly to comparable contexts, where the payer is a government that provides universal coverage with a regard for cost-effectiveness that is prominent and fairly clearly defined.
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Affiliation(s)
- Drew Carter
- Adelaide Health Technology Assessment, The University of Adelaide, Adelaide, South Australia, Australia.
| | - Tracy Merlin
- Adelaide Health Technology Assessment, The University of Adelaide, Adelaide, South Australia, Australia
| | - David Hunter
- School of Medicine, Flinders University, Adelaide, South Australia, Australia
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Lorente R, Antonanzas F, Rodriguez-Ibeas R. Implementation of risk-sharing contracts as perceived by Spanish hospital pharmacists. HEALTH ECONOMICS REVIEW 2019; 9:25. [PMID: 31317339 PMCID: PMC6734358 DOI: 10.1186/s13561-019-0242-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/08/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Concerns about financial sustainability of health systems have promoted the adoption of risk-sharing agreements. Nevertheless, few insights have been derived, due to their confidentiality. The purpose of this study is to analyze to what extent these agreements have been implemented in Spain and the importance of several clinical and management variables concerning their use. We also explore whether risk-sharing agreements promote the adoption of personalized medicine. We give a descriptive analysis based on a questionnaire sent to members of the Spanish Society of Hospital Pharmacy, asking about the implementation of risk-sharing contracts in their hospitals. RESULTS There were 80 replies. Implementation of risk-sharing agreements was high (90%), being oncology, neurology, dermatology and infectious diseases the main specialties. The most relevant variables were the number of units of medication per year (89%) in price-volume agreements, and the efficacy and uncertainty of treatments (over 75%) in pay-for-performance agreements. Price-volume agreements were suitable for both conventional and personalized medicine and pay-for-performance more specific for personalized medicine. Paying for performance promotes genetic testing (85%). CONCLUSIONS The results suggest health authorities should encourage the assessment of financial and health outcomes of real-world contracts of conventional and personalized medicine to better know the variables influencing their use.
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Affiliation(s)
- Reyes Lorente
- Departamento de Economiay Empresa, Universidad de La Rioja, Ciguena 60, 26004 Logrono, Spain
| | - Fernando Antonanzas
- Departamento de Economiay Empresa, Universidad de La Rioja, Ciguena 60, 26004 Logrono, Spain
| | - Roberto Rodriguez-Ibeas
- Departamento de Economiay Empresa, Universidad de La Rioja, Ciguena 60, 26004 Logrono, Spain
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Pouwels XGLV, Grutters JPC, Bindels J, Ramaekers BLT, Joore MA. Uncertainty and Coverage With Evidence Development: Does Practice Meet Theory? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:799-807. [PMID: 31277827 DOI: 10.1016/j.jval.2018.11.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/07/2018] [Accepted: 11/21/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES In theory, a successful coverage with evidence development (CED) scheme is one that addresses the most important uncertainties in a given assessment. We investigated the following: (1) which uncertainties were present during the initial assessment of 3 Dutch CED cases, (2) how these uncertainties were integrated in the initial assessments, (3) whether CED research plans included the identified uncertainties, and (4) issues with managing uncertainty in CED research and ways forward from these issues. METHODS Three CED initial assessment dossiers were analyzed and 16 stakeholders were interviewed. Uncertainties were identified in interviews and dossiers and were categorized in different causes: unavailability, indirectness, and imprecision of evidence. Identified uncertainties could be mentioned, described, and explored. Issues and ways forward to address uncertainty in CED schemes were discussed during the interviews. RESULTS Forty-two uncertainties were identified. Thirteen (31%) were caused by unavailability, 17 (40%) by indirectness, and 12 (29%) by imprecision. Thirty-four uncertainties (81%) were only mentioned, 19 (45%) were described, and the impact of 3 (7%) uncertainties on the results was explored in the assessment dossiers. Seventeen uncertainties (40%) were included in the CED research plans. According to stakeholders, research did not address the identified uncertainty, but CED research should be designed to focus on these. CONCLUSIONS In practice, uncertainties were neither systematically nor completely identified in the analyzed CED schemes. A framework would help to systematically identify uncertainty, and this process should involve all stakeholders. Value of information analysis, and the uncertainties that are not included in this analysis should inform CED research design.
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Affiliation(s)
- Xavier G L V Pouwels
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands; Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
| | | | - Jill Bindels
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bram L T Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands; Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Löblová O, Csanádi M, Ozierański P, Kaló Z, King L, McKee M. Alternative access schemes for pharmaceuticals in Europe: Towards an emerging typology. Health Policy 2019; 123:630-634. [DOI: 10.1016/j.healthpol.2019.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 05/08/2019] [Accepted: 05/13/2019] [Indexed: 12/20/2022]
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Kim H, Goodall S, Liew D. Health Technology Assessment Challenges in Oncology: 20 Years of Value in Health. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:593-600. [PMID: 31104740 DOI: 10.1016/j.jval.2019.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/19/2018] [Accepted: 01/06/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Oncology treatments have changed from chemotherapies to targeted therapies and more recently immuno-oncology. This has posed special challenges in the field of health technology assessment (HTA): capturing quality of life (QOL) associated with toxicity due to chemotherapy, crossover upon progression in targeted therapy trials, and survival extrapolation for immuno-oncology drugs. OBJECTIVES To showcase 20 years of Value in Health (ViH) publications in oncology. METHODS A review was undertaken of oncology articles published in ViH from May 1998 to August 2018. Full-length articles published in ViH with the keywords "oncology," "cancer," "h(a)ematology," and "malignancy" were included for review. Conference abstracts were excluded. RESULTS Four major themes were identified: (1) QOL and the development of multiple functional assessment of cancer therapy tools and mapping instruments; (2) analysis of clinical evidence using indirect comparisons, network analyses, and adjustment for crossovers; (3) modeling, Markov models, partitioned survival models, and extrapolation methods; and (4) financial implications and how to deal with uncertainty, introduction of conditional reimbursement, managed entry, and risk share agreements. DISCUSSION This review article highlights the important role ViH has played in disseminating HTA research in oncology. A few key issues loom on the horizon: precision medicine, further development and practical application of new QOL measures, methods for translating clinical evidence, and exploration of modeling techniques. For a better understanding of the complex interplay between access and financial risk management, ViH will no doubt continue to promote pioneering research in HTA and oncology.
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Affiliation(s)
- Hansoo Kim
- Monash University, Melbourne, Victoria, Australia.
| | - Stephen Goodall
- University of Technology Sydney, Sydney, New South Wales, Australia
| | - Danny Liew
- Monash University, Melbourne, Victoria, Australia
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Franklin M, Lomas J, Walker S, Young T. An Educational Review About Using Cost Data for the Purpose of Cost-Effectiveness Analysis. PHARMACOECONOMICS 2019; 37:631-643. [PMID: 30746613 DOI: 10.1007/s40273-019-00771-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This paper provides an educational review covering the consideration of costs for cost-effectiveness analysis (CEA), summarising relevant methods and research from the published literature. Cost data are typically generated by applying appropriate unit costs to healthcare resource-use data for patients. Trial-based evaluations and decision analytic modelling represent the two main vehicles for CEA. The costs to consider will depend on the perspective taken, with conflicting recommendations ranging from focusing solely on healthcare to the broader 'societal' perspective. Alternative sources of resource-use are available, including medical records and forms completed by researchers or patients. Different methods are available for the statistical analysis of cost data, although consideration needs to be given to the appropriate methods, given cost data are typically non-normal with a mass point at zero and a long right-hand tail. The choice of covariates for inclusion in econometric models also needs careful consideration, focusing on those that are influential and that will improve balance and precision. Where data are missing, it is important to consider the type of missingness and then apply appropriate analytical methods, such as imputation. Uncertainty around costs should also be reflected to allow for consideration on the impacts of the CEA results on decision uncertainty. Costs should be discounted to account for differential timing, and are typically inflated to a common cost year. The choice of methods and sources of information used when accounting for cost information within CEA will have an effect on the subsequent cost-effectiveness results and how information is presented to decision makers. It is important that the most appropriate methods are used as overlooking the complicated nature of cost data could lead to inaccurate information being given to decision makers.
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Affiliation(s)
- Matthew Franklin
- Health Economics and Decision Science (HEDS), School of Health and Related Research (ScHARR), University of Sheffield, West Court, 1 Mappin Street, Sheffield, S1 4DT, UK.
| | - James Lomas
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
| | - Simon Walker
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
| | - Tracey Young
- Health Economics and Decision Science (HEDS), School of Health and Related Research (ScHARR), University of Sheffield, West Court, 1 Mappin Street, Sheffield, S1 4DT, UK
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Holleman MS, Uyl-de Groot CA, Goodall S, van der Linden N. Determining the Comparative Value of Pharmaceutical Risk-Sharing Policies in Non-Small Cell Lung Cancer Using Real-World Data. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:322-331. [PMID: 30832970 DOI: 10.1016/j.jval.2018.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/01/2018] [Accepted: 08/29/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Risk-sharing arrangements (RSAs) can be used to mitigate uncertainty about the value of a drug by sharing the financial risk between payer and pharmaceutical company. We evaluated the projected impact of alternative RSAs for non-small cell lung cancer (NSCLC) therapies based on real-world data. METHODS Data on treatment patterns of Dutch NSCLC patients from four different hospitals were used to perform "what-if" analyses, evaluating the costs and benefits likely associated with various RSAs. In the scenarios, drug costs or refunds were based on response evaluation criteria in solid tumors (RECIST) response, survival compared to the pivotal trial, treatment duration, or a fixed cost per patient. Analyses were done for erlotinib, gemcitabine/cisplatin, and pemetrexed/platinum for metastatic NSCLC, and gemcitabine/cisplatin, pemetrexed/cisplatin, and vinorelbine/cisplatin for nonmetastatic NSCLC. RESULTS Money-back guarantees led to moderate cost reductions to the payer. For conditional treatment continuation schemes, costs and outcomes associated with the different treatments were dispersed. When price was linked to the outcome, the payer's drug costs reduced by 2.5% to 26.7%. Discounted treatment initiation schemes yielded large cost reductions. Utilization caps mainly reduced the costs of erlotinib treatment (by 16%). Given a fixed cost per patient based on projected average use of the drug, risk sharing was unfavorable to the payer because of the lower than projected use. The impact of RSAs on a national scale was dispersed. CONCLUSIONS For erlotinib and pemetrexed/platinum, large cost reductions were observed with risk sharing. RSAs can mitigate uncertainty around the incremental cost-effectiveness or budget impact of drugs, but only when the type of arrangement matches the setting and type of uncertainty.
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Affiliation(s)
- Marscha S Holleman
- Erasmus School of Health Policy & Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy & Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Stephen Goodall
- Center for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Naomi van der Linden
- Center for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
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Yoo SL, Kim DJ, Lee SM, Kang WG, Kim SY, Lee JH, Suh DC. Improving Patient Access to New Drugs in South Korea: Evaluation of the National Drug Formulary System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020288. [PMID: 30669602 PMCID: PMC6352121 DOI: 10.3390/ijerph16020288] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/08/2019] [Accepted: 01/12/2019] [Indexed: 11/16/2022]
Abstract
This study reviews and evaluates the national drug formulary system used to improve patient access to new drugs by making reimbursement decisions for new drugs as part of the South Korean national health insurance system. The national health insurance utilizes three methods for improving patient access to costly drugs: risk-sharing agreements, designation of essential drugs, and a waiver of cost-effectiveness analysis. Patients want reimbursement for new drugs to be processed quickly to improve their access to these drugs, whereas payers are careful about listing them given the associated financial burden and the uncertainty in cost-effectiveness. However, pharmaceutical companies are advocating for drug prices above certain thresholds to maintain global pricing strategies, cover the costs of drug development, and fund future investments into research and development. The South Korean government is expected to develop policies that will improve patient access to drugs with unmet needs for broadening health insurance coverage. Simultaneously, the designing of post-listing management methods is warranted for effectively managing the financial resources of the national health insurance system.
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Affiliation(s)
- Seung-Lai Yoo
- College of Pharmacy, Chung-Ang University, Seoul 06974, Korea.
| | - Dae-Jung Kim
- College of Pharmacy, Chung-Ang University, Seoul 06974, Korea.
| | - Seung-Mi Lee
- College of Pharmacy, Chung-Ang University, Seoul 06974, Korea.
| | - Won-Gu Kang
- College of Pharmacy, Chung-Ang University, Seoul 06974, Korea.
| | - Sang-Yoon Kim
- College of Pharmacy, Chung-Ang University, Seoul 06974, Korea.
| | - Jong Hyuk Lee
- Department of Pharmaceutical Engineering, Hoseo University, Asan 31499, Korea.
| | - Dong-Churl Suh
- College of Pharmacy, Chung-Ang University, Seoul 06974, Korea.
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Lomas J, Asaria M, Bojke L, Gale CP, Richardson G, Walker S. Which Costs Matter? Costs Included in Economic Evaluation and their Impact on Decision Uncertainty for Stable Coronary Artery Disease. PHARMACOECONOMICS - OPEN 2018; 2:403-413. [PMID: 29446055 PMCID: PMC6249199 DOI: 10.1007/s41669-018-0068-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Variation exists in the resource categories included in economic evaluations, and National Institute for Health and Care Excellence (NICE) guidance suggests the inclusion only of costs related to the index condition or intervention. However, there is a growing consensus that all healthcare costs should be included in economic evaluations for Health Technology Assessments (HTAs), particularly those related to extended years of life. OBJECTIVE AND METHODS We aimed to quantify the impact of a range of cost categories on the adoption decision about a hypothetical intervention, and uncertainty around that decision, for stable coronary artery disease (SCAD) based on a dataset comprising 94,966 patients. Three costing scenarios were considered: coronary heart disease (CHD) costs only, cardiovascular disease (CVD) costs and all costs. The first two illustrate different interpretations of what might be regarded as related costs. RESULTS Employing a 20-year time horizon, the highest mean expected incremental cost was when all costs were included (£2468) and the lowest when CVD costs only were included (£2377). The probability of the treatment being cost effective, estimating health opportunity costs using a ratio of £30,000 per quality-adjusted life-year (QALY), was different for each of the CHD (70%) costs, CVD costs (73%) and all costs (56%) scenarios. The results concern a hypothetical intervention and are illustrative only, as such they cannot necessarily be generalised to all interventions and diseases. CONCLUSIONS Cost categories included in an economic evaluation of SCAD impact on estimates of both cost effectiveness and decision uncertainty. With an aging and co-morbid population, the inclusion of all healthcare costs may have important ramifications for the selection of healthcare provision on economic grounds.
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Affiliation(s)
- James Lomas
- Centre for Health Economics, University of York, York, YO10 5DD, UK.
| | - Miqdad Asaria
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Laura Bojke
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Chris P Gale
- MRC Bioinformatics Centre, LICAMM, University of Leeds, Leeds, UK
| | - Gerry Richardson
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Simon Walker
- Centre for Health Economics, University of York, York, YO10 5DD, UK
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Ornstova E, Sebestianova M, Mlcoch T, Lamblova K, Dolezal T. Highly Innovative Drug Program in the Czech Republic: Description and Pharmacoeconomic Results-Cost-Effectiveness and Budget Impact Analyses. Value Health Reg Issues 2018; 16:92-98. [PMID: 30316030 DOI: 10.1016/j.vhri.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 08/14/2018] [Accepted: 08/23/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Highly innovative drugs (HIDs) can be granted 2 to 3 years of temporary reimbursement (TR) to provide timely patient access and to collect real-world evidence through registries in the Czech Republic. A TR applicant does not need to comply with cost-effectiveness (CE) requirements and the willingness-to-pay threshold. It is only when mandatory transition to permanent reimbursement (PR) status occurs does the drug need to comply with CE and willingness-to-pay requirements. OBJECTIVES To describe and evaluate the HID program in the Czech Republic by analyzing the pharmacoeconomic results when a drug starts with TR status and transitions to PR status. METHODS The study was a retrospective analysis of reimbursement decisions of HIDs. All drugs approved for TR (valid from January 2008 to January 2018) were identified. A description of the HIDs and their pharmacoeconomic results were analyzed. RESULTS Fifty TR drugs were identified. Most (68%) were oncology drugs and 44% were orphan drugs. After the expiration of their TR status, 83% were successfully transitioned to PR status. Cost-utility analysis was used to support CE results in 42% of the TR drugs. The mean incremental cost-effectiveness ratio (cost/quality-adjusted life-year) of drugs that entered TR status was €97,868. When the time came for transition to PR status, the mean incremental cost-effectiveness ratio was €34,086 (lower by 65%). Net budget impact increased by 3% and decreased by 25% in the first and fifth years, respectively, after applying for PR. CONCLUSIONS This analysis provides better insight into the HID program for costly innovative drugs over a 10-year follow-up. A successful transition to PR status was observed for most of the HIDs (83%).
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Makady A, van Veelen A, de Boer A, Hillege H, Klungel OH, Goettsch W. Implementing managed entry agreements in practice: The Dutch reality check. Health Policy 2018; 123:267-274. [PMID: 30316540 DOI: 10.1016/j.healthpol.2018.09.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/26/2018] [Accepted: 09/21/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Conditional financing (CF) of expensive hospital drugs was applied in the Netherlands between 2006 and 2012; a 4-year coverage with evidence development (CED) framework for expensive hospital drugs. This study aims to evaluate the CF framework, focusing on Health Technology Assessment (HTA) procedures. METHODS Using a standardised data extraction form, researchers independently extracted information on procedural, methodological and decision-making aspects from HTA reports of drugs selected for CF. RESULTS Forty-nine drugs were chosen for CF, of which 12 underwent the full procedure. The procedure extended beyond the envisioned 4 years period for 11/12 drugs. Outcomes research studies conducted as part of CF provided insufficient scientific data to reach conclusions on appropriate use and cost-effectiveness of 5/12 drugs. After re-assessment, continuation of reimbursement was advised for 10/12 drugs, with 6 necessitating yet additional conditions for evidence generation. Notably, advice to discontinue reimbursement for 2/12 drugs has not yet been implemented in Dutch healthcare practice. CONCLUSIONS Theoretically, CF provided an option for quick but conditional access to drugs. However, numerous aspects related to the design and implementation of CF negatively affected its value in practice. Future CED schemes should aim to incorporate learnings from the CF example to increase their impact in healthcare practice.
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Affiliation(s)
- A Makady
- National Healthcare Institute (ZIN), Diemen, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, the Netherlands.
| | - A van Veelen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, the Netherlands
| | - A de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, the Netherlands
| | - H Hillege
- Department of Epidemiology, University Medical Centre Groningen, Groningen, the Netherlands
| | - O H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, the Netherlands
| | - W Goettsch
- National Healthcare Institute (ZIN), Diemen, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, the Netherlands
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Felgner S, Ex P, Henschke C. Physicians' Decision Making on Adoption of New Technologies and Role of Coverage with Evidence Development: A Qualitative Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:1069-1076. [PMID: 30224111 DOI: 10.1016/j.jval.2018.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/09/2018] [Accepted: 03/08/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To foster value-based pricing and coverage with evidence development in Germany, certain new diagnostic and treatment methods have been subject to a benefit assessment since 2016 to determine their reimbursement. Although this is a paradigm shift, the German approach is limited to some few specific technologies for which reimbursement is requested. As physicians encounter this regulatory instrument, the aim of the study was to understand physicians' decision making regarding the adoption of new medical technologies and to identify their perspectives on the evidence base and financing with additional reimbursement systems. METHODS From April to August 2017, semistructured interviews with chief and senior physicians of vascular surgery and cardiology in inpatient care in Germany were conducted (N = 23). The interviews were carried out by one researcher in one-to-one appointments or via telephone. Data were analyzed inductively to identify factors and generate thematic categories using qualitative content analysis. RESULTS We identified 52 factors in eight categories influencing physicians' adoption of new technologies. The evidence base for new technologies was criticized (e.g., lack of available studies). Physicians' knowledge of the regulation of market approval and innovation payments varied. They recommended the utilization of new technologies in certain specialist centers and the facilitation of observational studies. CONCLUSIONS Physicians saw the need for the new approach and supported its aim. However, its design and implementation appeared to be questionable from their medical perspective. The provision of summarized information on the benefit of technologies might be a possibility to assist physicians' decision making.
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Affiliation(s)
- Susanne Felgner
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany.
| | - Patricia Ex
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Cornelia Henschke
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
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