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Lee TJ, Son KB. Perceptions of risk sharing agreements in South Korea from the viewpoints of key stakeholders: a convergent parallel mixed approach. Expert Rev Pharmacoecon Outcomes Res 2024:1-9. [PMID: 39325632 DOI: 10.1080/14737167.2024.2410250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 09/20/2024] [Accepted: 09/24/2024] [Indexed: 09/28/2024]
Abstract
OBJECTIVES In 2013, South Korea introduced risk-sharing agreements (RSAs) as a new reimbursement mechanism to enhance access to new medicines and to manage pharmaceutical expenditures. This study evaluates RSAs in South Korea from the viewpoints of key stakeholders. METHODS In 2022, a survey and semi-structured interviews were conducted. Study participants were recruited from academia (n = 3), domestic (n = 4) and foreign (n = 6) manufacturers, and government agencies (n = 6) using a purposive sampling method. RESULTS Key stakeholders perceived the objective of RSAs to be 'access to medicines' and understood RSAs to manage uncertainty about 'expenditures.' They responded that financial- and performance-based RSAs address uncertainty about 'expenditures' and 'clinical effectiveness,' respectively. All stakeholders agreed that RSAs have increased the likelihood that new medicines will be listed and have reduced out-of-pocket expenditures for patients. However, foreign manufacturers insisted that the benefits of RSAs are marginal, while the administrative burden on manufacturers is high. CONCLUSION The gaps in perception between stakeholders could be narrowed by conducting a comprehensive evaluation. Financial- and performance-based RSAs need to be clearly distinguished and aligned to address the uncertainties of a new medicine in health systems.
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Affiliation(s)
- Tae-Jin Lee
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Kyung-Bok Son
- College of Pharmacy, Hanyang University, Ansan, Gyeonggi-do, South Korea
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2
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Khuntha S, Prawjaeng J, Ponragdee K, Sanmaneechai O, Srinonprasert V, Leelahavarong P. Onasemnogene Abeparvovec Gene Therapy and Risdiplam for the Treatment of Spinal Muscular Atrophy in Thailand: A Cost-Utility Analysis. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024:10.1007/s40258-024-00915-y. [PMID: 39333302 DOI: 10.1007/s40258-024-00915-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/20/2024] [Indexed: 09/29/2024]
Abstract
OBJECTIVES Caring for individuals with spinal muscular atrophy (SMA), a rare genetic disorder, poses tremendous challenges for the economy and healthcare system. This study evaluated the cost-utility of onasemnogene abeparvovec-xioi gene therapy and risdiplam for SMA in Thailand. METHODS A Markov model was used to analyze the lifetime costs and outcomes of these treatments compared with standard of care for symptomatic SMA types 1 and 2-3. SMA type 1 patients were treated with one of either onasemnogene or risdiplam, while SMA types 2-3 patients received risdiplam. Data on disease progression and medical costs were sourced from hospital databases, while treatment efficacy was based on clinical trials. Interviews with patients and caregivers provided data on non-medical costs and utilities. Base case cost-effectiveness and sensitivity analyses were conducted, with the incremental cost-effectiveness ratio (ICER) calculated in US dollars (USD) per quality-adjusted life year (QALY) gained, against a willingness-to-pay threshold of 4444 USD/QALY gained. RESULTS For SMA type 1, the ICERs for onasemnogene and risdiplam were 163,102 and 158,357 USD/QALY gained, respectively. For SMA types 2-3, the ICER for risdiplam was 496,704 USD/QALY gained. CONCLUSIONS While onasemnogene and risdiplam exceeded the value-for-money threshold of the Thai healthcare system, they yielded the highest QALY gains among all approved medications. Policy-makers should incorporate various pieces of evidence alongside the cost-effectiveness results for rare diseases with costly drugs. Additionally, cost-effectiveness findings are useful for price negotiations and alternative financial funding, which allows policy-makers to seek solutions to ensure patient access, aligning with universal health coverage principles in Thailand.
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Affiliation(s)
- Sarayuth Khuntha
- Mahidol University Health Technology Assessment Program, Mahidol University, Bangkok, Thailand
| | - Juthamas Prawjaeng
- Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kunnatee Ponragdee
- Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Oranee Sanmaneechai
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Center of Research Excellent for Neuromuscular Diseases, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Varalak Srinonprasert
- Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pattara Leelahavarong
- Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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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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Carapinha JL. Market Transparency in Medicine Pricing: Pathways to Fair Pricing. PHARMACOECONOMICS 2024; 42:611-614. [PMID: 38722539 DOI: 10.1007/s40273-024-01390-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/25/2024]
Affiliation(s)
- João L Carapinha
- Syenza, Anaheim, CA, USA.
- School of Pharmacy and Pharmaceutical Sciences, Northeastern University, Boston, MA, 02115, USA.
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5
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Douglas CMW, Grunebaum S. Lessons learned from the Canadian Fabry Disease Initiative for future risk-sharing and managed access agreements for pharmaceutical and advanced therapies in Canada. Health Policy 2024; 143:105044. [PMID: 38508062 DOI: 10.1016/j.healthpol.2024.105044] [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: 06/14/2023] [Revised: 12/05/2023] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
Risk sharing agreements (RSAs) and managed access agreements have emerged as tools to overcome evidentiary uncertainty and contain costs of pharmaceuticals; however, Canada has relatively little experience with these health policy instruments. This article describes one of the few examples of national RSAs. Enzyme replacement therapies (ERT) were introduced in Canada to treat Fabry disease in the early 2000s through an RSA. Based on qualitative interviews with key participating actors, this article explains how this RSA ensured continuity of treatment for patients already on ERT, and collected robust real-world evidence to secure treatment for future Fabry patients. We show the importance of partnerships, collaborations, and active patient communities in establishing RSAs, as well as the critical role of robust registries for the collection, storage, and use of that real-world data. In doing so, this paper points to reasons that explain the relative dearth of RSAs in Canada, which can be resource (both human and finance) intensive and are difficult to broker in a federalist health system. Through these findings, policy lessons are developed concerning the need for technological and governance platforms on how RSA in Canada can be more effectively supported going forward in a broader move towards "social pharmaceutical innovation".
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Affiliation(s)
- Conor M W Douglas
- Department of Science, Technology & Society, Faculty of Sciences, York University, 307 Bethune College, 4700 Keele St., Toronto ON, Canada M3J 1P3.
| | - Shir Grunebaum
- Department of Science, Technology & Society, Faculty of Sciences, York University, 307 Bethune College, 4700 Keele St., Toronto ON, Canada M3J 1P3
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6
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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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Hospodková P, Karásek P, Tichopád A. Stakeholder Insights into Czech Performance-Based Managed Entry Agreements: Potential for Transformative Change in Pharmaceutical Access? Healthcare (Basel) 2024; 12:119. [PMID: 38201024 PMCID: PMC10779200 DOI: 10.3390/healthcare12010119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/31/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
Managed Entry Agreements (MEAs) play a pivotal role in addressing the challenges arising from escalating prices of innovative medical technologies, especially in areas like oncology, immunology, and rare diseases. Among MEAs, Performance-Based MEAs (PB MEAs) and Outcome-Based MEAs (OB MEAs) stand out as innovative strategies. This study examines the adoption of PB MEAs in the Czech Republic post a 2022 legislative change. Interviews with key stakeholders, including the Ministry of Health, pharmaceutical companies, insurers, and patient groups, were conducted to explore perceptions and challenges. Stakeholders expressed concerns about legislation completeness, data quality, transparency, and methodology. Interestingly, pharmaceutical companies were less concerned about transparency and methodology, likely due to their multinational experience. Despite legislative progress, challenges persist, especially in data infrastructure, risk-sharing perceptions, and stakeholder readiness. Addressing these issues requires collaboration between pharmaceutical companies and payers. Patient involvement, though mandated, remains limited, potentially due to a lack of awareness. This study emphasizes the need for a comprehensive transformation beyond legislation for a successful PB MEA implementation. Trust, technical infrastructure, and data availability are crucial, necessitating a holistic approach. It contributes to the global discourse on PB MEAs, stressing the adjustment of financial frameworks, embracing value-based healthcare principles, and ensuring high-quality health data metrics. A more holistic, value-based MEA approach could reshape pharmaceutical reimbursement in the future.
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Affiliation(s)
- Petra Hospodková
- Departement of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno, Czech Republic; (P.K.); (A.T.)
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Trotta F, Guerrizio MA, Di Filippo A, Cangini A. Financial Outcomes of Managed Entry Agreements for Pharmaceuticals in Italy. JAMA HEALTH FORUM 2023; 4:e234611. [PMID: 38153808 PMCID: PMC10755625 DOI: 10.1001/jamahealthforum.2023.4611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 10/25/2023] [Indexed: 12/30/2023] Open
Abstract
Importance Most countries in the Organisation for Economic Co-operation and Development apply managed entry agreements (MEAs), reimbursement arrangements between manufacturers and payers, to pharmaceuticals. Few data exist regarding their ability to lower expenditures. Objective To analyze the financial outcomes of MEAs for pharmaceuticals from 2019 to 2021 in Italy. Design, Setting, and Participants In this observational study of MEAs and pharmaceutical spending in Italy, medications that were monitored through individually collected data and generated paybacks from manufacturers during the 2019 to 2021 study period were included in the analysis. Payback data were collected through pharmaceutical spending monitoring activities conducted by the Agenzia Italiana del Farmaco (Italian Medicines Agency). Expenditure data were collected through the Italian Drug Traceability System. Products were categorized by type of MEA: financial-based, outcome-based, or mixed. Main Outcomes and Measures The main outcome was median payback as a proportion of expenditure by category of MEA. Results were also provided by subtype: cost sharing or capping models for financial-based MEAs and risk-sharing or payment-by-result models for outcome-based MEAs. Mixed MEAs were considered when medications had multiple indications with different MEA types. Results A total of 73 medications with MEAs generated a payback by manufacturers during the study period. Six were either not reimbursable or delivered within the Italian National Health Service, and 5 had incomplete data. Of the 62 medications analyzed, 24 (38.7%) had financial-based MEAs, 30 (48.4%) had outcome-based MEAs, and 8 (12.9%) had mixed MEAs. A total payback amount of €327.5 million was calculated during the 3 years, corresponding to 0.9% of the €41.1 billion of total expenditures for medications purchased by public health facilities in Italy. Financial-based MEAs returned the highest payback revenues, €158.1 million; the outcome-based MEAs and mixed MEAs generated smaller paybacks of €74.5 million and €94.9 million, respectively. Overall, the median proportion of payback to expenditure on the medications analyzed was 3.8%. For mixed MEAs, the payback-to-expenditure proportion was 6.7%; for outcome-based MEAs, 3.3%; and for financial-based MEAs, 3.7%. Conclusions and Relevance This observational study found limited evidence that MEAs lower pharmaceutical expenditures. Determining criteria for prioritizing MEA use, identifying potential design changes, and improving implementation may be needed in the future.
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Affiliation(s)
| | | | | | - Agnese Cangini
- Agenzia Italiana del Farmaco, Rome, Italy
- Università Cattolica del Sacro Cuore di Roma, Rome, Italy
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Butani D, Faradiba D, Dabak SV, Isaranuwatchai W, Huang-Ku E, Pachanee K, Soboon B, Culyer AJ, Teerawattananon Y. Expanding access to high-cost medicines under the Universal Health Coverage scheme in Thailand: review of current practices and recommendations. J Pharm Policy Pract 2023; 16:138. [PMID: 37936171 PMCID: PMC10631213 DOI: 10.1186/s40545-023-00643-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/21/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND There has been an increasing demand to reimburse high-cost medicines, through public health insurance schemes in Thailand. METHODS A mixed method approach was employed. First, a rapid review of select high-income countries was conducted, followed by expert consultations and an in-depth review of three countries: Australia, England and Republic of Korea to understand reimbursement mechanisms of high-cost medicines. In Thailand, current pathways for reimbursing high-cost medicines reviewed, the potential opportunity cost estimated, and stakeholder consultations were conducted to identify context specific considerations. RESULTS High-income countries reviewed have implemented a variety of pathways and mechanisms for reimbursing high-cost medicines under specific eligibility criteria, listing processes, varying cost-effectiveness thresholds and special funding arrangements. In Thailand, high-cost medicines that do not offer good value-for-money are excluded from the reimbursement process. A framework for reimbursing high-cost medicines that are not cost-effective at the current willingness-to-pay threshold was proposed for Thailand. Under this framework, specific criteria are proposed to determine their eligibility for reimbursement such life-saving nature, treatment of conditions with no alternative treatment options, and affordability. CONCLUSION High-cost medicines may become eligible for reimbursement through alternative mechanisms based on specific criteria which depend on each context. The application of HTA methods and processes is important in guiding these decisions to support sustainable access to affordable healthcare in pursuit of Universal Health Coverage (UHC).
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Affiliation(s)
- Dimple Butani
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi, 11000, Thailand
| | - Dian Faradiba
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi, 11000, Thailand
| | - Saudamini Vishwanath Dabak
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi, 11000, Thailand
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi, 11000, Thailand.
- Institute of Health Policy, Management and Evaluation, St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
| | - Evan Huang-Ku
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada
| | - Kumaree Pachanee
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi, 11000, Thailand
| | - Budsadee Soboon
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi, 11000, Thailand
| | - Anthony J Culyer
- Department of Economics and Related Studies and Centre for Health Economics, University of York, York, UK
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi, 11000, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
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Oborotov GA, Koshechkin KA, Orlov YL. Application of Artificial Intelligence or machine learning in risk sharing agreements for pharmacotherapy risk management. J Integr Bioinform 2023; 20:jib-2023-0014. [PMID: 38073025 PMCID: PMC10757074 DOI: 10.1515/jib-2023-0014] [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: 05/05/2023] [Accepted: 11/17/2023] [Indexed: 12/31/2023] Open
Abstract
Applications of Artificial Intelligence in medical informatics solutions risk sharing have social value. At a time of ever-increasing cost for the provision of medicines to citizens, there is a need to restrain the growth of health care costs. The search for computer technologies to stop or slow down the growth of costs acquires a new very important and significant meaning. We discussed the two information technologies in pharmacotherapy and the possibility of combining and sharing them, namely the combination of risk-sharing agreements and Machine Learning, which was made possible by the development of Artificial Intelligence (AI). Neural networks could be used to predict the outcome to reduce the risk factors for treatment. AI-based data processing automation technologies could be also used for risk-sharing agreements automation.
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Affiliation(s)
- Grigory A. Oborotov
- Chair of Information and Internet Technologies, Digital Health Institute, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Konstantin A. Koshechkin
- Chair of Information and Internet Technologies, Digital Health Institute, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Yuriy L. Orlov
- Institute of Cytology and Genetics SB RAS, Novosibirsk, Russia
- Agrarian and Technological Institute, Peoples’ Friendship University of Russia, Moscow, Russia
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Mitkova Z, Manev I, Tachkov K, Boyadzhieva V, Stoilov N, Doneva M, Petrova G. How Managed Entry Agreements Influence the Patients' Affordability to Biological Medicines-Bulgarian Example. Healthcare (Basel) 2023; 11:2427. [PMID: 37685461 PMCID: PMC10486911 DOI: 10.3390/healthcare11172427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/18/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Managed entry agreements are applied in almost all European countries in order to improve patients' access to therapy. The current study aims to evaluate the changes in the affordability of biological medicines for patients in Bulgaria during 2019-2022. The study is a top-down macroeconomic analysis of the key economic indicators and reimbursed costs of biologic therapies. Affordability was determined as the number of working hours needed to pay for monthly therapy. The average NHIF budget for pharmaceuticals increased significantly along with inflation in the healthcare sector. Bulgarian patients had to devote a large part of their income to buying medicines if a co-payment existed. The percentage of the monthly income of pensioners needed for therapy co-payment varied between 10% and 280%. The hours of work required to purchase a package of biologicals varied between 7 and 137 working hours. The global economic crisis has affected Bulgaria and led to worsening economic parameters. There are still no well-established practices to control public spending, as the measures taken to reduce the final cost of medicines mainly affect the pharmaceutical companies. This type of cost-containment policy provides an opportunity for innovative treatment with biologicals for patients with inflammatory diseases. Most of the therapies cost more than the patients' monthly income.
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Affiliation(s)
- Zornitsa Mitkova
- Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria; (I.M.); (K.T.); (M.D.); (G.P.)
| | - Ivan Manev
- Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria; (I.M.); (K.T.); (M.D.); (G.P.)
| | - Konstantin Tachkov
- Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria; (I.M.); (K.T.); (M.D.); (G.P.)
| | - Vladimira Boyadzhieva
- Rheumatology Clinic, University Hospital St. Ivan Rilski, Faculty of Medicine, Medical University of Sofia, 1612 Sofia, Bulgaria; (V.B.); (N.S.)
| | - Nikolay Stoilov
- Rheumatology Clinic, University Hospital St. Ivan Rilski, Faculty of Medicine, Medical University of Sofia, 1612 Sofia, Bulgaria; (V.B.); (N.S.)
| | - Miglena Doneva
- Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria; (I.M.); (K.T.); (M.D.); (G.P.)
| | - Guenka Petrova
- Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria; (I.M.); (K.T.); (M.D.); (G.P.)
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Hospodková P, Gilíková K, Barták M, Marušáková E, Tichopád A. Opportunities and Threats of the Legally Facilitated Performance-Based Managed Entry Agreements in Slovakia: The Early-Adoption Perspective. Healthcare (Basel) 2023; 11:healthcare11081179. [PMID: 37108013 PMCID: PMC10138524 DOI: 10.3390/healthcare11081179] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Slovakia has adopted an amendment to Act No. 363/2011, regulating, among other things, drug reimbursement and is undergoing a significant change in the availability of innovative treatments for patients. High expectations are associated with arrangements related to performance-based managed entry agreements. Opinions and positions towards this change appear to be inconsistent, and for the further application of the law in practice and when setting up the main implementation processes, it is necessary to understand the positions and opinions of the individual actors who are involved in the PB-MEA process. The interviews were conducted in the period from 20 May to 15 August 2022 around the same time as the finalisation of the amendment to Act No. 363/2011 and its adoption. A roughly one-hour open interview was conducted on a sample of 12 stakeholders in the following groups: representatives of the Ministry of Health, health-care providers, pharmaceutical companies and others, including a health insurance company. The main objective was to qualitatively describe the perception of this topic by key stakeholders in Slovakia. The responses were analysed using MAXQDATA 2022 software to obtain codes associated with key expressions. We identified three main strong top categories of expressions that strongly dominated the pro-management interviews with stakeholders: legislation, opportunities and threats. Ambiguity and insufficient coverage of the new law, improved availability of medicinal products and threats associated with data, IT systems and potentially unfavourable new reimbursement schemes were identified as key topics of each of the said top categories, respectively. Among individual sets of respondents, there is frequent consensus on both opportunities and threats in the area of implementing process changes in PB-MEA. For the successful implementation of the law in practice, some basic threats need to be removed, among which in particular is insufficient data infrastructure.
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Affiliation(s)
- Petra Hospodková
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno, Czech Republic
| | - Klára Gilíková
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno, Czech Republic
| | - Miroslav Barták
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno, Czech Republic
| | - Elena Marušáková
- Department of Public Health, Faculty of Health and Social Work, Trnava University, 917 01 Trnava, Slovakia
| | - Aleš Tichopád
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno, Czech Republic
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Kim H, Godman B, Kwon HY, Hong SH. Introduction of managed entry agreements in Korea: Problem, policy, and politics. Front Pharmacol 2023; 14:999220. [PMID: 37124231 PMCID: PMC10133550 DOI: 10.3389/fphar.2023.999220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 03/21/2023] [Indexed: 05/02/2023] Open
Abstract
Objectives: This study aimed to understand Managed Entry Agreements (MEAs) in Korea through the framework of three streams of the policy window model and its practical management and impact on pricing and reimbursement scheme. Methods: An extensive literature review based on Kingdon's model was conducted. We also performed descriptive analyses of MEA implementation using data on medicines listed in Korea and compared its MEA scheme with four different countries. Results: As per problem streams, patients with rare disease or cancers have considerable difficulties in affording their medicines and this has challenged the drug benefit system and raised an issue of patient's access. Policy streams highlighted that MEAs were introduced as a benefit enhancement plan for four major diseases since January 2014. MEAs have also been strengthened as a bypass mechanism to expand the insurance coverage especially for new premium-priced medicines under Moon Care (Listing all non-listed services). In descriptive analysis of MEAs, a total of 48 medicines were contracted as MEAs from January 2014 to December 2020, accounting for 73.4% of listed medicines for cancer or rare diseases and 97.9% of the cases were finance-based contracts. Meanwhile, outcome-based contracts such as CED accounted for only 2.1%. The application of MEAs differs across countries, resulting in a kappa coefficient of 0.00-0.14 (United Kingdom 0.03, Italy 0.00, Australia 0.14), indicating a lack of consistency compared to South Korea. Conclusion: MEAs, which were introduced as a bypass mechanism, have now superseded the standard process for anticancer agents or orphan drugs. Further studies are needed to evaluate the impact of the confidential agreements and effectiveness of new high-priced medicines with limited clinical data at launch.
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Affiliation(s)
- Hyungmin Kim
- College of Pharmacy, Seoul National University, Seoul, Republic of Korea
- National Health Insurance Service, Wonju, Republic of Korea
| | - Brian Godman
- Division of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Hye-Young Kwon
- Division of Biology and Public Health, Mokwon University, Daejeon, Republic of Korea
| | - Song Hee Hong
- College of Pharmacy, Seoul National University, Seoul, Republic of Korea
- Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 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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Affiliation(s)
- Victoria Charlton
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - James Lomas
- Department of Economics and Related Studies, University of York, York, UK
| | - Polly Mitchell
- Centre for Public Policy Research, King's College London, London, UK
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16
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Vogler S. Prices of new medicines: International analysis and policy options. ZEITSCHRIFT FÜR EVIDENZ, FORTBILDUNG UND QUALITÄT IM GESUNDHEITSWESEN 2022; 175:96-102. [DOI: 10.1016/j.zefq.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/16/2022] [Indexed: 11/12/2022]
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17
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Ádám I, Callenbach M, Németh B, Vreman RA, Tollin C, Pontén J, Dawoud D, Elvidge J, Crabb N, van Waalwijk van Doorn-Khosrovani SB, Pisters-van Roy A, Vincziczki Á, Almomani E, Vajagic M, Oner ZG, Matni M, Fürst J, Kahveci R, Goettsch WG, Kaló Z. Outcome-based reimbursement in Central-Eastern Europe and Middle-East. Front Med (Lausanne) 2022; 9:940886. [PMID: 36213666 PMCID: PMC9539523 DOI: 10.3389/fmed.2022.940886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Outcome-based reimbursement models can effectively reduce the financial risk to health care payers in cases when there is important uncertainty or heterogeneity regarding the clinical value of health technologies. Still, health care payers in lower income countries rely mainly on financial based agreements to manage uncertainties associated with new therapies. We performed a survey, an exploratory literature review and an iterative brainstorming in parallel about potential barriers and solutions to outcome-based agreements in Central and Eastern Europe (CEE) and in the Middle East (ME). A draft list of recommendations deriving from these steps was validated in a follow-up workshop with payer experts from these regions. 20 different barriers were identified in five groups, including transaction costs and administrative burden, measurement issues, information technology and data infrastructure, governance, and perverse policy outcomes. Though implementing outcome-based reimbursement models is challenging, especially in lower income countries, those challenges can be mitigated by conducting pilot agreements and preparing for predictable barriers. Our guidance paper provides an initial step in this process. The generalizability of our recommendations can be improved by monitoring experiences from pilot reimbursement models in CEE and ME countries and continuing the multistakeholder dialogue at national levels.
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Affiliation(s)
- Ildikó Ádám
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Marcelien Callenbach
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | | | - Rick A. Vreman
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
- National Health Care Institute, Zorginstituut Nederland, Diemen, Netherlands
| | - Cecilia Tollin
- The Dental and Pharmaceutical Benefits Agency, Tandvårds- och Låkemedelsförmånsverket, Stockholm, Sweden
| | - Johan Pontén
- The Dental and Pharmaceutical Benefits Agency, Tandvårds- och Låkemedelsförmånsverket, Stockholm, Sweden
| | - Dalia Dawoud
- National Institute for Health and Care Excellence, London, United Kingdom
- Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Jamie Elvidge
- National Institute for Health and Care Excellence, London, United Kingdom
| | - Nick Crabb
- National Institute for Health and Care Excellence, London, United Kingdom
| | | | - Anke Pisters-van Roy
- Department of Medical Advisory and Innovation, Centraal Ziekenfonds (CZ) Health Insurance, Tilburg, Netherlands
| | - Áron Vincziczki
- National Health Insurance Fund of Hungary, Nemzeti Egészségbiztosítási Alapkezelõ, Budapest, Hungary
| | - Emad Almomani
- Department for Health Technology Assessment, Jordanian Royal Medical Services, Amman, Jordan
| | | | | | - Mirna Matni
- Social Security Main Office, Caisse Nationale de la Sécurité Sociale, Beirut, Lebanon
| | - Jurij Fürst
- Department of Drugs, Health Insurance Institute of Slovenia, Ljubljana, Slovenia
| | - Rabia Kahveci
- Pharmaceutical Policies and Governance, Management Sciences for Health, Kyiv, Ukraine
| | - Wim G. Goettsch
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
- National Health Care Institute, Zorginstituut Nederland, Diemen, Netherlands
| | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
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18
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Douglas CMW, Aith F, Boon W, de Neiva Borba M, Doganova L, Grunebaum S, Hagendijk R, Lynd L, Mallard A, Mohamed FA, Moors E, Oliveira CC, Paterson F, Scanga V, Soares J, Raberharisoa V, Kleinhout-Vliek T. Social pharmaceutical innovation and alternative forms of research, development and deployment for drugs for rare diseases. Orphanet J Rare Dis 2022; 17:344. [PMID: 36064440 PMCID: PMC9446828 DOI: 10.1186/s13023-022-02476-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/13/2022] [Indexed: 11/10/2022] Open
Abstract
Rare diseases are associated with difficulties in addressing unmet medical needs, lack of access to treatment, high prices, evidentiary mismatch, equity, etc. While challenges facing the development of drugs for rare diseases are experienced differently globally (i.e., higher vs. lower and middle income countries), many are also expressed transnationally, which suggests systemic issues. Pharmaceutical innovation is highly regulated and institutionalized, leading to firmly established innovation pathways. While deviating from these innovation pathways is difficult, we take the position that doing so is of critical importance. The reason is that the current model of pharmaceutical innovation alone will not deliver the quantity of products needed to address the unmet needs faced by rare disease patients, nor at a price point that is sustainable for healthcare systems. In light of the problems in rare diseases, we hold that re-thinking innovation is crucial and more room should be provided for alternative innovation pathways. We already observe a significant number and variety of new types of initiatives in the rare diseases field that propose or use alternative pharmaceutical innovation pathways which have in common that they involve a diverse set of societal stakeholders, explicitly address a higher societal goal, or both. Our position is that principles of social innovation can be drawn on in the framing and articulation of such alternative pathways, which we term here social pharmaceutical innovation (SPIN), and that it should be given more room for development. As an interdisciplinary research team in the social sciences, public health and law, the cases of SPIN we investigate are spread transnationally, and include higher income as well as middle income countries. We do this to develop a better understanding of the social pharmaceutical innovation field's breadth and to advance changes ranging from the bedside to system levels. We seek collaborations with those working in such projects (e.g., patients and patient organisations, researchers in rare diseases, industry, and policy makers). We aim to add comparative and evaluative value to social pharmaceutical innovation, and we seek to ignite further interest in these initiatives, thereby actively contributing to them as a part of our work.
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Affiliation(s)
- Conor M W Douglas
- Department of Science, Technology and Society, 307 Bethune College, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
| | - Fernando Aith
- University of São Paulo Public Health School, Health Law Research Center of the University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, Brazil
| | - Wouter Boon
- Copernicus Institute of Sustainable Development, Universiteit Utrecht, Princetonlaan 8a, 3584 CB, Utrecht, The Netherlands
| | - Marina de Neiva Borba
- São Camilo Medical School, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, Brazil
| | - Liliana Doganova
- Mines ParisTech, Université PSL in Paris, 60 Boulevard Saint Michel, 75272, Paris Cedex 06, France
| | - Shir Grunebaum
- Department of Science and Technology Studies, 307 Bethune College, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Rob Hagendijk
- Faculty of Social and Behavioural Sciences, International School of Social Sciences and Humanities, University of Amsterdam, Spui 2, 1012 WX, Amsterdam, The Netherlands
| | - Larry Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Alexandre Mallard
- Center for Social Innovation, Université PSL in Paris, Mines ParisTech60 Boulevard Saint Michel, 75272, Paris Cedex 06, France
| | - Faisal Ali Mohamed
- Faculty of Health Policy and Equity, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Ellen Moors
- Innovation and Sustainability, Copernicus Institute of Sustainable Development, Universiteit Utrecht, Princetonlaan 8a, 3584 CB, Utrecht, The Netherlands
| | - Claudio Cordovil Oliveira
- Public Health at the Sergio Arouca National School of Public Health (ENSP/Fiocruz), Av. Brazil, 4365 - Manguinhos, Rio de Janeiro, Brazil
| | - Florence Paterson
- Mines ParisTech, Université PSL in Paris, 60 Boulevard Saint Michel, 75272, Paris Cedex 06, France
| | - Vanessa Scanga
- Osgoode Hall Law School of York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Julino Soares
- The Federal University of Sao Paulo (UNIFESP), School of Public Health at the University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, Brazil
| | - Vololona Raberharisoa
- Mines ParisTech, Université PSL in Paris, 60 Boulevard Saint Michel, 75272, Paris Cedex 06, France
| | - Tineke Kleinhout-Vliek
- Geosciences, Innovation Studies, Innovation and Sustainability Institute, Universiteit Utrecht, Princetonlaan 8a, 3584 CB, Utrecht, The Netherlands
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Efthymiadou O, Kanavos P. Impact of Managed Entry Agreements on availability of and timely access to medicines: an ex-post evaluation of agreements implemented for oncology therapies in four countries. BMC Health Serv Res 2022; 22:1066. [PMID: 35987627 PMCID: PMC9392357 DOI: 10.1186/s12913-022-08437-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the increased utilisation of Managed Entry Agreements (MEAs), empirical studies assessing their impact on achieving better access to medicines remains scarce. In this study we evaluated the role of MEAs on enhancing availability of and timely access to a sample of oncology medicines that had received at least one prior rejection from reimbursement. METHODS Funding decisions and their respective timelines for all oncology medicines approved between 2009 and 2018 in Australia, England, Scotland and Sweden were studied. A number of binary logit models captured the probability (Odds ratio (OR)) of a previous coverage rejection being reversed to positive after resubmission with vs. without a MEA. Gamma generalised linear models were used to understand if there is any association between time to final funding decision and the presence of MEA, among other decision-making variables, and if so, the strength and direction of this association (Beta coefficient (B)). RESULTS Of the 59 previously rejected medicine-indication pairs studied, 88.2% (n = 45) received a favourable decision after resubmission with MEA vs. 11.8% (n = 6) without. Average time from original submission to final funding decision was 404 (± 254) and 452 (± 364) days for submissions without vs. with MEA respectively. Resubmissions with a MEA had a higher likelihood of receiving a favourable funding decision compared to those without MEA (43.36 < OR < 202, p < 0.05), although approval specifically with an outcomes-based agreement was associated with an increase in the time to final funding decision (B = 0.89, p < 0.01). A statistically significant decrease in time to final funding decision was observed for resubmissions in Australia and Scotland compared to England and Sweden, and for resubmissions with a clinically relevant instead of a surrogate endpoint. CONCLUSIONS MEAs can improve availability of medicines by increasing the likelihood of reimbursement for medicines that would have otherwise remained rejected from reimbursement due to their evidentiary uncertainties. Nevertheless, approval with a MEA can increase the time to final funding decision, while the true, added value for patients and healthcare systems of the interventions approved with MEAs in comparison to other available interventions remains unknown.
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Affiliation(s)
- Olina Efthymiadou
- Medical Technology Research Group, Department of Health Policy, London School of Economics, Houghton Street, London, WC2A 2AE, England.
| | - Panos Kanavos
- Medical Technology Research Group, Department of Health Policy, London School of Economics, Houghton Street, London, WC2A 2AE, England
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20
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Thanimalai S, Choon WY, Lee KKC. Stakeholders' Views on Patient Access Schemes in Malaysia. Value Health Reg Issues 2022; 31:39-46. [PMID: 35398626 DOI: 10.1016/j.vhri.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 01/21/2022] [Accepted: 02/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The healthcare system aspires to ensure improved access to treatment while working within the existing financial constraints and increasing demands. Patient access schemes (PASs) are initiated to improve access. This study seeks the stakeholders' views on the PAS in the public healthcare sector in Malaysia. METHODS This is an exploratory qualitative study using a web-based online survey and semistructured interviews. The participants were recruited by purposive sampling, where the Ministry of Health of Malaysia staff, pharmaceutical organization personnel, and patient advocacy organization personnel with experience in PAS were invited to participate. A total of 42 consenting participants answered the survey, whereas the face-to-face interview had 8 participants. Interviews were thematically analyzed using the qualitative data analysis software NVivo V.12. The Medical Research and Ethics Committee, Ministry of Health of Malaysia, approved the study. RESULTS Only finance-based PAS was reportedly implemented, and it covered drugs for antineoplastic or immunomodulating therapy, alimentary tract and metabolism, sensory organs, and systemic hormonal preparations. A total of 3 major themes were identified. High upfront cost and high budget impact are a major concern leading to the need for PAS. Identifying the treatment needs was a major concern as well. The readiness of the health system to implement PAS will determine whether the PAS can be successfully implemented. Challenges similar to other jurisdictions were observed in Malaysia, concerns on data availability, the responsibility of the stakeholders, and the need for a legal framework. CONCLUSION Most stakeholders responded positively that the PAS would grow. Trust among stakeholders and a structured access plan would enhance the implementation and ensure its success.
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Affiliation(s)
- Subramaniam Thanimalai
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; Ministry of Health, Putrajaya, Malaysia.
| | - Wai Yee Choon
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
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21
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Whittal A, Jommi C, De Pouvourville G, Taylor D, Annemans L, Schoonaert L, Vermeersch S, Hutchings A, Patris J. Facilitating [corrected] More Efficient Negotiations for Innovative Therapies: A Value-Based Negotiation Framework. Int J Technol Assess Health Care 2022; 38:e23. [PMID: 35274602 DOI: 10.1017/s0266462322000095] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES An increasing number of innovative therapies (e.g., gene- and cell-based treatments) have been developed in the past 20 years. Despite the significant clinical potential of these therapies, access delays may arise because of differing perspectives of manufacturers and payers regarding issues such as the value of the product, clinical and financial uncertainties, and sustainability.Managed entry agreements (MEAs) can enable access to treatments that would not be reimbursed by conventional methods because of such concerns. However, although MEA typologies exist, there is currently no structured process to come to agreements on MEAs, which can be difficult to decide upon and implement.To facilitate more structured MEA negotiations, we propose a conceptual "value-based negotiation framework" with corresponding application tools. METHODS The framework was developed based on an iterative process of scientific literature review and expert input. RESULTS The framework aims to (i) systematically identify and prioritize manufacturer and payer concerns about a new treatment, and (ii) select a mutually acceptable combination of MEA terms that can best address priority concerns, with the lowest possible implementation burden. CONCLUSIONS The proposed framework will be tested in practice, and is a step toward supporting payers and manufacturers to engage in more structured, transparent negotiations to balance the needs of both sides, and enabling quicker, more transparent MEA negotiations and patient access to innovative products.
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Affiliation(s)
| | - Claudio Jommi
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | | | - David Taylor
- University College London, London, United Kingdom
| | - Lieven Annemans
- Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, Ghent, Belgium
| | | | | | | | - Julien Patris
- Alnylam Pharmaceuticals, Brussels, Belgium
- Alnylam Pharmaceuticals, Zug, Switzerland
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22
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Wettstein DJ, Boes S. How value-based policy interventions influence price negotiations for new medicines: An experimental approach and initial evidence. Health Policy 2021; 126:112-121. [PMID: 35000803 DOI: 10.1016/j.healthpol.2021.12.007] [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: 09/03/2021] [Revised: 12/26/2021] [Accepted: 12/27/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Various forms of value-based pricing policies for new medicines have recently been introduced in OECD countries. While these initiatives are expected to have a positive impact on societal outcomes such as availability, affordability and value for money, scientific evidence on this impact is scarce due to confidential agreements. OBJECTIVE We aimed to assess the impact of value-based policy interventions in price negotiations on patient benefit in an experimental setting. METHODS An online experiment was conducted (n = 269). Participants were randomly assigned into the active role of either a buyer or seller in two intervention groups (cost-benefit, risk-sharing) and one control group. Decisions had real monetary consequences on other participants and through donations to a patient association. RESULTS Patient access, benefit and value for money were higher in the cost-benefit group than in the risk-sharing group. An available alternative to the agreement led to higher price offers. This effect was weaker in the cost-benefit group. CONCLUSIONS Outcomes of price negotiations on patient benefit depend on the alternatives available for failed or delayed negotiations. A shared but voluntary valuation framework might increase patient access, benefit, and value for money. The cost containment effect of risk-sharing agreements may be offset by the negative impact on overall patient benefit. Further development of the approach could provide support for policy design of pharmaceutical pricing regulations.
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Affiliation(s)
- Dominik J Wettstein
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, P.O. Box 4466, CH-6002 Lucerne, Switzerland.
| | - Stefan Boes
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, P.O. Box 4466, CH-6002 Lucerne, Switzerland.
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23
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Facey KM, Espin J, Kent E, Link A, Nicod E, O'Leary A, Xoxi E, van de Vijver I, Zaremba A, Benisheva T, Vagoras A, Upadhyaya S. Implementing Outcomes-Based Managed Entry Agreements for Rare Disease Treatments: Nusinersen and Tisagenlecleucel. PHARMACOECONOMICS 2021; 39:1021-1044. [PMID: 34231135 PMCID: PMC8260322 DOI: 10.1007/s40273-021-01050-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 05/21/2023]
Abstract
BACKGROUND AND OBJECTIVE Enthusiasm for the use of outcomes-based managed entry agreements (OBMEAs) to manage uncertainties apparent at the time of appraisal/pricing and reimbursement of new medicines has waned over the past decade, as challenges in establishment, implementation and re-appraisal have been identified. With the recent advent of innovative treatments for rare diseases that have uncertainties in the clinical evidence base, but which could meet a high unmet need, there has been renewed interest in the potential of OBMEAs. The objective of this research was to review the implementation of OBMEAs for two case studies across countries in the European Union, Australia and Canada, to identify good practices that could inform development of tools to support implementation of OBMEAs. METHODS To investigate how OBMEAs are being implemented with rare disease treatments, we collected information from health technology assessment/payer experts in countries that had implemented OBMEAs for either nusinersen in spinal muscular atrophy or tisagenlecleucel in two cancer indications. Operational characteristics of the OBMEAs that were publicly available were documented. Then, the experts discussed issues in implementing these OBMEAs and specific approaches taken to overcome challenges. RESULTS The OBMEAs identified were based on individual outcomes to ensure appropriate use, manage continuation of treatment and in two cases linked to payment schedules, or they were population based, coverage with evidence development. For nusinersen, population-based OBMEAs are documented in Belgium, England and the Netherlands and individual-based schemes in Bulgaria, Ireland, Italy and Lithuania. For tisagenlecleucel, there were population-based schemes in Australia, Belgium, England and France and individual-based schemes in Italy and Spain. Comparison of the OBMEA constructs showed some clear published frameworks and clarity of the uncertainties to be addressed that were similar across countries. Agreements were generally made between the marketing authorisation holder and the payer with involvement of expert physicians. Only England and the Netherlands involved patients. Italy used its long-established, national, web-based, treatment-specific data collection system linked to reimbursement and Spain has just developed such a national treatment registry system. Other countries relied on a variety of data collection systems (including clinical registries) and administrative data. Durations of agreements varied for these treatments as did processes for interim reporting. The processes to ensure data quality, completeness and sufficiency for re-analysis after coverage with evidence development were not always clear, neither were analysis plans. CONCLUSIONS These case studies have shown that important information about the constructs of OBMEAs for rare disease treatments are publicly available, and for some jurisdictions, interim reports of progress. Outcomes-based managed entry agreements can play an important role not only in reimbursement, but also in treatment optimisation. However, they are complex to implement and should be the exception and not the rule. More recent OBMEAs have developed document covenants among stakeholders or electronic systems to provide assurances about data sufficiency. For coverage with evidence development, there is an opportunity for greater collaboration among jurisdictions to share processes, develop common data collection agreements, and share interim and final reports. The establishment of an international public portal to host such reports would be particularly valuable for rare disease treatments.
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Affiliation(s)
- Karen M Facey
- Usher Institute, University of Edinburgh, NINE Edinburgh Bioquarter, 9 Little France Road, Edinburgh, 16 4UX, EH, UK.
| | - Jaime Espin
- Andalusian School of Public Health/Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto de Investigación Biosanitaria ibs, Granada, Spain
| | - Emma Kent
- National Institute for Health and Care Excellence (NICE), London, UK
| | - Angèl Link
- Zorginstituut (ZIN) Nederland, Diemen, The Netherlands
| | - Elena Nicod
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
| | - Aisling O'Leary
- National Centre for Pharmacoeconomics (NCPE), Trinity Centre for Health Sciences, St. James's Hospital, Dublin, Ireland
| | - Entela Xoxi
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Inneke van de Vijver
- National Institute for Health and Disability Insurance (INAMI), Brussels, Belgium
| | - Anna Zaremba
- Agency for Health Technology Assessment and Tariff System (AOTMiT), Warsaw, Poland
| | | | - Andrius Vagoras
- Pharmacy Center, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Sheela Upadhyaya
- National Institute for Health and Care Excellence (NICE), London, UK
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Xoxi E, Facey KM, Cicchetti A. The Evolution of AIFA Registries to Support Managed Entry Agreements for Orphan Medicinal Products in Italy. Front Pharmacol 2021; 12:699466. [PMID: 34456724 PMCID: PMC8386173 DOI: 10.3389/fphar.2021.699466] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/10/2021] [Indexed: 12/12/2022] Open
Abstract
Italy has a well-established prominent system of national registries to support managed entry agreements (MEAs), monitoring innovative medicinal products (MPs) with clinical as well as economic uncertainties to ensure appropriate use and best value for money. The technological architecture of the registries is funded by pharmaceutical companies, but fully governed by the national medicines agency (AIFA). A desktop analysis was undertaken of data over a 15-year timeframe of all AIFA indication-based registries and associated EMA information. The characteristics of registries were evaluated, comparing orphan MPs vs. all MPs exploring cancer and non-cancer indications. OMP (orphan medicinal product) registries’ type vs. AIFA innovation status and EMA approval was reviewed. Of the 283 registries, 182 are appropriateness registries (35.2% relate to OMPs, with an almost equal split of cancer vs. non-cancer for OMPs and MPs), 35 include financial-based agreements [20% OMPs (2 non-cancer, 5 cancer)], and 60 registries are payment by result agreements [23.3% OMPs (4 non-cancer, 10 cancer)]. Most OMPs (53/88) came through the normal regulatory route. With the strengthening of the system for evaluation of innovation, fewer outcomes-based registries have been instigated. AIFA has overcome many of the challenges experienced with MEA through developing an integrated national web-based data collection system: the challenge that remains for AIFA is to move from using the system for individual patient decisions about treatment to reviewing the wealth of data it now holds to optimize healthcare.
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Affiliation(s)
- Entela Xoxi
- Graduate School of Health Economics and Management, Catholic University of the Sacred Heart, Rome, Italy
| | - Karen M Facey
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Americo Cicchetti
- Graduate School of Health Economics and Management, Catholic University of the Sacred Heart, Rome, Italy
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Cancer Drugs in Asian Populations: Availability, Accessibility, and Affordability. ACTA ACUST UNITED AC 2021; 26:323-329. [PMID: 32732675 DOI: 10.1097/ppo.0000000000000460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Accessibility to effective cancer treatments is a goal of Universal Health Coverage; yet, achieving this in the context of escalating costs in a diversity of Asian nations with different socioeconomic development is extremely challenging. Value-based assessments within the context of each health care system, financing infrastructure that will facilitate appropriate prioritization of high-cost medications, transparency in international pricing and reducing out-of-pocket costs through national insurance programs are measures that Asian countries should take toward Universal Health Coverage for cancer care. Encouraging sharing data on pricing through the World Health Organization, sharing expertise in health technology assessments and regulatory approvals, and exploring bulk negotiations would also strengthen the process of price control. For each individual country, rational selection of national cancer formulary, aiming at price reduction and sound procurement strategies for each drug, is important toward ensuring affordable access to quality cancer medications.
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Brammli-Greenberg S, Yaari I, Daniels E, Adijes-Toren A. How Managed Entry Agreements can improve allocation in the public health system: a mechanism design approach. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:699-709. [PMID: 33755868 DOI: 10.1007/s10198-021-01284-2] [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: 07/09/2020] [Accepted: 03/04/2021] [Indexed: 06/12/2023]
Abstract
The process of introducing a new health technology into a healthcare system is characterized by uncertainty and risk for those involved-pharmaceutical companies, payers, patients and the government. In view of the accelerated introduction of new technologies in recent years, mechanisms to reduce uncertainty are of growing interest. One example is the Managed Entry Agreement (MEA), which we explore using a mechanism design approach. We make use of the Israeli experience, in which pharmaceutical companies and health plans (i.e., payers) negotiate over the introduction of new technologies into the national Health Services Basket (HSB) with the Ministry of Health acting as a mediator. We use the framework of bargaining within a mechanism design framework to show that in the process of negotiation the parties, the pharmaceutical company (PC) and the health plan (HP), have independent private valuations and that a situation of common knowledge that gains from MEA exists is rare. Adding a mediator (i.e., the MEA team) to the mechanism, as in a direct-revelation mechanism, reduces the level of uncertainty for both sides (i.e., the PC and the HP), thus making it possible to meet the budget constraint while increasing value for patients and enhancing ex-post efficiency.
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Affiliation(s)
- Shuli Brammli-Greenberg
- Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem, Israel.
- School of Public Health, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Ira Yaari
- Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem, Israel
- School of Public Health, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Elad Daniels
- Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem, Israel
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Ariella Adijes-Toren
- Private Health Department, Division of Regulation, Computing and Digital Health, Ministry of Health, Jerusalem, Israel
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Fens T, van Puijenbroek EP, Postma MJ. Efficacy, Safety, and Economics of Innovative Medicines: The Role of Multi-Criteria Decision Analysis and Managed Entry Agreements in Practice and Policy. FRONTIERS IN MEDICAL TECHNOLOGY 2021; 3:629750. [PMID: 35047908 PMCID: PMC8757864 DOI: 10.3389/fmedt.2021.629750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Through the years, solutions for accelerated access to innovative treatments are implemented in models of regulatory approvals, yet with limited data. Besides efficacy data, providing adequate safety data is key to transferring conditional marketing authorization to final marketing authorization. However, this remains a challenge because of the restricted availability and transferability of such data. Within this study, we set up a challenge to analyze the answers of two questions. First, from regulatory bodies' point of view, we bring the question of whether multi-criteria decision analysis (MCDA) is an adequate tool for further improvement of health technology assessment (HTA) of innovative medicines. Second, we ask if managed entry agreements (MEAs) pose solutions for facilitating the access to innovative medicines and further strengthening the evidence base concerning efficacy and effectiveness, as well as safety. Elaborating on such challenges brought us to conclude that increasing the attention to safety in MCDAs and MEAs will increase the trust of the authorities and improve the access for the manufacturers and the early availability of safe and effective medicines for the patients.
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Affiliation(s)
- Tanja Fens
- Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
- Institute of Science in Healthy Aging and healthcaRE (SHARE), University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
- Department of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, School of Science and Engineering, University of Groningen, Groningen, Netherlands
- *Correspondence: Tanja Fens
| | - Eugène P. van Puijenbroek
- Department of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, School of Science and Engineering, University of Groningen, Groningen, Netherlands
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, Netherlands
| | - Maarten J. Postma
- Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
- Institute of Science in Healthy Aging and healthcaRE (SHARE), University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
- Department of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, School of Science and Engineering, University of Groningen, Groningen, Netherlands
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
- Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
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International Price Comparisons of Anticancer Drugs: A Scheme for Improving Patient Accessibility. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020670. [PMID: 33466893 PMCID: PMC7830510 DOI: 10.3390/ijerph18020670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
Abstract
Background: The demand for implementing a new listing scheme to expedite patient access to novel oncology drugs has increased in South Korea. This study was conducted to compare the prices of anticancer drugs between eight countries and to explore the feasibility of a ‘pre-listing and post-evaluation’ scheme to expedite patient access to oncology drugs. Methods: This study included 34 anticancer drugs, which were reimbursed between 1 January 2007 and 31 December 2017. The unit price and sales volume of the study drugs were collected from eight countries and IQVIA data, respectively. The prices were adjusted to estimate the ex-factory prices using the discount/rebate rate suggested by the Health Insurance Review Agency (HIRA). The four price indices of Laspeyres, Paasche, Fisher, and the unweighted index were calculated using the price in each country, the average price, and lowest price among the study countries. Each currency was converted using the currency exchange rate and purchasing power parity (PPP). The budget impact of implementing the proposed pre-listing and post-evaluation scheme on payers was calculated. Results: Based on the currency exchange rate, anticancer drug prices were higher in other countries (index range: 1.05–2.78) compared to Korea. The prices in Korea were similar to countries with the lowest prices. When the PPP was applied, prices were higher in the US, Germany, Italy, and Japan than in Korea (range: 1.10–2.13); however, the prices were lower in the UK, France, and Switzerland than in Korea (range: 0.72–0.99). The financial burden of implementing the pre-listing and post-evaluation scheme was calculated at 0.83% of the total anticancer drug sales value in Korea from 2013–2017. Conclusions: The prices of anticancer drugs in Korea were similar to the lowest prices among the seven other study countries. A pre-listing and post-evaluation scheme should be considered to improve patient access to novel anticancer drugs by reducing the reimbursement review time and uncertainties.
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Michelsen S, Nachi S, Van Dyck W, Simoens S, Huys I. Barriers and Opportunities for Implementation of Outcome-Based Spread Payments for High-Cost, One-Shot Curative Therapies. Front Pharmacol 2020; 11:594446. [PMID: 33363468 PMCID: PMC7753155 DOI: 10.3389/fphar.2020.594446] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/22/2020] [Indexed: 01/15/2023] Open
Abstract
Background: The challenging market access of high-cost one-time curative therapies has inspired the development of alternative reimbursement structures, such as outcome-based spread payments, to mitigate their unaffordability and answer remaining uncertainties. This study aimed to provide a broad overview of barriers and possible opportunities for the practical implementation of outcome-based spread payments for the reimbursement of one-shot therapies in European healthcare systems. Methods: A systematic literature review was performed investigating published literature and publicly available documents to identify barriers and implementation opportunities for both spreading payments and for implementing outcome-based agreements. Data was analyzed via qualitative content analysis by extracting data with a reporting template. Results: A total of 1,503 publications were screened and 174 were included. Main identified barriers for the implementation of spread payments are reaching an agreement on financial terms while considering 12-months budget cycles and the possible violation of corresponding international accounting rules. Furthermore, outcome correction of payments is currently hindered by the need for additional data collection, the lack of clear governance structures and the resulting administrative burden and cost. The use of spread payments adjusted by population- or individual-level data collected within automated registries and overseen by a governance committee and external advisory board may alleviate several barriers and may support the reimbursement of highly innovative therapies. Conclusion: High-cost advanced therapy medicinal products pose a substantial affordability challenge on healthcare systems worldwide. Outcome-based spread payments may mitigate the initial budget impact and alleviate existing uncertainties; however, their effective implementation still faces several barriers and will be facilitated by realizing the required organizational changes.
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Affiliation(s)
- Sissel Michelsen
- Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
- Healthcare Management Centre, Vlerick Business School, Ghent, Belgium
| | - Salma Nachi
- Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Walter Van Dyck
- Healthcare Management Centre, Vlerick Business School, Ghent, Belgium
| | - Steven Simoens
- Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
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Coyle D, Durand-Zaleski I, Farrington J, Garrison L, Graf von der Schulenburg JM, Greiner W, Longworth L, Meunier A, Moutié AS, Palmer S, Pemberton-Whiteley Z, Ratcliffe M, Shen J, Sproule D, Zhao K, Shah K. HTA methodology and value frameworks for evaluation and policy making for cell and gene therapies. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:1421-1437. [PMID: 32794011 DOI: 10.1007/s10198-020-01212-w] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 06/18/2020] [Indexed: 05/05/2023]
Abstract
This last decade has been marked by significant advances in the development of cell and gene (C&G) therapies, such as gene targeting or stem cell-based therapies. C&G therapies offer transformative benefits to patients but present a challenge to current health technology decision-making systems because they are typically reviewed when clinical efficacy data are very limited and when there is uncertainty about the long-term durability of outcomes. These challenges are not unique to C&G therapies, but they face more of these barriers, reflecting the need for adapting existing value assessment frameworks. Still, C&G therapies have the potential to be cost-effective even at very high price points. The impact on healthcare budgets will depend on the success rate of pipeline assets and on the extent to which C&G therapies will expand to wider pathologies beyond rare or ultra-rare diseases. Getting pricing and reimbursement models right is important for incentivising research and development investment while not jeopardising the sustainability of healthcare systems. Payers and manufacturers therefore need to acknowledge each other's constraints-limitations in the evidence generation on the manufacturer side, budget considerations on the payer side-and embrace innovative thinking and approaches to ensure timely delivery of therapies to patients. Several experts in health technology assessment and clinical experts have worked together to produce this publication and identify methodological and policy options to improve the assessment of C&G therapies, and make it happen better, faster and sustainably in the coming years.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Stephen Palmer
- Center for Health Economics, University of York, York, UK
| | | | | | | | | | - Kun Zhao
- China National Health Development Research Center, Beijing, China
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Zampirolli Dias C, Godman B, Gargano LP, Azevedo PS, Garcia MM, Souza Cazarim M, Pantuzza LLN, Ribeiro-Junior NG, Pereira AL, Borin MC, de Figueiredo Zuppo I, Iunes R, Pippo T, Hauegen RC, Vassalo C, Laba TL, Simoens S, Márquez S, Gomez C, Voncina L, Selke GW, Garattini L, Kwon HY, Gulbinovic J, Lipinska A, Pomorski M, McClure L, Fürst J, Gambogi R, Ortiz CH, Canuto Santos VC, Araújo DV, Araujo VE, Acurcio FDA, Alvares-Teodoro J, Guerra-Junior AA. Integrative Review of Managed Entry Agreements: Chances and Limitations. PHARMACOECONOMICS 2020; 38:1165-1185. [PMID: 32734573 DOI: 10.1007/s40273-020-00943-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Managed entry agreements (MEAs) consist of a set of instruments to reduce the uncertainty and the budget impact of new high-priced medicines; however, there are concerns. There is a need to critically appraise MEAs with their planned introduction in Brazil. Accordingly, the objective of this article is to identify and appraise key attributes and concerns with MEAs among payers and their advisers, with the findings providing critical considerations for Brazil and other high- and middle-income countries. METHODS An integrative review approach was adopted. This involved a review of MEAs across countries. The review question was 'What are the health technology MEAs that have been applied around the world?' This review was supplemented with studies not retrieved in the search known to the senior-level co-authors including key South American markets. It also involved senior-level decision makers and advisers providing guidance on the potential advantages and disadvantages of MEAs and ways forward. RESULTS Twenty-five studies were included in the review. Most MEAs included medicines (96.8%), focused on financial arrangements (43%) and included mostly antineoplastic medicines. Most countries kept key information confidential including discounts or had not published such data. Few details were found in the literature regarding South America. Our findings and inputs resulted in both advantages including reimbursement and disadvantages including concerns with data collection for outcome-based schemes. CONCLUSIONS We are likely to see a growth in MEAs with the continual launch of new high-priced and often complex treatments, coupled with increasing demands on resources. Whilst outcome-based MEAs could be an important tool to improve access to new innovative medicines, there are critical issues to address. Comparing knowledge, experiences, and practices across countries is crucial to guide high- and middle-income countries when designing their future MEAs.
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Affiliation(s)
- Carolina Zampirolli Dias
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Ludmila Peres Gargano
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Pâmela Santos Azevedo
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Marina Morgado Garcia
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Maurílio Souza Cazarim
- Department of Pharmaceutical Sciences, Pharmacy School, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Minas Gerais, Brazil
| | - Laís Lessa Neiva Pantuzza
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
| | - Nelio Gomes Ribeiro-Junior
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - André Luiz Pereira
- Gerência de Planejamento, Monitoramento e Avaliação Assistenciais Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marcus Carvalho Borin
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Isabella de Figueiredo Zuppo
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | | | - Tomas Pippo
- Pan American Health Organization (PAHO), Brasília, Brazil
| | - Renata Curi Hauegen
- National Institute of Science and Technology for Innovation on Diseases of Neglected Populations (INCT-IDPN), Center for Technological Development in Health (CDTS), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Carlos Vassalo
- Facultad de Ciencias Médicas, Universidad Nacional del Litoral, Santa Fe, Argentina
| | - Tracey-Lea Laba
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Haymarket, Sydney, NSW, Australia
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Louvain, Belgium
| | - Sergio Márquez
- Economista, Administradora de los Recursos del Sistema General de Seguridad Social en Salud (ADRES), Bogotá, Colombia
| | - Carolina Gomez
- Think Tank "Medicines, Information and Power", National University of Colombia, Bogotá, Colombia
| | | | | | - Livio Garattini
- CESAV, Centre for Health Economics, IRCCS Institute for Pharmacological Research 'Mario Negri', Ranica, Bergamo, Italy
| | - Hye-Young Kwon
- Division of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, United Kingdom
- College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Jolanta Gulbinovic
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, Vilnius, Lithuania
| | - Aneta Lipinska
- Agency for Health Technology Assessment and Tariff System (AOTMiT), Warsaw, Poland
| | - Maciej Pomorski
- Agency for Health Technology Assessment and Tariff System (AOTMiT), Warsaw, Poland
| | - Lindsay McClure
- Procurement, Commissioning and Facilities, NHS National Services Scotland, Edinburgh, UK
| | - Jurij Fürst
- Health Insurance Institute, Ljubljana, Slovenia
| | | | | | | | - Denizar Vianna Araújo
- Secretariat of Science, Technology and Strategic Inputs, Ministry of Health, Brasília, Brazil
| | - Vânia Eloisa Araujo
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- Pontifical Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Francisco de Assis Acurcio
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Juliana Alvares-Teodoro
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Augusto Afonso Guerra-Junior
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil.
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil.
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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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Geenen JW, Belitser SV, Vreman RA, van Bloois M, Klungel OH, Boersma C, Hövels AM. A novel method for predicting the budget impact of innovative medicines: validation study for oncolytics. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:845-853. [PMID: 32248313 PMCID: PMC7366590 DOI: 10.1007/s10198-020-01176-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/06/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND High budget impact (BI) estimates of new drugs have led to decision-making challenges potentially resulting in restrictions in patient access. However, current BI predictions are rather inaccurate and short term. We therefore developed a new approach for BI prediction. Here, we describe the validation of our BI prediction approach using oncology drugs as a case study. METHODS We used Dutch population-level data to estimate BI where BI is defined as list price multiplied by volume. We included drugs in the antineoplastic agents ATC category which the European Medicines Agency (EMA) considered a New Active Substance and received EMA marketing authorization (MA) between 2000 and 2017. A mixed-effects model was used for prediction and included tumor site, orphan, first in class or conditional approval designation as covariates. Data from 2000 to 2012 were the training set. BI was predicted monthly from 0 to 45 months after MA. Cross-validation was performed using a rolling forecasting origin with e^|Ln(observed BI/predicted BI)| as outcome. RESULTS The training set and validation set included 25 and 44 products, respectively. Mean error, composed of all validation outcomes, was 2.94 (median 1.57). Errors are higher with less available data and at more future predictions. Highest errors occur without any prior data. From 10 months onward, error remains constant. CONCLUSIONS The validation shows that the method can relatively accurately predict BI. For payers or policymakers, this approach can yield a valuable addition to current BI predictions due to its ease of use, independence of indications and ability to update predictions to the most recent data.
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Affiliation(s)
- Joost W Geenen
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Svetlana V Belitser
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Rick A Vreman
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
- National Health Care Institute, Eekholt 4, 1112 XH, Diemen, The Netherlands
| | | | - Olaf H Klungel
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands.
| | - Cornelis Boersma
- Health-Ecore, 1e Hogeweg 196, 3701 HL, Zeist, The Netherlands
- Division of Global Health, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - Anke M Hövels
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
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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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Németh B, Goettsch W, Kristensen FB, Piniazhko O, Huić M, Tesař T, Atanasijevic D, Lipska I, Kaló Z. The transferability of health technology assessment: the European perspective with focus on central and Eastern European countries. Expert Rev Pharmacoecon Outcomes Res 2020; 20:321-330. [PMID: 32500749 DOI: 10.1080/14737167.2020.1779061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Lower-income European countries have a worse health status and less funds for health care compared to Western Europe. Despite their limited human and financial capacities for conducting Health Technology Assessment (HTA), the need for evidence-based decision-making is growing. Two main approaches emerged as potential solutions: joint clinical assessments on the European level, and simplified procedures relying on the judgments of well-established HTA agencies of Western countries. AREAS COVERED Based on considerations of transferability, the European Network for Health Technology Assessment (EUnetHTA) was built up to harmonize HTA methodologies across the European Union, and to develop an HTA Core Model by focusing on joint production of relative effectiveness assessment, which can be used as a basis for national value assessments. The second approach has been suggested in various forms without considering transferability issues. EXPERT OPINION Joint clinical assessments reduce duplication of efforts based on appropriate scientific rationale. On the other hand, recent examples show that relying on judgments of HTA agencies from wealthier countries with potentially different health-care priorities can lead to suboptimal allocation decisions. In the short term, some stakeholders may benefit from ignoring transferability, but it will ultimately lead to limited access in other disease areas.
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Affiliation(s)
| | - Wim Goettsch
- WHO CollaboratingUtrecht Centre for Pharmaceutical Policy, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University , Utrecht, The Netherlands.,National Health Care Institute , Diemen, The Netherlands
| | - Finn Børlum Kristensen
- Faculty of Health Sciences, Department of Public Health, Research Unit of User Perspectives, University of Southern Denmark , Odense, Denmark.,Department of Strategy and Innovation, Copenhagen Business School , Copenhagen, Denmark
| | - Oresta Piniazhko
- Health Technology Assessment Department, State Expert Centre of Ministry of Health of Ukraine , Kyiv, Ukraine
| | | | - Tomáš Tesař
- Department of Organisation and Management in Pharmacy, Faculty of Pharmacy, Comenius University , Bratislava, Slovakia
| | | | - Iga Lipska
- Departament of Health Care Services, National Health Fund HQ , Warsaw, Poland
| | - Zoltán Kaló
- Syreon Research Institute , Budapest, Hungary.,Centre for Health Technology Assessment, Semmelweis University , Budapest, Hungary
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O'Brien GL, McAlister M, Byrne S, Gallagher J. Overcoming hurdles: measurement of health-related outcomes associated with national level medicines usage in Ireland. Drugs Context 2020; 9:dic-2020-4-2. [PMID: 32547624 PMCID: PMC7250493 DOI: 10.7573/dic.2020-4-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 11/21/2022] Open
Abstract
Public discourse on medicine provision predominantly focuses on overall expenditure. However, current literature suggests measurement of alternative indicators can provide a method to benchmark or ameliorate medicine provision. Previous research has investigated the viability of using health-related outcome metrics, such as the number of patients treated, quality-adjusted life-year gain and life-year gain, to provide macro-level estimates on medicines’ societal contributions. This editorial provides an overview of the evolving healthcare landscape surrounding medicine usage estimation and valuation in Ireland and offers recommendations on how improved methods of measuring health-related outcomes may help ameliorate efficiencies and the sustainability of a healthcare system.
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Affiliation(s)
- Gary L O'Brien
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, College Road, Cork, Ireland
| | - Muireann McAlister
- Pfizer Healthcare Ireland, 9 Riverwalk, National Digital Park, Citywest Business Campus, Dublin 24, Ireland
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, College Road, Cork, Ireland
| | - James Gallagher
- Pfizer Healthcare Ireland, 9 Riverwalk, National Digital Park, Citywest Business Campus, Dublin 24, Ireland
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Nevens D, Kindts I, Defourny N, Boesmans L, Van Damme N, Engels H, Van de Voorde C, Lievens Y. The financial impact of SBRT for oligometastatic disease: A population-level analysis in Belgium. Radiother Oncol 2020; 145:215-222. [PMID: 32065901 DOI: 10.1016/j.radonc.2020.01.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 01/09/2020] [Accepted: 01/27/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION There is a steady rise in Stereotactic Body RadioTherapy (SBRT) utilization in oligometastatic disease (OMD). This may generate important financial consequences for radiotherapy budgets. The National Institute for Health and Disability Insurance of Belgium (NIHDI) initiated a coverage with evidence development (CED) project for innovative radiotherapy, including SBRT, in 2011. A cost calculation and budget estimation for SBRT in the OMD setting was carried out. MATERIALS AND METHODS Predictive growth scenarios for future uptake of SBRT for OMD in Belgium were developed using demographics and CED data. The provider cost of SBRT for OMD in Belgium was calculated using the Time-Driven Activity-Based Costing (TD-ABC) model developed by ESTRO-HERO, alimented with national data on resources, treatments and operational parameters, and compared to the new reimbursement. Combining these, the future financial impact of this novel treatment indication for healthcare providers and payers in Belgium was evaluated. RESULTS The number of 428 OMDs treated with SBRT in Belgium in 2017 is expected to increase between 484 and 2073 courses annually by 2025. A provider cost of €4360 per SBRT was calculated (range: €3488-€5654), whereas the reimbursement covers between €4139 and €4654. Large variations in potential extra provider costs by 2025 ensue from the different scenarios, ranging between €1,765,993 and €9,038,754. Provider costs and reimbursement show good agreement. CONCLUSION Although the financial impact of SBRT for OMD in Belgium is forecasted to remain acceptable, even in extreme scenarios, further clinical trials and real-life clinical and financial monitoring with prospective data gathering are necessary to refine the data.
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Affiliation(s)
- Daan Nevens
- Iridium Kankernetwerk, Radiation Oncology Department, Universiteit Antwerpen, Belgium.
| | - Isabelle Kindts
- Department of Radiotherapy, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Noémie Defourny
- ESTRO, European Society for Radiotherapy and Oncology, Brussels, Belgium; Radiation Oncology and Experimental Cancer Research, Ghent University, Belgium
| | | | | | - Hilde Engels
- NIHDI, National Institute for Health and Disability Insurance, Brussels, Belgium
| | | | - Yolande Lievens
- Radiation Oncology and Experimental Cancer Research, Ghent University, Belgium; Radiation Oncology Department, Ghent University Hospital, Belgium
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Pani L, Keefe RS. Approaches to attenuated psychosis syndrome treatments: A perspective on the regulatory issues. Schizophr Res Cogn 2019; 18:100155. [PMID: 31431890 PMCID: PMC6580145 DOI: 10.1016/j.scog.2019.100155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/21/2019] [Accepted: 05/26/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Luca Pani
- Department of Psychiatry and Behavioral Sciences, University of Miami, USA
- VeraSci, Durham, NC, USA
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Italy
| | - Richard S.E. Keefe
- VeraSci, Durham, NC, USA
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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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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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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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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Iunes RF, Uribe MV, Torres JB, Garcia MM, Dias CZ, Alvares-Teodoro J, de Assis Acurcio F, Guerra-Junior AA. Confidentiality agreements: a challenge in market regulation. Int J Equity Health 2019; 18:11. [PMID: 31155003 PMCID: PMC6545740 DOI: 10.1186/s12939-019-0916-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/06/2019] [Indexed: 02/03/2023] Open
Abstract
Background Sustainability and the ability to maintain the right to health, with the guarantee of access to quality medicines and health services, have been a great challenge for countries with universal health systems. The great technological advances bring with it an expressive increase in the expenditures of the health systems, especially those directed towards the acquisition of high-cost drugs, which are still under patent protection, have a high cost and, in some cases, present uncertainties about their effectiveness and safety. As a way of maintaining the proper functioning of the systems and guaranteeing access to these medicines, some countries started to negotiate discounts with manufacturing companies. Pricing agreements have been adopted by developed countries with the objective of reducing their spending on high-cost medicines and, although they represent an opportunity for better negotiation with the industries, they violate the principle of transparency that regulates the world market. However, the existence of confidentiality agreements has meant that the declared prices are not the actual prices, unfairly harming the countries that use these price lists as beacons in their systems. Methods Representatives of health, judicial, legislative, patient organizations and academics from eight countries in Latin America and South Korea participated in a meeting in September 2017 in Chile to discuss price confidentiality agreements and the impact on public health policies. During the meeting, participants were presented with a hypothetical case to subsidize the discussion on the topic. Divided into groups, participants should propose recommendations for the problem by pointing out the pros and cons if each proposed recommendation was adopted. The groups were then confronted by a simulated jury and finally issued a single and final recommendation for the problem. Results The topic was widely discussed and recommendations were raised by the participants. Among them, it is worth noting the elaboration of norms that regulate the negotiations of prices between the countries bringing transparency and harmony in the adopted conducts. In addition, the possible consequences and potential impacts of confidentiality on drug prices and inputs, such as information asymmetry and inequity of access between countries, were pointed out. Conclusion Despite there are efforts to make price negotiations more transparent, there is still no well-established standardization that promotes a well-functioning market. Confidentiality agreements hamper the fairness of access to essential health products.
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Affiliation(s)
| | | | | | - Marina Morgado Garcia
- Department of Social Pharmacy, Graduate Program of Medicines and Pharmaceutical Services, Federal University of Minas Gerais, Av. Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil.
| | - Carolina Zampirolli Dias
- Department of Social Pharmacy, Graduate Program of Medicines and Pharmaceutical Services, Federal University of Minas Gerais, Av. Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Juliana Alvares-Teodoro
- Department of Social Pharmacy, Public Health, Federal University of Minas Gerais, Av. Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Francisco de Assis Acurcio
- Department of Social Pharmacy, Federal University of Minas Gerais, Av. Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Augusto Afonso Guerra-Junior
- Department of Social Pharmacy, Public Health, Federal University of Minas Gerais, Av. Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
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Use of Real-World Data Sources for Canadian Drug Pricing and Reimbursement Decisions: Stakeholder Views and Lessons for Other Countries. Int J Technol Assess Health Care 2019; 35:181-188. [DOI: 10.1017/s0266462319000291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackgroundCanada has a long history of the use of clinical evidence to support healthcare decision making. Given improvements in data holdings and analytic capacity in Canada and stakeholder interest, the purpose of this study is to reflect on perceptions of the value of real-world evidence in pricing and reimbursement decisions, barriers to its optimal use in pricing and reimbursement, current initiatives that may lead to its increased use, and what role the pharmaceutical industry may play in this.Methods/ResultsTo capture stakeholder perceptions, ninety-one participants identified as key stakeholders were identified according to background roles and geography and invited to participate in four round table discussions conducted under Chatham House rule. Important themes emerging from these discussions included: (i) the need to understand what “real world” evidence means; (ii) barriers to using real world evidence from differences in access, governance, inter-operability, system structures, expertise, and quality across Canadian health systems; (iii) differing views on industry's role.ConclusionsThe use of real-world data in Canada to inform pricing and reimbursement decisions is far from routine but nascent and slowly increasing. Barriers, including interoperability concerns, may also apply to other federated health systems that need to focus on the networking of healthcare administrative data across provincial jurisdictional boundaries. There also appears to be a desire to see better use of pragmatic trials linked to these administrative data sets. Emerging initiatives are under way to use real world evidence more broadly, and include identification of common data elements and approaches to networking data.
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Verghese NR, Barrenetxea J, Bhargava Y, Agrawal S, Finkelstein EA. Government pharmaceutical pricing strategies in the Asia-Pacific region: an overview. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2019; 7:1601060. [PMID: 31007877 PMCID: PMC6461095 DOI: 10.1080/20016689.2019.1601060] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/19/2019] [Accepted: 03/25/2019] [Indexed: 06/09/2023]
Abstract
Background and objectives: Governments in Asia Pacific (APAC) are increasingly using pharmaceutical pricing strategies to contain rising healthcare costs. The objective of this narrative review is to discuss formal pricing strategies for reimbursed prescription medication in APAC, supported by relevant examples of implementation differences across countries. In the discussion section, we examine key advantages and disadvantages of each strategy. Methods: A narrative review of the peer-reviewed and grey literature was undertaken to retrieve information, including strategy definitions, practising countries, country-specific implementation considerations, and merits and demerits of each strategy. Results: Seven strategies (Internal Reference Pricing, External Reference Pricing, Special Pricing Agreements, Pharmacoeconomic Evaluation, Cost plus pricing, Price Maintenance Premium, and Tendering and negotiations) were identified as most commonly practised in APAC through the review process. Most countries use multiple strategies that differ in how they are implemented. Conclusion: APAC countries use multiple strategies simultaneously with varying implementation methods, including different formulae and sub-types of medication that a strategy applies to, whether the strategy is a mandate or guideline, and the extent of negotiations and transparency. Strategies are instituted partly with the aim of cost containment, and may also promote price stability, innovation, and increased access in the short and longer term. Abbreviations: APAC - Asia Pacific; WHO - World Health Organisation; IRP - Internal Reference Pricing; ERP - External Reference Pricing; SPA - Special Pricing Agreement; MES - Managed Entry Scheme; PVA - Price-Volume Agreement; RSA - Risk Sharing Agreement; NHIS - National Health Insurance System; PE - Pharmacoeconomic Evaluation; CEA - Cost-Effectiveness Analysis; QALY - Quality-adjusted Life Year; BIA - Budget Impact Analysis; PMP - Price Maintenance Premium; R&D - Research & Development.
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Affiliation(s)
- Naina R. Verghese
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Jon Barrenetxea
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Yukti Bhargava
- HTA and Pricing, APAC, Roche Singapore Pte Ltd, Singapore, Singapore
| | - Sagun Agrawal
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Eric Andrew Finkelstein
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Global Health Institute, Duke University, Global Health Institute, Durham, NC, USA
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Wettstein DJ, Boes S. Effectiveness of National Pricing Policies for Patent-Protected Pharmaceuticals in the OECD: A Systematic Literature Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:143-162. [PMID: 30367350 DOI: 10.1007/s40258-018-0437-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVES The aim of this review is to assess the current state of empirical research regarding the effectiveness of national pricing regulations of the patent-protected market for prescription pharmaceuticals. Effectiveness is understood to be the capacity of policies to have a desired impact on outcomes, such as health status, patient access, healthcare expenditure, and research investments, among others. METHODS A systematic review of the published literature on pricing regulations in OECD countries was performed. The PubMed, MEDLINE, Scopus, Web of Science, Cochrane Library and the OECD iLibrary databases were searched in September 2016 and December 2017, with an update in August 2018. Interrupted time series studies and additional empirical studies were included, as well as systematic reviews if appropriate methods were applied. The risk of bias was assessed based on the recommendations of the BMJ guidelines, Cochrane EPOC criteria, QHES instrument, HTA good practice guidelines, CRD's guidance and the CHEC criteria. The quality of evidence was evaluated using the suggestions from EPOC and GRADE. RESULTS Thirty-one publications met the inclusion criteria. Most of the assessed empirical research included therapeutic (TRP) and/or external reference pricing (ERP), with a clear majority focusing on TRP. The main outcomes that were analysed were drug prices, expenditures and drug use. For value-based pricing (VBP), only limited empirical data were found. CONCLUSIONS We found evidence that TRP may reduce pharmaceutical prices and expenditures in the short term. Furthermore, TRP may lead to substitution effects towards lower-priced pharmaceuticals. The effects of TRP on patient access, healthcare utilisation and R&D investments were found to be uncertain. No conclusions were drawn for ERP and VBP. No evidence was found for the effects on health outcomes for any of the analysed policies. There is a strong need for evidence generation regarding effective pricing policies, particularly for VBP, managed entry agreements and non-financial outcomes.
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Affiliation(s)
- Dominik J Wettstein
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland.
| | - Stefan Boes
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
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María Paredes Fernández D, Christian Lenz Alcayaga R. Acuerdos de Riesgo Compartido: Lecciones Para su Diseño e Implementación a la Luz de la Experiencia Internacional. Value Health Reg Issues 2019; 20:51-59. [PMID: 30870806 DOI: 10.1016/j.vhri.2018.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 10/04/2018] [Accepted: 12/24/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the growing interest in risk-sharing agreements as appropriate payment mechanisms for high-cost treatments, few practical resources facilitate their adoption. OBJECTIVE To identify and propose lessons for designing and implementing these models based on a review of the international experience, and to offer a concise model based on these lessons. METHODS The steps of the Joanna Briggs Institute were adopted, which included identifying the concept and its relevant variants in scientific and gray literature. RESULTS Forty-one references were examined in depth. The design of these payment mechanisms should be a process carried out by competent actors (payer, producer, specialists, patients, and a neutral entity); the design must be supported by a sound regulatory and contractual framework that structures its components and clarifies the functions of each actor. Finally, there are critical activities for each actor in each phase of the agreement's progress. CONCLUSIONS The participation of all actors and the clarification of critical elements and tasks are fundamental for the optimal development of the experiences.
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Affiliation(s)
- Daniela María Paredes Fernández
- Department for Health Promotion for Women and Newborn, University of Chile, Santiago, Chile; Public Health Institute, University Andrés Bello, Santiago, Chile; Lenz Consultores, Santiago, Chile.
| | - Rony Christian Lenz Alcayaga
- Public Health Institute, University Andrés Bello, Santiago, Chile; Lenz Consultores, Santiago, Chile; Chilean Chapter, International Society for Pharmaeconomics and Outcomes Research (ISPOR), Santiago, Chile
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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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Jørgensen J, Mungapen L, Kefalas P. Data collection infrastructure for patient outcomes in the UK - opportunities and challenges for cell and gene therapies launching. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2019; 7:1573164. [PMID: 30774785 PMCID: PMC6366432 DOI: 10.1080/20016689.2019.1573164] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/08/2019] [Accepted: 01/11/2019] [Indexed: 05/05/2023]
Abstract
Background: Cell and gene therapies are associated with uncertainty around their value claims at launch due to limitations of supporting clinical data; furthermore, their high costs present affordability issues for payers. Outcomes-based reimbursement can reduce payer decision uncertainty and improve patient access, however, requires data collection infrastructure and practice to be operational. Objective: To identify indications most likely to see launch of cell or gene therapies in the UK over the next five years, and to perform a qualitative assessment of how conducive the existing data collection infrastructure and clinical practice is in facilitating adoption of outcomes-based reimbursement in the corresponding indications. Methodology: Through secondary research, we identified target indications for cell or gene therapies at a mature clinical development stage (Phase III) with EU and/or US trial sites, and assessed availability of relevant data collection infrastructures in the UK. Secondary research findings were validated through primary research (expert interviews). Key parameters considered for the suitability of existing data collection infrastructure in supporting outcomes-based reimbursement include time horizon of data collection, whether data entry is mandatory and whether infrastructure is product or therapy area-specific. Findings: We identified 58 cell or gene therapies, spanning 47 indications, 20 of which are in oncology. Oncology seems well placed for outcomes data collection (through the mandatory Systemic Anti-Cancer Treatment database), however data entry compliance can be an issue (due to resource limitations), and upgrading will be needed for the purpose of outcomes-based reimbursement. Among non-oncology indications ~two-thirds have data collection infrastructures in place, but only three come close to the requirements for outcomes-based reimbursement. Conclusions: Existing data collection infrastructure in indications with potential cell or gene therapies launches in the next five years in the UK is overall not sufficient to facilitate outcomes-based reimbursement.
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Affiliation(s)
- Jesper Jørgensen
- Health Economics and Market Access, Cell and Gene Therapy Catapult, London, UK
| | - Laura Mungapen
- Health Economics and Market Access, Cell and Gene Therapy Catapult, London, UK
| | - Panos Kefalas
- Health Economics and Market Access, Cell and Gene Therapy Catapult, London, UK
- CONTACT Panos Kefalas Head of Health Economics and Market Access, Cell and Gene Therapy Catapult, 12th Floor Tower Wing, Guys Hospital, Great Maze Pond, LondonSE1 9RT, UK
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Engagement of Canadian Patients with Rare Diseases and Their Families in the Lifecycle of Therapy: A Qualitative Study. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 11:353-359. [PMID: 29299833 DOI: 10.1007/s40271-017-0293-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Patient involvement is increasingly recognized as critical to the development, introduction and use (i.e. the lifecycle) of new and effective therapies, particularly those for rare diseases, where natural histories and the impact on patients and families are less well-understood than for common diseases. However, little is known about how patients and families would like to be involved during the lifecycle. OBJECTIVE The aim of this study was to explore ways in which Canadian patients with rare diseases and their families would like to be involved in the lifecycle of therapies and identify their priorities for involvement. METHODS Patients with rare diseases and their families were recruited to participate in two deliberative sessions, during which concepts related to decision-making uncertainty and the technology lifecycle were introduced before eliciting input around ways in which they could be involved. This was followed by a webinar, which was used to further identify opportunities for involvement. The data were then analyzed qualitatively using eclectic coding. RESULTS Patients and families identified opportunities that fell into three goals: (1) incorporation of their 'lived experience' in coverage decision making (i.e. decisions by governments on funding new therapies); (2) improved care for patients; and (3) greater awareness of rare diseases, with the first being a priority. CONCLUSIONS Opportunities for patients and families to contribute their 'lived experience' are needed throughout the orphan drug lifecycle, but the ideal mechanisms for providing this input have yet to be determined.
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