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Farmer C, Barnish MS, Trigg LA, Hayward S, Shaw N, Crathorne L, Strong T, Groves B, Spoors J, Melendez Torres GJ. An evaluation of managed access agreements in England based on stakeholder experience. Int J Technol Assess Health Care 2023; 39:e55. [PMID: 37497570 DOI: 10.1017/s0266462323000478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVES The objective of this research was to evaluate managed access policy in England, drawing upon the expertise of a range of stakeholders involved in its implementation. METHODS Seven focus groups were conducted with payer and health technology assessment representatives, clinicians, and representatives from industry and patient/carer organizations within England. Transcripts were analyzed using framework analysis to identify stakeholders' views on the successes and challenges of managed access policy. RESULTS Stakeholders discussed the many aims of managed access within the National Health Service in England, and how competing aims had affected decision making. While stakeholders highlighted a number of priorities within eligibility criteria for managed access agreements (MAAs), stakeholders agreed that strict eligibility criteria would be challenging to implement due to the highly variable nature of innovative technologies and their indications. Participants highlighted challenges faced with implementing MAAs, including evidence generation, supporting patients during and after the end of MAAs, and agreeing and reinforcing contractual agreements with industry. CONCLUSIONS Managed access is one strategy that can be used by payers to resolve uncertainty for innovative technologies that present challenges for reimbursement and can also deliver earlier access to promising technologies for patients. However, participants cautioned that managed access is not a "silver bullet," and there is a need for greater clarity about the aims of managed access and how these should be prioritized in decision making. Discussions between key stakeholders involved in managed access identified challenges with implementing MAAs and these experiences should be used to inform future managed access policy.
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Affiliation(s)
- Caroline Farmer
- Peninsula Technology Assessment Group (PenTAG), Department of Public Health and Sport Sciences, University of Exeter Medical School, Exeter, UK
| | - Maxwell S Barnish
- Peninsula Technology Assessment Group (PenTAG), Department of Public Health and Sport Sciences, University of Exeter Medical School, Exeter, UK
| | - Laura A Trigg
- Peninsula Technology Assessment Group (PenTAG), Department of Public Health and Sport Sciences, University of Exeter Medical School, Exeter, UK
| | - Samuel Hayward
- Health and Care Public Health Team, North Somerset Council
| | - Naomi Shaw
- Peninsula Technology Assessment Group (PenTAG), Department of Public Health and Sport Sciences, University of Exeter Medical School, Exeter, UK
| | - Louise Crathorne
- Peninsula Technology Assessment Group (PenTAG), Department of Public Health and Sport Sciences, University of Exeter Medical School, Exeter, UK
| | - Thomas Strong
- Managed Access Team, National Institute for Health and Care Excellence (NICE), London, UK
| | - Brad Groves
- Managed Access Team, National Institute for Health and Care Excellence (NICE), London, UK
| | - John Spoors
- Medicines Value and Access Unit, NHS England, London, UK
| | - G J Melendez Torres
- Peninsula Technology Assessment Group (PenTAG), Department of Public Health and Sport Sciences, University of Exeter Medical School, Exeter, UK
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Farmer C, O'Toole B, Barnish MS, Trigg LA, Hayward S, Crathorne L, Kasten Z, Spoors J, Melendez Torres GJ. EARLY ACCESS SCHEMES FOR INOVATIVE HEALTH TECHNOLOGIES: THE VIEWS OF INTERNATIONAL STAKEHOLDERS. Int J Technol Assess Health Care 2023:1-30. [PMID: 37409515 DOI: 10.1017/s0266462323000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVES Early access schemes (EASs) are approaches used by payers to balance and facilitate earlier patient access to innovative health technologies while evidence generation is ongoing. Schemes require investment from payers and are associated with significant risk since not all technologies will be routinely reimbursed. The purpose of this study was to gain the perspectives of policy experts about the key challenges for EASs and potential solutions for their optimal design and implementation. METHODS Two virtual workshops were convened including (i) UK-based policy experts (England, Wales, and Scotland) and (ii) representatives from multiple healthcare systems (England, France, Sweden, Canada, Poland, and Norway). Participants were encouraged to share their experiences with EASs in their healthcare system and highlight key challenges for policy makers. Discussions were transcribed and analyzed using framework analysis. RESULTS Participants agreed that EASs have value when targeted toward innovative technologies with the potential for significant clinical benefit in an area of high unmet need. Participants discussed potential solutions to the challenges faced by payers implementing EASs, including defining eligibility criteria, supporting evidence generation, and approaches to reimbursement. CONCLUSIONS Participants agreed that EASs are one possible solution for their healthcare systems and have the potential to deliver significant clinical value to patients. However, widespread adoption of EASs is limited due to concerns about the risks for patients and healthcare budgets, further solutions are needed to deliver EASs for targeted therapies.
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Ponsford R, Bragg S, Meiksin R, Tilouche N, Van Dyck L, Sturgess J, Allen E, Elbourne D, Hadley A, Lohan M, Mercer CH, Melendez Torres GJ, Morris S, Young H, Campbell R, Bonell C. Feasibility and acceptability of a whole-school social-marketing intervention to prevent unintended teenage pregnancies and promote sexual health: evidence for progression from a pilot to a phase III randomised trial in English secondary schools. Pilot Feasibility Stud 2022; 8:52. [PMID: 35246272 PMCID: PMC8895534 DOI: 10.1186/s40814-022-00971-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 01/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background Reducing unintended teenage pregnancy and promoting adolescent sexual health remains a priority in England. Both whole-school and social-marketing interventions are promising approaches to addressing these aims. However, such interventions have not been rigorously trialled in the UK and it is unclear if they are appropriate for delivery in English secondary schools. We developed and pilot trialled Positive Choices, a new whole-school social marketing intervention to address unintended teenage pregnancy and promote sexual health. Our aim was to assess the feasibility and acceptability of the intervention and trial methods in English secondary schools against pre-defined progression criteria (relating to randomisation, survey follow-up, intervention fidelity and acceptability and linkage to birth/abortion records) prior to carrying out a phase III trial of effectiveness and cost-effectiveness. Methods Pilot RCT with integral process evaluation involving four intervention and two control schools in south-east England. The intervention comprised a student needs survey; a student/staff-led school health promotion council; a classroom curriculum for year-9 students (aged 13–14); whole-school student-led social-marketing activities; parent information; and a review of local and school-based sexual health services. Baseline surveys were conducted with year 8 (aged 12–13) in June 2018. Follow-up surveys were completed 12 months later. Process evaluation data included audio recording of staff training, surveys of trained staff, staff log books and researcher observations of intervention activities. Survey data from female students were linked to records of births and abortions to assess the feasibility of these constituting a phase III primary outcome. Results All six schools were successfully randomised and retained in the trial. Response rates to the survey were above 80% in both arms at both baseline and follow-up. With the exception of the parent materials, the fidelity target for implementation of essential elements in three out of four schools was achieved. Student surveys indicated 80% acceptability among those who reported awareness of the programme and interviews with staff suggested strong acceptability. Linkage to birth/abortion records was feasible although none occurred among participants. Conclusions The criteria for progression to a phase III trial were met. Our data suggest that a whole-school social-marketing approach may be appropriate for topics that are clearly prioritised by schools. A phase III trial of this intervention is now warranted to establish effectiveness and cost-effectiveness. Births and terminations are not an appropriate primary outcome measure for such a trial. Trial registration ISRCTN65324176.
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Affiliation(s)
- R Ponsford
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - S Bragg
- Department of Education, Practice and Society, University College London, 20 Bedford Way, WC1H 0AL, London, UK
| | - R Meiksin
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - N Tilouche
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - L Van Dyck
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - J Sturgess
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - E Allen
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - D Elbourne
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - A Hadley
- Teenage Pregnancy Knowledge Exchange, University of Bedfordshire, University Square, Luton, LU1 3JU, UK
| | - M Lohan
- School of Nursing and Midwifery, Queens University Belfast, University Road, Belfast, BT7 1NN, UK
| | - C H Mercer
- University College London, Gower Street, London, WC1E 6BT, UK
| | | | - S Morris
- Department of Health and Primary Care, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - H Young
- School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
| | - R Campbell
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - C Bonell
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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