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Leonard C, Crabb N, Glover D, Cooper S, Bouvy J, Wobbe M, Perkins M. Can the UK 'Netflix' Payment Model Boost the Antibacterial Pipeline? Appl Health Econ Health Policy 2023; 21:365-372. [PMID: 36646872 PMCID: PMC9842493 DOI: 10.1007/s40258-022-00786-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/18/2022] [Indexed: 05/03/2023]
Abstract
The silent pandemic of antimicrobial resistance (AMR) is a global issue needing prompt attention. A comprehensive one-health approach across human and animal health, agriculture and the environment is needed to solve this, addressing overuse of antibacterials, and of course, optimising measures for preventing and controlling infection. We also need a robust pipeline of new antibacterials. However, the current pipeline is inadequate and several companies with new antibacterials have gone bankrupt due to low sales, leading to a 'broken market'. To address this, the UK has completed a project using novel approaches to value assessment and reimbursement for two antibacterials. The new funding arrangements for these products commenced on 1st July 2022, delinking reimbursement from volume of sales; a so-called 'pull incentive', with payments based on the added value to the whole-health and social-care system, not just to individual patients. This article describes how the project was devised, developed, and progressed. The learning from this work might help other countries to adopt or adapt the approach to fit with their national systems, and collectively achieve a global incentive to reinvigorate the antibacterial pipeline.
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Affiliation(s)
- Colm Leonard
- National Institute for Health and Care Excellence, Level 1A, City Tower, Manchester, M1 4BT, UK.
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
| | - Nick Crabb
- National Institute for Health and Care Excellence, Level 1A, City Tower, Manchester, M1 4BT, UK
| | - David Glover
- NHS England and NHS Improvement, Skipton House, 80 London Road, London, SE1 6LH, UK
| | - Sophie Cooper
- National Institute for Health and Care Excellence, Level 1A, City Tower, Manchester, M1 4BT, UK
| | - Jacoline Bouvy
- National Institute for Health and Care Excellence, Level 1A, City Tower, Manchester, M1 4BT, UK
| | - Milena Wobbe
- National Institute for Health and Care Excellence, Level 1A, City Tower, Manchester, M1 4BT, UK
| | - Mark Perkins
- NHS England and NHS Improvement, Skipton House, 80 London Road, London, SE1 6LH, UK
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Adler A, Cooper S, Crabb N. New ways of evaluating and purchasing antimicrobials. Lancet Infect Dis 2022; 22:1542. [PMID: 36309023 DOI: 10.1016/s1473-3099(22)00671-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Cooper S, Bouvy JC, Baker L, Maignen F, Jonsson P, Clark P, Palmer S, Boysen M, Crabb N. How should we assess the clinical and cost effectiveness of histology independent cancer drugs? BMJ 2020; 368:l6435. [PMID: 31896539 DOI: 10.1136/bmj.l6435] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Sophie Cooper
- National Institute for Health and Care Excellence (NICE), 10 Spring Gardens, London SW1A 2BU, UK
| | - Jacoline C Bouvy
- National Institute for Health and Care Excellence (NICE), 10 Spring Gardens, London SW1A 2BU, UK
| | | | - Francois Maignen
- National Institute for Health and Care Excellence (NICE), 10 Spring Gardens, London SW1A 2BU, UK
| | - Pall Jonsson
- National Institute for Health and Care Excellence (NICE), 10 Spring Gardens, London SW1A 2BU, UK
| | | | | | - Meindert Boysen
- National Institute for Health and Care Excellence (NICE), 10 Spring Gardens, London SW1A 2BU, UK
| | - Nick Crabb
- National Institute for Health and Care Excellence (NICE), 10 Spring Gardens, London SW1A 2BU, UK
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Lim R, Lee DK, Sabourin P, Ferguson J, Metcalf M, Smith M, Corriol-Rohou S, Eichler HG, Lumpkin M, Hirsch G, Chen IM, O'Rourke B, Schiel A, Crabb N, Aronson N, Pezalla E, Boutin M, Binder L, Wilhelm L. Recognizing that Evidence is Made, not Born. Clin Pharmacol Ther 2018; 105:844-856. [PMID: 30472743 PMCID: PMC6590384 DOI: 10.1002/cpt.1317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/14/2018] [Indexed: 01/26/2023]
Abstract
Therapeutic product development, licensing and reimbursement may seem a well-oiled machine, but continuing high attrition rates, regulatory refusals, and patients' access issues suggest otherwise; despite serious efforts, gaps persist between stakeholders' stated evidence requirements and actual evidence supplied. Evidentiary deficiencies and/or human tendencies resulting in avoidable inefficiencies might be further reduced with fresh institutional cultures/mindsets, combined with a context-adaptable practices framework that integrates emerging innovations. Here, Structured Evidence Planning, Production, and Evaluation (SEPPE) posits that evidence be treated as something produced, much like other manufactured goods, for which "built-in quality" (i.e., "people" and "process") approaches have been successfully implemented globally. Incorporating proactive, iterative feedback-and-adjust loops involving key decision-makers at critical points could curtail avoidable evidence quality and decision hazards-pulling needed therapeutic products with high quality evidence of beneficial performance through to approvals. Critical for success, however, is dedicated, long-term commitment to systemic transformation.
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Affiliation(s)
- Robyn Lim
- Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - David K Lee
- Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Pierre Sabourin
- Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | | | - Marilyn Metcalf
- GlaxoSmithKline (GSK), Research Triangle Park, North Carolina, USA
| | | | | | | | - Murray Lumpkin
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - Gigi Hirsch
- MIT Center for Biomedical Innovation, NEWDIGS, Cambridge, Massachusetts, USA
| | | | - Brian O'Rourke
- Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada
| | - Anja Schiel
- HTA Division, Norwegian Medicines Agency, Oslo, Norway
| | | | - Naomi Aronson
- Blue Cross Blue Shield Association, Chicago, Illinois, USA
| | - Edmund Pezalla
- Enlightenment Bioconsult LLC, Wethersfield, Connecticut, USA
| | - Marc Boutin
- National Health Council, Washington, District of Columbia, USA
| | - Louise Binder
- Save Your Skin Foundation, North Vancouver, British Columbia, Canada
| | - Linda Wilhelm
- Canadian Arthritis Patient Alliance, Midland, New Brunswick, Canada
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Bouvy JC, Jonsson P, Longson C, Crabb N, Garner S. Health Technology Assessment in the Context of Adaptive Pathways for Medicines in Europe: Challenges and Opportunities. Clin Pharmacol Ther 2016; 100:594-597. [DOI: 10.1002/cpt.448] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/09/2016] [Accepted: 08/10/2016] [Indexed: 01/13/2023]
Affiliation(s)
- JC Bouvy
- National Institute for Health and Care Excellence (NICE); London England United Kingdom
| | - P Jonsson
- National Institute for Health and Care Excellence (NICE); London England United Kingdom
| | - C Longson
- National Institute for Health and Care Excellence (NICE); London England United Kingdom
| | - N Crabb
- National Institute for Health and Care Excellence (NICE); London England United Kingdom
| | - S Garner
- National Institute for Health and Care Excellence (NICE); London England United Kingdom
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Abstract
Companion diagnostics are used to aid clinical decision making to identify patients who are most likely to respond to treatment. They are becoming increasingly important as more new pharmaceuticals receive licensed indications that require the use of a companion diagnostic to identify the appropriate patient subgroup for treatment. These pharmaceuticals have proven benefit in the treatment of some cancers and other diseases, and also have potential to precisely tailor treatments to the individual in the future. However, the increasing use of companion diagnostics could place a substantial burden on health system resources to provide potentially high volumes of testing. This situation, in part, has led policy makers and Health Technology Assessment (HTA) bodies to review the policies and methods used to make reimbursement decisions for pharmaceuticals requiring companion diagnostics. The assessment of a pharmaceutical alongside the companion diagnostic used in the clinical trials may be relatively straightforward, although there are a number of challenges associated with assessing pharmaceuticals where a range of alternative companion diagnostics are available for use in routine clinical practice. The UK HTA body, the National Institute for Health and Care Excellence (NICE), has developed policy for considering companion diagnostics using its Technology Appraisal and Diagnostics Assessment Programs. Some HTA bodies in other countries have also adapted their policies and methods to accommodate the assessment of companion diagnostics. Here, we provide insight into the HTA of companion diagnostics for reimbursement decisions and how the associated challenges are being addressed, in particular by NICE. See all articles in this CCR Focus section, "The Precision Medicine Conundrum: Approaches to Companion Diagnostic Co-development."
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Affiliation(s)
- Sarah K Byron
- Authors' Affiliations: Diagnostics Assessment Programme; and Diagnostics Advisory Committee, National Institute for Health and Care Excellence, Manchester; and Technology Appraisal Programme, National Institute for Health and Care Excellence, London, United Kingdom
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Affiliation(s)
- Carole Longson
- National Institute for Health and Care Excellence, Manchester M1 4BD, UK
| | - Nick Crabb
- National Institute for Health and Care Excellence, Manchester M1 4BD, UK
| | - Leeza Osipenko
- National Institute for Health and Care Excellence, Manchester M1 4BD, UK
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Blessington B, Crabb N, Karkee S, Northage A. Chromatographic approaches to the quality control of chiral propionate anti-inflammatory drugs and herbicides. J Chromatogr A 1989; 469:183-90. [PMID: 2768367 DOI: 10.1016/s0021-9673(01)96453-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The chiral analysis of a range of propionate anti-inflammatory drugs and herbicides was accomplished by gas chromatographic separation of their R-alpha-phenylethylamide diastereomeric derivatives. Using a packed column (3% OV-l on Chromosorb G) good separations were obtained but analysis times were rather long. Examination of the same crystalline derivatives using a capillary column (bonded methylsilicone) resulted in good separations together with much reduced total analysis times. The technique was validated through the analysis of several derivatives prepared on a micro scale and examined directly by gas chromatography without any crystallisation step. Racemic materials all gave virtually 50:50 response ratios while the analysis of optically pure samples produced no evidence of significant racemization. Derivatives of phenoxyacetic acid and myristic acid were also prepared and chromatographed as potential internal standards.
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Affiliation(s)
- B Blessington
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Bradford, West Yorkshire U.K
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Blessington B, Crabb N. Proposed primary reference methods for the determination of some commercially important chiral aryloxypropionate herbicides in both free acid and ester forms. J Chromatogr A 1989. [DOI: 10.1016/s0021-9673(01)93134-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Blessington B, Crabb N, O'Sullivan J. Chiral high-performance liquid chromatographic studies of 2-(4-chloro-2-methylphenoxy)propanoic acid. J Chromatogr A 1987; 396:177-82. [PMID: 3624369 DOI: 10.1016/s0021-9673(01)94054-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The direct enantiomeric resolution of the racemic herbicide 2-(4-chloro-2-methylphenoxy)propanoic acid (CMPP) was demonstrated on an Enantiopac (alpha 1-acid glycoprotein) chiral high-performance liquid chromatographic (HPLC) column. The HPLC separation of various amide derivatives of CMPP on a chiral "Ionic Pirkle" column comprising of N-(3,5-dinitrobenzoyl) (R)-(-)phenylglycine as chiral ligand, was also accomplished. These amides and racemic ibuprofen, however could not be separated on the Enantiopac system. The performance, stability and cost of the two systems were compared. Using optically pure CMPP enantiomers the elution order was determined and shown to reverse between the two systems. It was also shown that negligible racemisation occurred during derivatization.
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