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Bloemen B, Oortwijn W, van der Wilt GJ. Understanding the Normativity of Health Technology Assessment: Ontological, Moral, and Epistemological Commitments. HEALTH CARE ANALYSIS 2024:10.1007/s10728-024-00487-x. [PMID: 38884685 DOI: 10.1007/s10728-024-00487-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 06/18/2024]
Abstract
The inherent normativity of HTA can be conceptualized as a result of normative commitments, a concept that we further specify to encompass moral, epistemological and ontological commitments at play in the practice of HTA. Based on examples from literature, and an analysis of the example of assessing Non-Invasive Prenatal Testing (NIPT), we will show that inevitable normative decisions in conducting an assessment commits the HTA practitioner to moral (regarding what makes a health technology desirable), ontological (regarding which effects of health technology are conceivable), and epistemological (regarding how to obtain reliable information about health technology) norms. This highlights and supports the need for integrating normative analysis and stakeholder participation, providing guidance to HTA practitioners when making normative choices. This will foster a shared understanding between those who conduct, use, or are impacted by assessments regarding what are conceivable and desirable outcomes of using health technology, and how to collect reliable information to assess whether these outcomes are (going to be) realized. It also provides more insight into the implications of different normative choices.
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Affiliation(s)
- Bart Bloemen
- Department IQ Health Science, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Wija Oortwijn
- Department IQ Health Science, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gert Jan van der Wilt
- Department IQ Health Science, Radboud University Medical Center, Nijmegen, The Netherlands
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Nicholls K, Denaro C, Tchan M, Ellaway C, Bratkovic D, Campbell S, Fookes M, Thomas M. Fabry-specific treatment in Australia: time to align eligibility criteria with international best practices. Intern Med J 2024; 54:882-890. [PMID: 38212950 DOI: 10.1111/imj.16327] [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: 08/25/2023] [Accepted: 12/20/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Disease-specific therapy aims to improve symptoms, stabilise current disease and delay progression in patients with Fabry disease. In Australia, treatment access is subject to eligibility criteria initially established in 2004. Patients and their clinicians question why these criteria have remained unchanged despite significant progress in disease understanding. AIMS Appraise the clinical quality of the Australian treatment access criteria. METHODS The Fabry Australia Medical Advisory Committee (N = 6) used the Appraisal of Guidelines for REsearch and Evaluation Global Rating Scale (AGREE II GRS) to assess the clinical quality of the current treatment eligibility criteria. They reviewed the literature, developed 17 clinical statements to help guide reforms of the eligibility criteria and achieved consensus (achievement of ≥75% agreement in the range 5-7 on a 7-point Likert scale) through anonymous voting. The findings were applied to develop proposals for revised classification and treatment initiation criteria. RESULTS The current treatment eligibility criteria underperformed on the AGREE II GRS. They are pragmatic but out-of-step with contemporary data. Consensus was achieved on all 17 proposed clinical statements. There was strong agreement to differentiate classical male Fabry patients to facilitate timelier access to Fabry-specific treatment. There was also agreement on the value of adopting relevant organ involvement criteria in classical female patients and patients with non-classical disease. CONCLUSIONS Australian access criteria are misaligned with current clinical evidence. The clinical statements and proposed classification and initiation criteria should prompt discussions to support more equitable access to treatment and better align Australian practice with contemporary evidence and international guidelines.
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Affiliation(s)
- Kathleen Nicholls
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Charles Denaro
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Academy of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Michel Tchan
- Department of Genetic Medicine, Westmead Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Carolyn Ellaway
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Genetic Metabolic Disorders Service, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Drago Bratkovic
- Department of Internal Medicine and Aged Care, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | | | - Megan Fookes
- Fabry Australia, Sydney, New South Wales, Australia
| | - Mark Thomas
- Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Australia
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Sarri G, Rizzo M, Upadhyaya S, Paly VF, Hernandez L. Navigating the unknown: how to best 'reflect' standard of care in indications without a dedicated treatment pathway in health technology assessment submissions. J Comp Eff Res 2024; 13:e230145. [PMID: 38226913 PMCID: PMC10842305 DOI: 10.57264/cer-2023-0145] [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: 09/26/2023] [Accepted: 12/12/2023] [Indexed: 01/17/2024] Open
Abstract
There is an urgent need for expedited approval and access for new health technologies targeting rare and very rare diseases, some of which are associated with high unmet treatment needs. Once a new technology achieves regulatory approval, the technology needs to be assessed by health technology assessment (HTA) bodies to inform coverage and reimbursement decisions. This assessment quantitatively examines the clinical effectiveness, safety and/or economic impact of the new technology relative to standard of care (SoC) in a specific market. However, in rare and very rare diseases, the patient populations are small and there is often no established treatment pathway available to define 'SoC'. In these situations, several challenges arise to assess the added benefit of a new technology - both clinically and economically - due to lack of established SoC to guide an appropriate comparator selection. These challenges include: How should 'SoC' be defined and characterized in HTA submissions for new technologies aiming to establish new treatment standards? What is usual care without an established clinical pathway? How should the evidence for the comparator 'SoC' (i.e., usual care) arm be collected in situations with low patient representation and, sometimes, limited disease-specific clinical knowledge in certain geographies? This commentary outlines the evidence generation challenges in designing clinical comparative effectiveness for a new technology when there is a lack of established SoC. The commentary also proposes considerations to facilitate the reliable integration of real-world evidence into HTA and decision-making based on the collective experience of the authors.
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Affiliation(s)
| | | | | | | | - Luis Hernandez
- Takeda Pharmaceuticals America, Inc., Lexington, MA, USA
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Aryankhesal A, Behzadifar M, Bakhtiari A, Shahabi S, Azari S, Darvishi Teli B, Rezapour A, Ehsanzadeh SJ, Behzadifar M. Exploring the landscape of health technology assessment in Iran: perspectives from stakeholders on needs, demand and supply. Health Res Policy Syst 2024; 22:11. [PMID: 38225573 PMCID: PMC10789076 DOI: 10.1186/s12961-023-01097-0] [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: 09/09/2023] [Accepted: 12/20/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND The evaluation of health technologies plays a crucial role in the allocation of resources and the promotion of equitable healthcare access, known as health technology assessment (HTA). This study focuses on Iran's efforts to integrate HTA and aims to gain insights into stakeholder perspectives regarding capacity needs, demand and implementation. METHODS In this study, we employed the HTA introduction status analysis questionnaire developed by the International Decision Support Initiative (iDSI), which has been utilized in various countries. The questionnaire consisted of 12 questions divided into three sections: HTA need, demand and supply. To identify key informants, we conducted a literature review and consulted with the Ministry of Health and Medical Education (MOHME), as well we experts in policy-making, health service provision and HTA. We selected stakeholders who held decision-making positions in the healthcare domain. A modified Persian version of the questionnaire was administered online from September 2022 to January 2023 and was pretested for clarity. The analysis of the collected data involved quantitative methods for descriptive analysis and qualitative methods for thematic analysis. RESULTS In this study, a total of 103 questionnaires were distributed, resulting in a favourable response rate of 61% from 63 participants, of whom 68% identified as male. The participants, when assessing the needs of HTA, rated allocative efficiency as the highest priority, with a mean rating of 8.53, thereby highlighting its crucial role in optimizing resource allocation. Furthermore, healthcare quality, with a mean rating of 8.17, and transparent decision-making, with a mean rating of 7.92, were highly valued for their impact on treatment outcomes and accountability. The importance of budget control (mean rating 7.58) and equity (mean rating 7.25) were also acknowledged, as they contribute to maintaining sustainability and promoting social justice. In terms of HTA demand, safety concerns were identified as the top priority, closely followed by effectiveness and cost-effectiveness, with an expanded perspective on the economy. However, limited access to local data was reported, which arose from various factors including data collection practices, system fragmentation and privacy concerns. The priorities of HTA users encompassed coverage, payment reform, benefits design, guidelines, service delivery and technology registration. Evidence generation involved the participation of medical universities, research centres and government bodies, albeit with ongoing challenges in research quality, data access and funding. The study highlights government support and medical education as notable strengths in this context. CONCLUSIONS This study provides a comprehensive evaluation of Iran's HTA landscape, considering its capacity, demand and implementation aspects. It underlines the vital role of HTA in optimizing resources, improving healthcare quality and promoting equity. The study also sheds light on the strengths of evidence generation in the country, while simultaneously identifying challenges related to data access and system fragmentation. In terms of policy priorities, evidence-based decision-making emerges as crucial for enhancing healthcare access and integrating technology. The study stresses the need for evidence-based practices, a robust HTA infrastructure and collaboration among stakeholders to achieve better healthcare outcomes in Iran.
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Affiliation(s)
- Aidin Aryankhesal
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Meysam Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ahad Bakhtiari
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Saeed Shahabi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samad Azari
- Hospital Management Research Center, Health Management Research Institute, University of Medical Sciences, Tehran, Iran
| | - Banafshe Darvishi Teli
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Health Management Research Institute, Iran, University of Medical Sciences, Tehran, Iran
| | - Seyed Jafar Ehsanzadeh
- English Language Department, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
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Honda D, Li PH, Jindal AK, Katelaris CH, Zhi YX, Thong BYH, Longhurst HJ. Uncovering the true burden of hereditary angioedema due to C1-inhibitor deficiency: A focus on the Asia-Pacific region. J Allergy Clin Immunol 2024; 153:42-54. [PMID: 37898409 DOI: 10.1016/j.jaci.2023.09.039] [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: 06/28/2023] [Revised: 09/01/2023] [Accepted: 09/28/2023] [Indexed: 10/30/2023]
Abstract
Hereditary angioedema (HAE) due to C1-inhibitor deficiency or dysfunction is a rare genetic disorder that causes recurrent episodes of swelling in various parts of the body. Treatment goals of HAE aim to "normalize" life for all patients; however, lack of diagnostic facilities and limited access to effective treatment options in developing nations cause delays in diagnosis and place a significant burden on patients. In this review, we aim to highlight the burden of disease caused by C1-inhibitor HAE across the Asia-Pacific region, considering its epidemiology, morbidity and mortality, and socioeconomic and psychological impact. We also review the availability of guideline-recommended diagnostic facilities and treatments, and how patients are currently managed. Data were collected from published literature and HAE experts in the region, who provided information regarding diagnosis and management in their countries. Current practice was reviewed against international guidelines, as well as local guidelines/consensus used in Australia, Japan, and China. Suggestions are provided for improving the time to diagnosis in the region, increasing access to guideline-recommended treatments, and providing support to reduce the burden on patients and caregivers. There is an urgent need to improve HAE services and provide access to life-saving treatment in developing countries, and efforts should be made to increase awareness of guideline recommendations in high-income economies that do not currently provide long-term prophylactic treatments.
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Affiliation(s)
- Daisuke Honda
- Department of Nephrology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Philip Hei Li
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Ankur Kumar Jindal
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Constance H Katelaris
- Immunology and Allergy Unit, Department of Medicine, Campbelltown Hospital and Western Sydney University, Campbelltown, Sydney, Australia
| | - Yu-Xiang Zhi
- Department of Allergy and Clinical Immunology, Peking Union Medical College Hospital and Chinese Academy of Medical Sciences, Beijing, China
| | - Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
| | - Hilary J Longhurst
- Department of Immunology, Auckland City Hospital, Grafton, Auckland, New Zealand; Department of Medicine, University of Auckland, Auckland, New Zealand.
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Marshall DA, Gerber B, Lorenzetti DL, MacDonald KV, Bohach RJ, Currie GR. Are We Capturing the Socioeconomic Burden of Rare Genetic Disease? A Scoping Review of Economic Evaluations and Cost-of-Illness Studies. PHARMACOECONOMICS 2023; 41:1563-1588. [PMID: 37594668 DOI: 10.1007/s40273-023-01308-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Rare diseases have a significant impact on patients, families, the health system, and society. Measuring the socioeconomic burden is crucial to valuing interventions for rare diseases. Healthcare system costs are significant, but so are costs to other government sectors, patients, families, and society. To understand the breadth of costs captured in rare disease studies, we examined the cost categories and elements of socioeconomic burden captured in published studies. METHODS A scoping review was conducted using five electronic databases to identify English language economic evaluations and cost-of-illness studies of interventions for rare diseases (2011-21). We mapped costs using a previously developed evidence-informed framework of socioeconomic burden costs for rare disease. RESULTS Of 4890 studies identified, 48 economic evaluations and 22 cost-of-illness studies were included. While 18/22 cost-of-illness studies utilized a societal perspective, only 7/48 economic evaluations incorporated societal costs. Most reported cost categories related to medical costs, with medication and hospitalizations being the most common elements for both study designs. Costs borne by patients, families, and society were reported less among economic evaluations than cost-of-illness studies. These included: productivity (10% vs 77%), travel/accommodation (6% vs 68%), government benefits (4% vs 18%), and family impacts (0% vs 50%). CONCLUSIONS Contrary to cost-of-illness analyses, most of the included economic evaluations did not account for the hidden burden of rare diseases, that is, costs borne by patients, families, and societies. Including these types of costs in future studies would provide a more comprehensive picture of the burden of disease, providing empirical data to inform how we value and make decisions regarding rare disease interventions, health policy, and resource allocation.
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Affiliation(s)
- Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Brittany Gerber
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Diane L Lorenzetti
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Health Sciences Library, University of Calgary, Calgary, AB, Canada
| | - Karen V MacDonald
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Riley Jewel Bohach
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Gillian R Currie
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
- Department of Pediatrics, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
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Merlin T, Street J, Carter D, Haji Ali Afzali H. Challenges in the Evaluation of Emerging Highly Specialised Technologies: Is There a Role for Living HTA? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:823-830. [PMID: 37824056 PMCID: PMC10628011 DOI: 10.1007/s40258-023-00835-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/13/2023]
Abstract
There is currently deep uncertainty about the clinical benefits and cost effectiveness of highly specialised technologies (HSTs), like gene and cell therapies. These treatments are novel, typically have high upfront costs, the patient populations are small and heterogenous, there is minimal information on their long-term safety and effectiveness, and data are limited and often of poor quality. With the increasing number of these technologies and their high cost burden on governments and health care providers, policy makers are currently walking a decision tightrope. On the one hand, an unfavourable funding decision could potentially limit patient access to life-saving treatments, while on the other, a favourable decision could result in unsustainable budget impacts and perhaps poorer patient health outcomes. Health technology assessment (HTA) is meant to determine the value of a health technology in order to promote an equitable, efficient, and high-quality health system. However, standard HTA processes have failed to mitigate the deep uncertainties associated with these technologies. In this paper, we propose a Living HTA framework to address these challenges. This framework includes a one-off process for making explicit the societal values associated with HSTs. These would inform the decision-making approach, data collection and the development of disease-specific reference models to be used by industry sponsors as the basis for their submissions for public funding. Coverage with an evidence development mechanism is also proposed by which data can be collected in real time to update the reference model on a rolling basis, thereby allowing re-assessment of the clinical and cost effectiveness of individual HSTs. The HTA would be 'live' until the results indicate there is sufficient certainty for the funding decision to be confirmed, the price changed or the funding removed.
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Affiliation(s)
- Tracy Merlin
- School of Public Health, Adelaide Health Technology Assessment (AHTA), University of Adelaide, Mail Drop DX650545, Adelaide, SA, 5000, Australia.
| | - Jackie Street
- School of Public Health, Adelaide Health Technology Assessment (AHTA), University of Adelaide, Mail Drop DX650545, Adelaide, SA, 5000, Australia
| | - Drew Carter
- School of Public Health, Adelaide Health Technology Assessment (AHTA), University of Adelaide, Mail Drop DX650545, Adelaide, SA, 5000, Australia
| | - Hossein Haji Ali Afzali
- School of Public Health, Adelaide Health Technology Assessment (AHTA), University of Adelaide, Mail Drop DX650545, Adelaide, SA, 5000, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
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Mahlich J, Riou S, Verry M. The philosophy of pharmaceutical regulation-Paternalism or freedom of choice? Front Med (Lausanne) 2023; 10:1264021. [PMID: 37964884 PMCID: PMC10641726 DOI: 10.3389/fmed.2023.1264021] [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: 07/20/2023] [Accepted: 10/10/2023] [Indexed: 11/16/2023] Open
Abstract
When assessing the value of new drugs regulatory authorities across the world frequently make different decisions even though their decisions are based on the same evidence package. In this perspective we argue that even in today's world regulatory and medical decision making is framed by conflicting philosophical schools of thought, namely the liberal tradition of the Anglo Saxon countries pioneered by the Scotsman Adam Smith and the continental European tradition of paternalism that roots back to the German philosopher Georg Friedrich Hegel. We outline the basics of these two philosophical theories and show that countries following the liberal tradition are more reluctant to reject new drugs due to weak evidence. Instead, they leave decisions to a greater extend to those who are affected, namely patients and their caregivers.
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Affiliation(s)
- Jörg Mahlich
- Miltenyi Biomedicine, Bergisch Gladbach, Germany
- Düsseldorf Institute for Competition Economics (DICE), Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Sybille Riou
- Miltenyi Biomedicine, Bergisch Gladbach, Germany
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Currie GR, Gerber B, Lorenzetti D, MacDonald K, Benseler SM, Bernier FP, Boycott KM, Carias KV, Hamelin B, Hayeems RZ, LeBlanc C, Twilt M, van Rooijen G, Wong-Rieger D, Yeung RSM, Marshall DA. Developing a Framework of Cost Elements of Socioeconomic Burden of Rare Disease: A Scoping Review. PHARMACOECONOMICS 2023; 41:803-818. [PMID: 37029233 DOI: 10.1007/s40273-023-01262-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Rare diseases place a significant burden on patients, families, the healthcare system, and society. Evidence on the socioeconomic burden of rare disease is limited and mostly reflects diseases where treatments are available. We developed a framework encompassing recommended cost elements for studies of the socioeconomic burden of rare diseases. METHODS A scoping review, conducted in five databases (Cochrane Library, EconLit, Embase, MEDLINE, and APA PsycINFO), identified English language publications from 2000 to 2021 presenting frameworks developed for determining, measuring or valuing costs for rare or chronic diseases. Cost elements were extracted and used to develop a literature-informed framework. Structured feedback was gathered from experts in rare diseases, health economics/health services, and policy research to revise the framework. RESULTS Of 2990 records identified, eight papers were included and informed our preliminary framework; three focused on rare disease and five on chronic disease. Following expert input, we developed a framework consisting of nine cost categories (inpatient, outpatient, community, healthcare products/goods, productivity/education, travel/accommodation, government benefits, family impacts, and other), with several cost elements within each category. Our framework includes unique costs, added from the expert feedback, including genetic testing to inform treatment, use of private laboratories or out-of-country testing, family involvement in foundations and organizations, and advocacy costs for special access programs. CONCLUSIONS Our work is the first to identify a comprehensive list of cost elements for rare disease for use by researchers and policy makers to fully capture socioeconomic burden. Use of the framework will increase the quality and comparability of future studies. Future work should focus on measuring and valuing these costs through onset, diagnosis, and post-diagnosis.
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Affiliation(s)
- Gillian R Currie
- Department of Pediatrics, Health Research Innovation Centre, University of Calgary, Room 3C56, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
| | - Brittany Gerber
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Diane Lorenzetti
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Health Sciences Library, University of Calgary, Calgary, AB, Canada
| | - Karen MacDonald
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Susanne M Benseler
- Department of Pediatrics, Health Research Innovation Centre, University of Calgary, Room 3C56, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Francois P Bernier
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Medical Genetics, Alberta Children's Hospital, Calgary, AB, Canada
| | - Kym M Boycott
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Robin Z Hayeems
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Claire LeBlanc
- Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Marinka Twilt
- Department of Pediatrics, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, and the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | | | | | - Rae S M Yeung
- Departments of Paediatrics, Immunology and Medical Science, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
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10
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Hwang SE, Kim M, Hong Y, Lee D, Kim T, Park J, Bae J, Lee JH. Effect of the copayment reduction system on accessibility to orphan drugs in South Korea. Expert Rev Pharmacoecon Outcomes Res 2023; 23:519-525. [PMID: 36922505 DOI: 10.1080/14737167.2023.2192481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE This study aims to analyze the effect of the copayment reduction system on accessibility to orphan drugs (ODs) in South Korea. METHODS Data on approval and reimbursement for drugs designated as ODs for the last 10 years (2012-2021) in South Korea were extracted. Among them, with 136 approved products as of 31 December 2022, the reimbursement rates and lead time to reimbursement between drugs for rare diseases (DRDs) and nondrugs for rare diseases (non-DRDs) were analyzed. The pricing and reimbursement (P&R) pathways between drugs for only rare diseases (DORDs) and drugs for rare and cancerous diseases (DRCDs) were compared. RESULTS The reimbursement rates for DRDs and non-DRDs were 54.8% and 33.3%, respectively, and the lead time to reimbursement for DRDs and non-DRDs were 16.1 months and 31.2 months, respectively. The P&R pathways for DORDs and DRCDs were pharmacoeconomic evaluation waivers (21.7% and 52.6%), weighted average price (52.2% and 13.2%), and risk-sharing agreement (30.4% and 81.6%). CONCLUSION The copayment reduction system may act as a driver and also barrier for the reimbursement of ODs. To expand treatment accessibility to ODs, it is necessary to consistently grants benefits in all processes from OD designation to market access.
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Affiliation(s)
- Se-Eun Hwang
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Minyoung Kim
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Youngjun Hong
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Dongyun Lee
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Taehyang Kim
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Jihee Park
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Junkyu Bae
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Jong Hyuk Lee
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
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Stafinski T, Street J, Young A, Menon D. Moving beyond the Court of Public Opinion: A Citizens' Jury Exploring the Public's Values around Funding Decisions for Ultra-Orphan Drugs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:633. [PMID: 36612953 PMCID: PMC9819519 DOI: 10.3390/ijerph20010633] [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: 11/04/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
Health system decision-makers need to understand the value of new technology to make "value for money" decisions. Typically, narrow definitions of value are used. This paper reports on a Canadian Citizens' Jury which was convened to elicit those aspects of value that are important to the public. The criteria used by the public to determine value included those related to the patient, those directly related to caregivers and those directly created for society. Their choices were not binary (e.g., cost vs. health gained), but rather involved multiple factors (e.g., with respect to patient factors: disease severity, health gained with the drug, existence of alternatives, life expectancy, patient age and affordability). Overall, Jurors prioritized funding treatments for ultra-rare disease populations when the treatment offered significant improvements in health and quality of life, and when the pre-treatment health state was considered extremely poor. The prevalence of the disease by itself was not a factor in the choices. Some of the findings differ from previous work, which use survey methods. In our Citizens' Jury, Jurors were able to become more familiar with the question at hand and were exposed to a broad and balanced collection of viewpoints before and throughout engaging in the exercises. This deliberative approach allows for a more nuanced approach to understanding value.
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Affiliation(s)
- Tania Stafinski
- Health Technology & Policy Unit, School of Public Health, 4-343, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada
| | - Jacqueline Street
- Australian Centre for Engagement, Evidence and Values, University of Wollongong, Northfields Ave, Wollongong 2522, Australia
| | - Andrea Young
- Health Technology & Policy Unit, School of Public Health, 4-343, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada
| | - Devidas Menon
- Health Technology & Policy Unit, School of Public Health, 4-343, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada
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Shengnan D, Zixuan L, Na Z, Weikai Z, Yuanyuan Y, Jiasu L, Ni Y. Using 5 consecutive years of NICE guidance to describe the characteristics and influencing factors on the economic evaluation of orphan oncology drugs. Front Public Health 2022; 10:964040. [PMID: 36187695 PMCID: PMC9519130 DOI: 10.3389/fpubh.2022.964040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/22/2022] [Indexed: 01/24/2023] Open
Abstract
Objective Orphan oncology drugs used in this article were defined by the type of disease treated by drugs, as drugs used to treat rare diseases with a prevalence of ≤ 500 per million people per year. In this article, our concern was to explore focus on the economic evaluation of the National Institute for Health and Care Excellence (NICE), when orphan oncology drugs were appraised for reimbursement, and provide advice and suggestions to decision-makers. Methods A retrospective study was used in this study. Thirty guidance were gathered as our subject by NICE from 2016 to 2020, excluded drugs were not identified as orphan by European Medicines Agency (EMA) and orphan drugs were not used for cancer, and orphan oncology drugs were terminated at the time of data collection at NICE. Qualitative analysis, descriptive statistics, and Fisher's exact test were conducted. Results Of all guidance, the partitioned survival model was used most to appraise orphan oncology drugs, and every drug had a kind of commercial arrangement such as patient access scheme (PAS), managed access arrangements (MAAs), and commercial access agreement (CAAs). End of life is an important indicator that had been defined by NICE in the methods of technology appraisal in 2013, and drugs that met the criterion would be given a higher threshold of ICER. In addition, we found that potential health benefits were increasingly concerned such as drug delivery. Conclusion In the setting of uncertain clinical and cost efficacy, orphan oncology drugs are comprehensively evaluated in multiple additional dimensions, which include life-extending benefits, and innovation. NICE uses a combination of special considerations for incomplete data, appropriate economic models, and appropriate health technology assessment (HTA) methods during the assessment process, besides, orphan oncology drugs with insufficiency evidence were recommended Cancer Drugs fund (CDF) to afford for patients, which would obtain more availability and accessibility, based on which, high-quality drugs for treating rare cancers can fall within the scope of affordable healthcare provided by the English medical insurance fund.
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Affiliation(s)
- Duan Shengnan
- School of Public Health, Dalian Medical University, Dalian, China
| | - Lv Zixuan
- School of Public Health, Dalian Medical University, Dalian, China
| | - Zhou Na
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Zhu Weikai
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yi Yuanyuan
- Department of Respiratory Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Liu Jiasu
- Department of Ophthalmology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yuan Ni
- School of Public Health, Dalian Medical University, Dalian, China,*Correspondence: Yuan Ni
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