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Kleining K, Laufenberg J, Thrun P, Ehlert D, Wasem J, Bartol A. Ten years of German benefit assessment: price analysis for drugs with unproven additional benefit. HEALTH ECONOMICS, POLICY, AND LAW 2024; 19:216-233. [PMID: 37577932 DOI: 10.1017/s1744133123000117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Since 2011, the prices for all new drugs in Germany are negotiated based on a benefit assessment. The purpose of this study was to analyze the price regulation of drugs with unproven additional benefit. METHODS Benefit assessment procedures from 2011 to 2020 were reviewed and selected through AMNOG Monitor and Lauer Taxe. Negotiated annual therapy costs, the annual costs of the most cost-efficient appropriate comparative therapy (ACT) and the potential budget impact for 33 included procedures were calculated. RESULTS 55% of the included drugs achieved a negotiated price higher than the most cost-efficient ACT, 3% were identified as equal and 42% showed lower negotiated prices. The potential savings exceeded expenditures by around EUR 523.5 m. After price flexibility was adopted by the legislator in 2017, the overall potential savings still outweighed the expenditures by around EUR 62 m. CONCLUSIONS Our analysis shows that making price negotiations more flexible by law does not undermine the fundamental aim of the AMNOG, which is to avoid additional expenditure without increased patient benefit. The regulation can thus fulfill the objective provided by the legislature of keeping drugs without proven additional benefits in the German healthcare system.
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Affiliation(s)
- Katrin Kleining
- Health Economics, Market Access & Reimbursement, Janssen-Cilag GmbH, Pharmaceutical Companies of Johnson & Johnson, Neuss, Germany
| | - Jan Laufenberg
- Health Economics, Market Access & Reimbursement, Janssen-Cilag GmbH, Pharmaceutical Companies of Johnson & Johnson, Neuss, Germany
| | - Philip Thrun
- Health Economics, Market Access & Reimbursement, Janssen-Cilag GmbH, Pharmaceutical Companies of Johnson & Johnson, Neuss, Germany
| | - Dorothee Ehlert
- Health Economics, Market Access & Reimbursement, Janssen-Cilag GmbH, Pharmaceutical Companies of Johnson & Johnson, Neuss, Germany
| | - Jürgen Wasem
- Institute for Health Services Management and Research, Universität Duisburg-Essen, Essen, Germany
- Essen Research Institute for Medical Management (EsFoMed) GmbH, Essen, Germany
| | - Arne Bartol
- Health Economics, Market Access & Reimbursement, Janssen-Cilag GmbH, Pharmaceutical Companies of Johnson & Johnson, Neuss, Germany
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Rand LZ, Kesselheim AS. Getting the Price Right: Lessons for Medicare Price Negotiation from Peer Countries. PHARMACOECONOMICS 2022; 40:1131-1142. [PMID: 36348153 DOI: 10.1007/s40273-022-01195-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 06/16/2023]
Abstract
The USA pays more for brand-name prescription drugs than any other country and new legislation from August 2022 gives Medicare the authority to directly negotiate certain drug prices with manufacturers starting in 2026-something the federal insurer had been prohibited from doing for its prior history. As the USA prepares for negotiations, we therefore surveyed how comparable industrialized countries use statutory requirements and procedures to negotiate brand-name drug prices. Guidance documents, regulations, government and academic publications were reviewed to identify the process of negotiating drug prices in peer countries that have been cited as potential examples for US payment reform: Australia, Canada, France, Germany, and the UK. Processes for arriving at a final price for a drug generally fall under three approaches: statutory rebates, setting a maximum price, and arbitration between national (public) insurers and manufacturers. Each approach to price negotiation could be adopted by Medicare and reduce spending even if Medicare does not adopt an exclusionary or closed formulary. Much remains to be determined about how the new price negotiation authority in the USA will be implemented, and policymakers can learn from comparator countries' statutory and regulatory strategies for price negotiation.
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Affiliation(s)
- Leah Z Rand
- The Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, 1620 Tremont St., Suite 3030, Boston, MA, 02120, USA.
- Harvard Medical School, Boston, MA, USA.
- Harvard Medical School Center for Bioethics, Boston, MA, USA.
| | - Aaron S Kesselheim
- The Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, 1620 Tremont St., Suite 3030, Boston, MA, 02120, USA
- Harvard Medical School, Boston, MA, USA
- Harvard Medical School Center for Bioethics, Boston, MA, USA
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Dintsios CM, Chernyak N. How Far is Germany From Value-Based Pricing 10 Years After the Introduction of AMNOG? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:287-290. [PMID: 34964091 PMCID: PMC9021141 DOI: 10.1007/s40258-021-00712-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/05/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Charalabos-Markos Dintsios
- Institute for Health Services Research and Health Economics, Medical Faculty, Heinrich Heine University, Building 17.11, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Nadja Chernyak
- Institute for Health Services Research and Health Economics, Medical Faculty, Heinrich Heine University, Building 17.11, Moorenstr. 5, 40225 Düsseldorf, Germany
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Dintsios CM. A decade of early benefit assessment of ophthalmic drugs in Germany: success story or not? Expert Rev Pharmacoecon Outcomes Res 2021; 22:283-297. [PMID: 33999735 DOI: 10.1080/14737167.2021.1930532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To analyze how ophthalmic drugs fared in the early benefit assessment (EBA) after its introduction in Germany up to 2020 and to quantify its impact on their negotiated prices. METHODS Relevant documents were screened and essential content on added benefit outcomes and the underlying evidence was extracted next to pricing information. In addition to descriptive statistics, cross-stakeholder analyses and agreement statistics were implemented. RESULTS Thirteen completed EBA were identified involving eight drugs. Only four drugs (30.8%) received an added benefit. The OR for no added benefit of ophthalmic drugs versus all other drugs was 2.971 (0.902-9.781). The agreement between manufacturers' claims and decision-maker appraisals is fair (kappa 0.435). In all cases, evidence was derived for RCTs, but for different reasons, not all of them allowed direct comparisons with the comparator as defined by the decision-maker. The negotiated rebates on manufacturer's selling prices varied from 6.8% up to 47.4%. Nevertheless, the rebates for ophthalmic drugs (median 14.5%) were lower than those for all negotiated drugs (median 24%). CONCLUSION Over the past decade, the EBA of ophthalmic drugs was not necessarily a success story, but in most of the cases, the drugs were successful in the market.
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Affiliation(s)
- Charalabos-Markos Dintsios
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, German Diabetes Center at the Heinrich-Heine-University, Leibniz-Center for Diabetes Research, Düsseldorf, Germany
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Gandjour A, Schüßler S, Hammerschmidt T, Dintsios CM. Predictors of negotiated prices for new drugs in Germany. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:1049-1057. [PMID: 32451745 PMCID: PMC7423852 DOI: 10.1007/s10198-020-01201-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 05/13/2020] [Indexed: 05/25/2023]
Abstract
INTRODUCTION In Germany, all new, innovative medicines are subject to an early benefit assessment by the German Federal Joint Committee with subsequent price negotiation and optional arbitration. The purpose of this study was to identify drivers of negotiated (including arbitrated) prices of new, non-orphan innovative medicines in Germany. METHODS The analysis considered all non-orphan drugs that underwent a benefit appraisal between January 2011 and June 2016, and displayed a reimbursement price in the German Drug Directory (Lauer-Taxe®) in November 2017. Negotiated annual treatment costs were analyzed with respect to 11 explanatory variables in regression models. RESULTS The total sample included 106 non-orphan drugs. The analysis showed a significant and positive association of log-transformed negotiated annual treatment cost of new medicines with log-transformed annual treatment cost of its comparator(s), extent of added benefit, and log-transformed size of the target population. Analyzing the effects of specific endpoints instead of the overall added benefit revealed that the single endpoint with the largest impact on price is adverse events (AEs). Surprisingly, an increase in AEs significantly increased the price. Various subgroup and sensitivity analyses demonstrated the robustness of the results. The adjusted R squared for all models was above 80%. CONCLUSIONS The analysis was able to confirm that variables whose consideration is mandated by law are, in fact, the key drivers of negotiated prices. Somewhat puzzling, the analysis also found an increase in AEs to move prices significantly upward.
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Affiliation(s)
- Afschin Gandjour
- Frankfurt School of Finance and Management, Frankfurt am Main, Germany
| | - Sofia Schüßler
- Frankfurt School of Finance and Management, Frankfurt am Main, Germany
| | - Thomas Hammerschmidt
- Faculty of Applied Health and Social Sciences, Technical University of Applied Sciences Rosenheim, Rosenheim, Germany
| | - Charalabos-Markos Dintsios
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Gebäude 12.49, Moorenstraße 5, 40225 Düsseldorf, Germany
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Prieto-Pinto L, Garzón-Orjuela N, Lasalvia P, Castañeda-Cardona C, Rosselli D. International Experience in Therapeutic Value and Value-Based Pricing: A Rapid Review of the Literature. Value Health Reg Issues 2020; 23:37-48. [PMID: 32688214 DOI: 10.1016/j.vhri.2019.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 10/17/2019] [Accepted: 11/09/2019] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To characterize at a global level the concept of therapeutic value (TV) and describe the experience of value-based pricing (VBP) policies in 6 reference countries. METHODS We conducted a rapid review of the literature that addressed 2 exploratory research questions. A systematic and exhaustive search was carried out up to July 2018 in MEDLINE (Ovid), Embase, Scopus, and Web of Science. RESULTS The concepts of TV and VBP are related; value frameworks for medicines should include social preferences, comparative effectiveness, safety, adoption viability, social impact, high quality of evidence, severity of illness, and innovation. The added therapeutic value (ATV) is the manner of measuring the therapeutic advantages of new medicines compared with existing ones in terms of comparative effectiveness and safety. There are variations in the mechanisms of reimbursement and drug pricing regulation between the countries of study. CONCLUSION In a VBP system it is essential to establish the TV and ATV of a new medicine. Although there are no methodological guidelines for the implementation of VBP policies, the process implies from the beginning the definition of TV categories that will be included in the drug pricing and reimbursement systems. Agreements between the pharmaceutical industry and governments have become a useful tool as a negotiating mechanism in most countries.
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Affiliation(s)
| | | | - Pieralessandro Lasalvia
- Department of Evidence-Based Medicine, NeuroEconomix, Bogotá, Colombia; Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Diego Rosselli
- Department of Evidence-Based Medicine, NeuroEconomix, Bogotá, Colombia; Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Bogotá, Colombia
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Lauenroth VD, Kesselheim AS, Sarpatwari A, Stern AD. Lessons From The Impact Of Price Regulation On The Pricing Of Anticancer Drugs In Germany. Health Aff (Millwood) 2020; 39:1185-1193. [DOI: 10.1377/hlthaff.2019.01122] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Victoria D. Lauenroth
- Victoria D. Lauenroth was a research associate at the Hamburg Center for Health Economics, in Hamburg, Germany, and a visiting researcher at the Harvard-MIT Center for Regulatory Science, Harvard Medical School, in Boston, Massachusetts, when this work was conducted
| | - Aaron S. Kesselheim
- Aaron S. Kesselheim is a professor of medicine and the director of the Program on Regulation, Therapeutics, and Law in the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, in Boston
| | - Ameet Sarpatwari
- Ameet Sarpatwari is an assistant professor of medicine and the assistant director of the Program on Regulation, Therapeutics, and Law in the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School
| | - Ariel D. Stern
- Ariel D. Stern is the Poronui Associate Professor of Business Administration in the Technology and Operations Unit at Harvard Business School and the Harvard-MIT Center for Regulatory Science, both in Boston
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Abstract
BACKGROUND AND OBJECTIVE Legislation introduced in 2011 in Germany has instituted an early benefit assessment of newly licensed pharmaceuticals with a subsequent price negotiation. For orphan drugs (ODs) a special legal framework applies, which accounts for the fact that ODs do not have to prove an added benefit over an appropriate comparative therapy previously determined by the decision maker. As, in addition, the content of negotiations between pharmaceutical companies and the payer is confidential, the aim of this study was to identify factors influencing the negotiated prices of ODs. METHODS Twelve hypotheses on factors influencing the negotiated OD price were derived based on the existing literature and framework agreement between payers and pharmaceutical unions according to German social legislation. Univariate analyses were applied to detect statistically significant correlations between annual therapeutic costs of ODs and the hypothesized factors. Bivariate analyses were used to determine confounding factors. In addition, a multiple ordinary least squares (OLS) regression with backward selection was conducted. Finally, sensitivity analyses assessed the robustness of the results. RESULTS Thirty-five ODs were included in the analysis. The univariate analyses and subsequent sensitivity analyses validated five of the 12 hypotheses formulated. Univariate analyses suggest a statistically significant association between the OD price and the (i) therapeutic area; (ii) approval for pediatric care; (iii) treatment population size; (iv) cost of comparative therapies; and (v) European prices. The OLS regression identified European prices as the variable with the strongest association with the negotiated prices. CONCLUSION We show that German OD pricing is a multivariate phenomenon. However, due to interdependencies, these results must be treated with caution.
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Affiliation(s)
- Franziska Worm
- Health Economics, University Duisburg-Essen, Essen, Germany
| | - Charalabos-Markos Dintsios
- Institute for Health Services Research and Health Economics, Medical Faculty, Heinrich-Heine-University Düsseldorf, Building: 12.49, Moorenstr. 5, 40225, Düsseldorf, Germany.
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Dintsios CM, Beinhauer I. The impact of additive or substitutive clinical study design on the negotiated reimbursement for oncology pharmaceuticals after early benefit assessment in Germany. HEALTH ECONOMICS REVIEW 2020; 10:7. [PMID: 32172494 PMCID: PMC7071579 DOI: 10.1186/s13561-020-00263-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 02/28/2020] [Indexed: 05/03/2023]
Abstract
BACKGROUND We analysed the impact of clinical study design for oncological pharmaceuticals on the subsequent price negotiations after early benefit assessment between pharmaceutical companies and the German National Association of Statutory Health Insurance Funds. The analysis was conducted for all oncology pharmaceuticals that underwent the early benefit assessment in Germany since its introduction in 2011 up to September 2016. METHODS It was differentiated between additive (new therapy in addition to baseline therapy) and substitutive study designs (baseline therapy to be replaced). The study design was derived from the dossiers of the pharmaceutical companies submitted to the Federal Joint Committee. Subgroup specific costs in case of granted added benefit were calculated as annual therapy costs and compared with the costs of the appropriate comparators to quantify price premiums. Further price influencing factors were analysed in univariate and multivariate regression analysis considering the budget impact for the statutory health insurance as well. RESULTS The mean and the median of the additive premiums for substitutive designs (€50,477.68 and €49,841.24) were higher than for additive designs, if the comparator was different to best supportive care (€48,750.00 and €42,820.44). The mean multiplicative premium for the substitutive designs was 15.07 versus 2.29 for the additive designs. EU-Prices and target population size had a significant effect on the reimbursement. The adjusted R-square in the log Premium OLS-regressions reached 0.708 when including all explanatory variables and considering interaction between target population and annual costs of the comparator. CONCLUSIONS Study design as an additional important influencing factor of the negotiations next to those stated in the framework agreement was identified and verified. Therefore, study design should be considered by pharmaceutical companies and by decision makers and payers within strategic price planning as a potential predictor. For some specific categories the number of cases was small. Further analyses should be performed when more oncology pharmaceuticals have passed the early benefit assessment.
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Affiliation(s)
- C. M. Dintsios
- Medical Faculty, Institute for Health Services Research and Health Economics, Heinrich Heine University, Building: 12.49, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - I. Beinhauer
- Health Economics, Cologne, Trainee at Bayer Vital GmbH, Leverkusen, Germany
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Molitor M, Dintsios CM. Failure due to formal reasons within German benefit assessment of medicinal products: the dilemma between marketing authorization and HTA. Expert Rev Pharmacoecon Outcomes Res 2020; 21:145-157. [DOI: 10.1080/14737167.2020.1729131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Charalabos-Markos Dintsios
- Institute for Health Services Research and Health Economics, Heinrich Heine University, Düsseldorf, Germany
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Dintsios CM, Worm F, Ruof J, Herpers M. Different interpretation of additional evidence for HTA by the commissioned HTA body and the commissioning decision maker in Germany: whenever IQWiG and Federal Joint Committee disagree. HEALTH ECONOMICS REVIEW 2019; 9:35. [PMID: 31848760 PMCID: PMC6918554 DOI: 10.1186/s13561-019-0254-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 12/04/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The purpose of this study was to analyse the impact of commissioned addenda by the Federal Joint Committee (FJC) to the HTA body (IQWiG) and their agreement with FJC decisions and to identify potential additional decisive factors of FJC. METHODS All available relevant documents up to end of 2017 were screened and essential content extracted. Next to descriptive statistics, differences between IQWiG and FJC were tested and explored by agreement statistics (Cohen's kappa and Fleiss' kappa) and ordinal logistic regression. RESULTS Most of the 90 addenda concerned oncological products. In all contingent comparisons, positive changes in added benefit or evidence level on a subpopulation basis (n = 124) prevailed negative ones. Fleiss' ordinal kappa for agreement of assessments, addenda, and appraisals reached a moderate strength for added benefit (0.474, 95%-CI, 0.408-0.540). Overall agreement between addenda and appraisals on a binary nominal basis is poor for added benefit (Cohen's kappa 0.183; 95%-CI: 0.010-0.357) ranging from "less than by chance" (respiratory diseases) to "perfect" (neurological diseases). The OR of the selected regression model showed that i) mortality, ii) unmet need, the positions of iii) the physicians' drug commission and iv) medical societies, and v) the annual therapeutic costs of the appropriate comparative therapy had a high influence on FJC's appraisals deviating from IQWiG's addenda recommendation. CONCLUSIONS IQWiG's addenda have a high impact on decision-maker's appraisals offering additional analyses of supplementary evidence submitted by the manufacturers. Nevertheless, the agreement between addenda and appraisals varies, highlighting different decisive factors between IQWiG and FJC.
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Affiliation(s)
- C. M. Dintsios
- Institute for Health Services Research and Health Economics, Medical Faculty, Heinrich Heine University, Building: 12.49 Moorenstr. 5, 40225 Düsseldorf, Germany
| | - F. Worm
- Health Economics, University Duisburg-Essen, Essen, Germany
| | - J. Ruof
- Medical School of Hannover, Hannover, Germany
- r-connect ltd, Basel, Switzerland
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Stern AD, Pietrulla F, Herr A, Kesselheim AS, Sarpatwari A. The Impact Of Price Regulation On The Availability Of New Drugs In Germany. Health Aff (Millwood) 2019; 38:1182-1187. [DOI: 10.1377/hlthaff.2018.05142] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ariel D. Stern
- Ariel D. Stern is an associate professor of business administration and a Hellman Faculty Fellow in the Department of Technology and Operations Management, Harvard Business School, in Boston, Massachusetts
| | - Felicitas Pietrulla
- Felicitas Pietrulla is a student in the Harvard Program in Therapeutic Science, Harvard Medical School, in Boston
| | - Annika Herr
- Annika Herr is a professor in the Institute of Health Economics, Leibniz University Hannover, in Germany, and a research affiliate in the Department of Economics, Heinrich Heine University Düsseldorf, in Germany
| | - Aaron S. Kesselheim
- Aaron S. Kesselheim is a professor of medicine at Harvard Medical School and director of the Program on Regulation, Therapeutics, and Law in the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, both in Boston
| | - Ameet Sarpatwari
- Ameet Sarpatwari is an instructor in medicine at Harvard Medical School and assistant director of the Program on Regulation, Therapeutics, and Law in the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School
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Staab TR, Walter M, Mariotti Nesurini S, Dintsios CM, Graf von der Schulenburg JM, Amelung VE, Ruof J. "Market withdrawals" of medicines in Germany after AMNOG: a comparison of HTA ratings and clinical guideline recommendations. HEALTH ECONOMICS REVIEW 2018; 8:23. [PMID: 30229501 PMCID: PMC6755547 DOI: 10.1186/s13561-018-0209-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 09/10/2018] [Indexed: 05/16/2023]
Abstract
BACKGROUND According to the AMNOG act, the German Federal Joint Committee (G-BA) determines the additional benefit of new medicines as a basis for subsequent price negotiations. Pharmaceutical companies may withdraw their medications from the market at any time during the process. This analysis aims to compare recommendations in clinical guidelines and HTA appraisals of medicines that were withdrawn from the German market since the introduction of AMNOG in 2011. METHODS Medications withdrawn from the German market between January 2011 and June 2016 following benefit assessment were categorized as opt-outs (max. 2 weeks after start of price negotiations) or supply terminations (during or after further price negotiations). Related guidelines were systematically analyzed. For all withdrawals, therapeutic area, additional benefit rating and recommendation status in relevant clinical guidelines were assessed. RESULTS Among 139 medications, 10 opt-outs and 12 supply terminations were identified. Twenty-one out of 22 withdrawn medicines (95%) received 'no additional benefit' appraisal by the G-BA (average 'no additional benefit' rating for all AMNOG products: 47%). Of the 22 medicines, 15 (68%) were recommended by at least one guideline at the time of benefit assessment and 18 (82%) on 1 June 2016. Heterogeneity among guidelines was high. Acceptance of clinical trial endpoints was different between G-BA appraisals and clinical guidelines. CONCLUSION Our analysis revealed considerable differences across clinical guidelines as well as between clinical guidelines and HTA appraisals of the medicines that were withdrawn from the German market. Better alignment of the clinical perspective and close collaboration between all involved parties is required to achieve and maintain optimization of patient care.
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Affiliation(s)
- Thomas R. Staab
- Roche Pharma AG, Grenzach-Wyhlen, Germany
- Medical School of Hanover, Hanover, Germany
| | | | | | | | | | | | - Jörg Ruof
- Medical School of Hanover, Hanover, Germany
- r-connect ltd, Hauensteinstr. 132, 4059 Basel, Switzerland
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Lauenroth VD, Stargardt T. Pharmaceutical Pricing in Germany: How Is Value Determined within the Scope of AMNOG? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:927-935. [PMID: 28712622 DOI: 10.1016/j.jval.2017.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 04/04/2017] [Accepted: 04/08/2017] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To analyze how value is determined within the scope of the German Pharmaceutical Restructuring Act, which came into effect in 2011. METHODS Using data from all pharmaceuticals that had undergone assessment, appraisal, and price negotiations in Germany before June 30, 2016, we applied generalized linear model regression to analyze the impact of added benefit on the difference between negotiated prices and the prices of comparators. Data were extracted from the Federal Joint Committee's appraisals and price databases. We specified added benefit in various ways. In all models, we controlled for additional criteria such as size of patient population, European price levels, and whether the comparators were generic. RESULTS Our regression results confirmed the descriptive results, with price premiums reflecting the extent of added benefit as appraised by the Federal Joint Committee. On the substance level, an added benefit was associated with an increase in price premium of 227.2% (P < 0.001) compared with no added benefit. Moreover, we saw increases in price premium of 377.5% (P < 0.001), 90.0% (P < 0.001), and 336.8% (P < 0.001) for added benefits that were "considerable," "minor," and "not quantifiable," respectively. Beneficial effects on mortality were associated with the greatest price premium (624.3%; P < 0.001), followed by such effects on morbidity (174.7%; P < 0.001) and adverse events (93.1%; P = 0.019). CONCLUSIONS Price premiums, or "value," are driven by health gain, the share of patients benefiting from a pharmaceutical, European price levels, and whether comparators are generic. No statement can be made, however, about the appropriateness of the level of price premiums.
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Affiliation(s)
| | - Tom Stargardt
- Hamburg Center for Health Economics, Hamburg, Germany
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