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Daigl M, Abogunrin S, Castro F, McGough SF, Sturrup RH, Boersma C, Abrams KR. Advancing the role of real-world evidence in comparative effectiveness research. J Comp Eff Res 2024:e240101. [PMID: 39392412 DOI: 10.57264/cer-2024-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2024] Open
Abstract
Aim: Comparative effectiveness research (CER) is essential for making informed decisions about drug access. It provides insights into the effectiveness and safety of new drugs compared with existing treatments, thereby guiding better healthcare decisions and ensuring that new therapies meet the real-world needs of patients and healthcare systems. Objective: To provide a tool that assists analysts and decision-makers in identifying the most suitable analytical approach for answering a CER question, given specific data availability contexts. Methods: A systematic literature review of the scientific literature was performed and existing regulatory and health technology assessment (HTA) guidance were evaluated to identify and compare recommendations and best practices. Based on this review a methods flowchart that synthesizes current practices and requirements was proposed. Results: The review did not find any papers that clearly identified the most appropriate analytical approach for answering CER questions under various conditions. Therefore, a methods flowchart was designed to inform analyst and decision makers choices starting from a well-defined scientific question. Conclusion: The proposed methods flowchart offers clear guidance on CER methodologies across a range of settings and research needs. It begins with a well-defined research question and considers multiple feasibility aspects related to CER. This tool aims to standardize methods, ensure rigorous and consistent research quality and promote a culture of evidence-based decision-making in healthcare.
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Affiliation(s)
- Monica Daigl
- Global Access F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland
| | - Seye Abogunrin
- Global Access F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland
| | - Felipe Castro
- Data Science, F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland
| | - Sarah F McGough
- Computational Sciences, Genentech Inc., South San Franscisco, CA 94080, USA
| | | | - Cornelis Boersma
- Health-Ecore, 3704 HE Zeist, The Netherlands
- Department of Health Sciences, University Medical Center Groningen, Groningen, 9700 AB, The Netherlands
- Department of Management Sciences, Open University, Heerlen, 6419 AT, The Netherlands
| | - Keith R Abrams
- Department of Statistics & Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
- Centre for Health Economics, University of York, York, YO10 5DD, UK
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Sciriha GG, Sultana J, Borg J. Pharmacological treatment for transforming growth factor beta induced corneal dystrophies: what is the way forward? Expert Rev Clin Pharmacol 2023; 16:275-278. [PMID: 36945753 DOI: 10.1080/17512433.2023.2193683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Affiliation(s)
| | - Janet Sultana
- Exeter College of Medicine and Health, University of Exeter, Exeter, UK
| | - Joseph Borg
- Department of Applied Biomedical Science, Faculty of Health Sciences, University of Malta, Msida, Malta
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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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Jorda A, Zeitlinger M. Preclinical Pharmacokinetic/Pharmacodynamic Studies and Clinical Trials in the Drug Development Process of EMA-Approved Antibacterial Agents: A Review. Clin Pharmacokinet 2021; 59:1071-1084. [PMID: 32356105 PMCID: PMC7467913 DOI: 10.1007/s40262-020-00892-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Development of new antibacterial agents is necessary as drug-resistant bacteria are a threat to global health. In Europe, the European Medicines Agency has been guiding this development process for more than two decades. We investigated preclinical and clinical pre-approval studies to illuminate the current authorization process with emphasis on pharmacokinetic/pharmacodynamic approaches and clinical phases. All centrally authorized systemic antibacterial and antimycobacterial drugs within the European Union were included without any time restriction. Additionally, US Food and Drug Administration-approved antibiotics of the previous 3 years, which were not yet approved by the European Medicines Agency, were included. We focused on preclinical pharmacokinetic/pharmacodynamic studies and phase II and phase III clinical trials. Furthermore, we looked at the recommended dosing regimens and approved indications. In this review, we designed tree diagrams as a new means of illustrating the development process of antibiotics to relate pharmacokinetic/pharmacodynamic phase II and III studies to approved indications. We included 23 (European Medicines Agency, 18; US Food and Drug Administration, 5) antimicrobial agents. Tetracyclines, carbapenems, and cephalosporins were the leading classes. The recommended dosing intervals were significantly shorter in time- vs exposure-dependent drugs (median 8 vs 12, p = 0.006). The majority of approved indications (i.e., acute bacterial skin and soft-tissue infection, community-acquired pneumonia, complicated intra-abdominal infection, complicated urinary tract infection, and complicated skin and soft-tissue infection) used non-inferiority trials. Phase II and III clinical trials investigating community-acquired pneumonia involved the fewest patients. Some promising drugs were marketed in recent years; the individual steps to their authorizations are illuminated. We confirmed the relevance of preclinical pharmacokinetic/pharmacodynamic studies in dosing optimization and decision making in antimicrobial drug development. Non-inferiority clinical trials predominated.
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Affiliation(s)
- Anselm Jorda
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Li M, Chen S, Lai Y, Liang Z, Wang J, Shi J, Lin H, Yao D, Hu H, Ung COL. Integrating Real-World Evidence in the Regulatory Decision-Making Process: A Systematic Analysis of Experiences in the US, EU, and China Using a Logic Model. Front Med (Lausanne) 2021; 8:669509. [PMID: 34136505 PMCID: PMC8200400 DOI: 10.3389/fmed.2021.669509] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/04/2021] [Indexed: 12/11/2022] Open
Abstract
Real world evidence (RWE) and real-world data (RWD) are drawing ever-increasing attention in the pharmaceutical industry and drug regulatory authorities (DRAs) all over the world due to their paramount role in supporting drug development and regulatory decision making. However, there is little systematic documentary analysis about how RWE was integrated for the use by the DRAs in evaluating new treatment approaches and monitoring post-market safety. This study aimed to analyze and discuss the integration of RWE into regulatory decision-making process from the perspective of DRAs. Different development strategies to develop and adopt RWE by the DRAs in the US, Europe, and China were reviewed and compared, and the challenges encountered were discussed. It was found that different strategies on development of RWE were applied by FDA, EMA, and NMPA. The extent to which RWE was adopted in China was relatively limited compared to that in the US and EU, which was highly related to the national pharmaceutical environment and development stages. A better understanding of the overall goals, inputs, activities, outputs, and outcomes in developing RWE will help inform actions to harness RWD and leverage RWE for better health care decisions.
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Affiliation(s)
- Meng Li
- State Key Laboratory in Quality Research of Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Shengqi Chen
- State Key Laboratory in Quality Research of Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Yunfeng Lai
- State Key Laboratory in Quality Research of Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Zuanji Liang
- State Key Laboratory in Quality Research of Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Jiaqi Wang
- State Key Laboratory in Quality Research of Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Junnan Shi
- State Key Laboratory in Quality Research of Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Haojie Lin
- State Key Laboratory in Quality Research of Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Dongning Yao
- State Key Laboratory in Quality Research of Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Hao Hu
- State Key Laboratory in Quality Research of Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Carolina Oi Lam Ung
- State Key Laboratory in Quality Research of Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
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Halminen O, Chen A, Tenhunen H, Lillrank P. Demonstrating the value of digital health: Guidance on contextual evidence gathering for companies in different stages of maturity. Health Serv Manage Res 2020; 34:13-20. [PMID: 33291977 DOI: 10.1177/0951484820971447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Application of value-based healthcare policies affects all actors in social and health care field, including the Digital Health Intervention (DHI) providers aiming to enter the industry or expand their market. Apparent lack of fit between evidence and expectations inhibits the growth of DHI companies. The companies need efficient and credible methods to access and demonstrate the value of their DHIs. Building on the stage-of-maturity logic presented in World Health Organization's (WHO) guide of monitoring and evaluating digital health interventions and Context-Intervention-Mechanism-Outcome (CIMO) logic, we provide a potential approach for DHI companies to assess the evidence needed in their current situation. The proposed approach takes into account the company's future development goals and the business environment, reflecting for every stage of technology maturity according to the WHO guidelines and through the CIMO lens. The focus is on specific intervention and its fit for different organizational and national contexts. The solution guides the research process of the company to understand which evidence-gathering topics should be addressed. This evidence can be beneficial for companies to enter into, occupy, expand or sustain in the domestic or international market.
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Affiliation(s)
- Olli Halminen
- Department of Industrial Engineering and Management, School of Science, Aalto University, Espoo, Finland
| | - An Chen
- Department of Industrial Engineering and Management, School of Science, Aalto University, Espoo, Finland
| | - Henni Tenhunen
- Department of Industrial Engineering and Management, School of Science, Aalto University, Espoo, Finland
| | - Paul Lillrank
- Department of Industrial Engineering and Management, School of Science, Aalto University, Espoo, Finland
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Ofori-Asenso R, Hallgreen CE, De Bruin ML. Improving Interactions Between Health Technology Assessment Bodies and Regulatory Agencies: A Systematic Review and Cross-Sectional Survey on Processes, Progress, Outcomes, and Challenges. Front Med (Lausanne) 2020; 7:582634. [PMID: 33178721 PMCID: PMC7596325 DOI: 10.3389/fmed.2020.582634] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/25/2020] [Indexed: 12/30/2022] Open
Abstract
The need to optimize drug development and facilitate faster access for patients has ignited discussions around the importance of improving interactions between health technology assessment (HTA) bodies and regulatory agencies. In this study, we conducted a systematic review to examine processes, progress, outcomes, and challenges of harmonization/interaction initiatives between HTA bodies and regulatory agencies. MEDLINE, EMBASE, and the International Pharmaceutical Abstracts database were searched up to 21 October 2019. Searches for gray literature (working papers, commissioned reports, policy documents, etc.) were performed via Google scholar and several institutional websites. An online cross-sectional survey was also conducted among HTA (n = 22) and regulatory agencies (n = 6) across Europe to supplement the systematic review. Overall, we found that while there are areas of divergence, there has been progress over time in narrowing the gap in evidentiary requirements for HTA bodies and regulatory agencies. Most regulatory agencies (4/6; 67%) and half (11/22, 50%) of the HTA bodies reported having a formal link for “collaborating” with the other. Several mechanisms such as early tripartite dialogues, parallel submissions (reviews), adaptive licensing pathways, and postauthorization data generation have been explored as avenues for improving collaboration. A number of pilot initiatives have shown positive effects of these models to reduce the time between regulatory and HTA decisions, which may translate into faster access for patients to life-saving therapies. Thus, future approaches aimed at improving harmonization/interaction between HTA bodies and regulatory agencies should build on these existing models/mechanisms while examining their long-term impacts. Several barriers including legal, organizational, and resource-related factors were also identified, and these need to be addressed to achieve greater alignment in the current regulatory and reimbursement landscape.
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Affiliation(s)
- Richard Ofori-Asenso
- Copenhagen Centre for Regulatory Science (CORS), Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Christine E Hallgreen
- Copenhagen Centre for Regulatory Science (CORS), Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marie Louise De Bruin
- Copenhagen Centre for Regulatory Science (CORS), Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
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Prieto-Pinto L, Garzón-Orjuela N, Lasalvia P, Castañeda-Cardona C, Rosselli D. International Experience in Therapeutic Value and Value-Based Pricing: A Rapid Review of the Literature. Value Health Reg Issues 2020; 23:37-48. [PMID: 32688214 DOI: 10.1016/j.vhri.2019.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 10/17/2019] [Accepted: 11/09/2019] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To characterize at a global level the concept of therapeutic value (TV) and describe the experience of value-based pricing (VBP) policies in 6 reference countries. METHODS We conducted a rapid review of the literature that addressed 2 exploratory research questions. A systematic and exhaustive search was carried out up to July 2018 in MEDLINE (Ovid), Embase, Scopus, and Web of Science. RESULTS The concepts of TV and VBP are related; value frameworks for medicines should include social preferences, comparative effectiveness, safety, adoption viability, social impact, high quality of evidence, severity of illness, and innovation. The added therapeutic value (ATV) is the manner of measuring the therapeutic advantages of new medicines compared with existing ones in terms of comparative effectiveness and safety. There are variations in the mechanisms of reimbursement and drug pricing regulation between the countries of study. CONCLUSION In a VBP system it is essential to establish the TV and ATV of a new medicine. Although there are no methodological guidelines for the implementation of VBP policies, the process implies from the beginning the definition of TV categories that will be included in the drug pricing and reimbursement systems. Agreements between the pharmaceutical industry and governments have become a useful tool as a negotiating mechanism in most countries.
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Affiliation(s)
| | | | - Pieralessandro Lasalvia
- Department of Evidence-Based Medicine, NeuroEconomix, Bogotá, Colombia; Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Diego Rosselli
- Department of Evidence-Based Medicine, NeuroEconomix, Bogotá, Colombia; Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Bogotá, Colombia
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Neez E, Hwang TJ, Sahoo SA, Naci H. European Medicines Agency's Priority Medicines Scheme at 2 Years: An Evaluation of Clinical Studies Supporting Eligible Drugs. Clin Pharmacol Ther 2019; 107:541-552. [PMID: 31591708 DOI: 10.1002/cpt.1669] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 09/20/2019] [Indexed: 11/10/2022]
Abstract
The Priority Medicines (PRIME) scheme was launched by the European Medicines Agency (EMA) in 2016 to expedite the development and approval of promising products targeting conditions with high unmet medical need. Manufacturers of PRIME drugs receive extensive regulatory advice on their trial designs. Until June 2018, the EMA granted PRIME status to 39 agents, evaluated in 138 studies (102 initiated before and 36 after PRIME eligibility). A third of the studies forming the basis of PRIME designation were randomized controlled trials, and a quarter of the studies were blinded. There was no statistically significant difference between trials initiated before and after PRIME designation in terms of randomized design and use of blinding. However, significantly more efficacy studies included a clinical end point after PRIME designation than before, and significantly fewer included surrogate measures alone. There were no statistically significant differences between the trial designs of PRIME and non-PRIME-designated products.
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Affiliation(s)
- Emilie Neez
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Thomas J Hwang
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Harvard Medical School, Boston, Massachusetts, USA
| | - Samali Anova Sahoo
- Department of Life Sciences and Management, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, UK
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