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Qouhafa M, Benaji B, Lebbar S, Marrakchi A, Soulaymani A, Nsiri B, Alaoui MHEY, Abdelrhani M, Azougagh M. Research cartography of implantable medical devices in the three Maghreb countries: A comparative study between Morocco, Algeria, and Tunisia. ANNALES PHARMACEUTIQUES FRANÇAISES 2024; 82:522-530. [PMID: 38135036 DOI: 10.1016/j.pharma.2023.12.005] [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: 12/02/2023] [Accepted: 12/18/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Biosafety and efficacy are essential aspects in the use of implantable medical devices (IMD) in several medical and surgical disciplines. To this effect, and depending on the therapeutic indication, the diversity of IMD imposes enormous evaluation strategies from their design through to their impact on improving the patient's quality of life. OBJECTIVE To elaborate cartography which traces back the research tracks published on IMD regarding the three Maghreb countries, namely Morocco, Algeria, and Tunisia, and this through laying emphasis on a comparative study in view of highlighting the similarities and differences between them. METHODS First, the research work was concerned with studies on IMD published between 2013 and 2023, which met the inclusion criteria, and which used the above-mentioned keywords on the four databases Scopus, Web of Science, ScienceDirect and PubMed. Second, the results are processed for a comparative descriptive study. In second, a descriptive and inferential analysis of association and classification to establish a research map on IMD. RESULTS Articles selected; 86 articles out of 1081 for Morocco, 70 out of 900 for Algeria and 136 out of 1303 for Tunisia. Unlike domains (P=0.014), the research methods used highlights similarities in methodological research (P>0.05) ranging from simple descriptions to meta-analyses for the medical sciences with an inequitable distribution whose high share in favor of patient-reports. CONCLUSION The design of maps raises a diversity of fields that concern medical and engineering sciences, while medical economic studies have yet to be developed in all three countries.
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Affiliation(s)
- Meryem Qouhafa
- Laboratory Health and Biology, Faculty of Sciences, Ibn Tofail University, Kenitra, Morocco; Research Group of Biomedical Engineering and Pharmaceuticals Sciences, Health Technology Engineering Department, Higher National School of Arts and Crafts Rabat, Mohammed V University Rabat, Rabat, Morocco; Higher Institute of Nursing and Health Technology Rabat, Ministry of Health and Social Welfare, Rabat, Morocco.
| | - Brahim Benaji
- Research Group of Biomedical Engineering and Pharmaceuticals Sciences, Health Technology Engineering Department, Higher National School of Arts and Crafts Rabat, Mohammed V University Rabat, Rabat, Morocco
| | - Souad Lebbar
- Laboratory Health and Biology, Faculty of Sciences, Ibn Tofail University, Kenitra, Morocco
| | - Asmaa Marrakchi
- Laboratory Health and Biology, Faculty of Sciences, Ibn Tofail University, Kenitra, Morocco; Higher Institute of Nursing and Health Technology Rabat, Ministry of Health and Social Welfare, Rabat, Morocco
| | - Abdelmajid Soulaymani
- Laboratory Health and Biology, Faculty of Sciences, Ibn Tofail University, Kenitra, Morocco
| | - Benayad Nsiri
- Research Group of Biomedical Engineering and Pharmaceuticals Sciences, Health Technology Engineering Department, Higher National School of Arts and Crafts Rabat, Mohammed V University Rabat, Rabat, Morocco
| | - My Hachem El Yousfi Alaoui
- Research Group of Biomedical Engineering and Pharmaceuticals Sciences, Health Technology Engineering Department, Higher National School of Arts and Crafts Rabat, Mohammed V University Rabat, Rabat, Morocco
| | - Mokhtari Abdelrhani
- Laboratory Health and Biology, Faculty of Sciences, Ibn Tofail University, Kenitra, Morocco
| | - Mohammed Azougagh
- Research Group of Biomedical Engineering and Pharmaceuticals Sciences, Health Technology Engineering Department, Higher National School of Arts and Crafts Rabat, Mohammed V University Rabat, Rabat, Morocco
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Boccato C, Vienken J. Do medical devices contribute to sustainability? Environmental, societal and governance aspects. Int J Artif Organs 2024; 47:229-239. [PMID: 38622935 DOI: 10.1177/03913988241245015] [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: 04/17/2024]
Abstract
Sustainability of a product or device is currently primarily related to its environmental footprint. Here, a wider concept of sustainability is introduced for medical devices and their components in healthcare provision. Such devices sustain healthcare and patient wellbeing due to their quality specifications for material composition, product design and performance. The term quality must be intended in the most comprehensive term, including purity and biocompatibility of materials, device reliability, limited number of recalls and reduced risks as well as acceptability for patients. A close look on medical device specification shows, however, that additional parameters, such as societal, demographic and economic factors also determine medical device sustainability. The medical device life cycle, from design phase, production process to clinical application and the final disposal, also determines its impact. Recommendations for healthcare operators and managers will complete the hypothesis of this paper, that a thoroughly outlined device choice and operation together with a careful waste management of spent medical devices and their components positively affects medical device sustainability. As an example, the limited quantity of wastes and the reduced risks for adverse reaction have a positive impact on both the environmental pollution and on the costs sustained by the healthcare organisations and by the community. These factors determine both, the success of healthcare manoeuvres and the related environmental footprint.
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Hollingworth SA, Leaupepe GA, Nonvignon J, Fenny AP, Odame EA, Ruiz F. Economic evaluations of non-communicable diseases conducted in Sub-Saharan Africa: a critical review of data sources. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:57. [PMID: 37641087 PMCID: PMC10463745 DOI: 10.1186/s12962-023-00471-7] [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: 06/13/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Policymakers in sub-Saharan Africa (SSA) face challenging decisions regarding the allocation of health resources. Economic evaluations can help decision makers to determine which health interventions should be funded and or included in their benefits package. A major problem is whether the evaluations incorporated data from sources that are reliable and relevant to the country of interest. We aimed to review the quality of the data sources used in all published economic evaluations for cardiovascular disease and diabetes in SSA. METHODS We systematically searched selected databases for all published economic evaluations for CVD and diabetes in SSA. We modified a hierarchy of data sources and used a reference case to measure the adherence to reporting and methodological characteristics, and descriptively analysed author statements. RESULTS From 7,297 articles retrieved from the search, we selected 35 for study inclusion. Most were modelled evaluations and almost all focused on pharmacological interventions. The studies adhered to the reporting standards but were less adherent to the methodological standards. The quality of data sources varied. The quality level of evidence in the data domains of resource use and costs were generally considered of high quality, with studies often sourcing information from reliable databases within the same jurisdiction. The authors of most studies referred to data sources in the discussion section of the publications highlighting the challenges of obtaining good quality and locally relevant data. CONCLUSIONS The data sources in some domains are considered high quality but there remains a need to make substantial improvements in the methodological adherence and overall quality of data sources to provide evidence that is sufficiently robust to support decision making in SSA within the context of UHC and health benefits plans. Many SSA governments will need to strengthen and build their capacity to conduct economic evaluations of interventions and health technology assessment for improved priority setting. This capacity building includes enhancing local infrastructures for routine data production and management. If many of the policy makers are using economic evaluations to guide resource allocation, it is imperative that the evidence used is of the feasibly highest quality.
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Affiliation(s)
| | | | | | - Ama Pokuaa Fenny
- Institute of Social, Statistical and Economic Research, University of Ghana, Accra, Ghana
| | - Emmanuel A Odame
- Dept of Medical Affairs, Korle Bu Teaching Hospital, Accra, Ghana
| | - Francis Ruiz
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Porzsolt F, Weiß C, Weiss M. [Covid-19: Twin Method for Verifying Real-World Effectiveness Under Everyday Conditions]. DAS GESUNDHEITSWESEN 2023; 85:22-25. [PMID: 35738304 DOI: 10.1055/a-1819-6237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The positive side of the Covid-19 pandemic is that it has provided a stimulation for innovations. As an example, we discuss the Pragmatic Controlled Trial (PCT), a twin study that can be used to confirm the real-world effectiveness (RWE) of health services under the non-standardized conditions of everyday care. Proof of the RWE could generally be important for health services with conditional approval. The PCT uses the Bayesian principle instead of randomization. It enables care under non-standardized everyday conditions and, by describing the endpoint-specific risks of each individual patient and by classifying the interventions, creates an unbiased evaluation in a non-experimental, but risk-stratified and controlled study. Patients expect a timely solution to their health problems. Until now, science has required sufficiently well-founded results before approving an innovation. The Covid-19 pandemic has shown that the demand for immediate and best possible care can be met through the conditional approval of a new care principle. With the PCT, we describe a procedure with which, after conditional approval, the missing data can be collected in order to successfully complete the approval process.
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Affiliation(s)
| | - Christel Weiß
- Medizinische Statistik, Biomathematik und Informationsverarbeitung, Medizinische Fakultät Mannheim der Universitätsmedizin Heidelberg, Mannheim, Germany
| | - Manfred Weiss
- Anästhesiologie und Intensivmedizin, Universitätsklinikum Ulm, Ulm, Germany
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Rutten-van Mölken MPMH, Hartgers-Gubbels ES, Chambers M. Value Insider Season 1 Episode 4: How are Costs Measured, and How are CEAs Constructed and Used? (CEA) [Podcast]. Int J Gen Med 2022; 15:8055-8061. [DOI: 10.2147/ijgm.s391712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 11/10/2022] Open
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Garrison LP, Hartgers-Gubbels ES, Chambers M. Value Insider Season 1 Episode 5: What Other Aspects of Value May Be Relevant? (Societal Impact) [Podcast]. Int J Gen Med 2022; 15:8217-8224. [DOI: 10.2147/ijgm.s392906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022] Open
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Drummond MF, Hartgers-Gubbels ES, Chambers M. Value Insider Season 1 Episode 1: The Importance of Payers and HTA: How Did We End Up Here? (Introduction to Value) [Podcast]. Int J Gen Med 2022; 15:7487-7492. [PMID: 36213303 PMCID: PMC9532943 DOI: 10.2147/ijgm.s389025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 11/29/2022] Open
Abstract
The importance of payers and HTA: How did we end up here? In this episode of the Value Insider podcast, host Mike Chambers speaks with Prof. Mike Drummond about Health Technology Assessment (HTA) and how value is defined. Prof. Drummond is professor of Health Economics of York University, former president of the International Society of Pharmacoeconomics and Outcomes Research (ISPOR), and author of two major textbooks in the field, as well as over 700 publications, and has acted as consultant to the WHO as well as European Union with regards to value assessment. Starting from the very beginning, Prof. Drummond explains in a simple yet engaging way why demonstrating value of new interventions has become so important.
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Affiliation(s)
| | - Elisabeth Sophia Hartgers-Gubbels
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
- Correspondence: Elisabeth Sophia Hartgers-Gubbels, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany, Email
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Dimitrova M, Jakab I, Mitkova Z, Kamusheva M, Tachkov K, Nemeth B, Zemplenyi A, Dawoud D, Delnoij DMJ, Houýez F, Kalo Z. Potential Barriers of Patient Involvement in Health Technology Assessment in Central and Eastern European Countries. Front Public Health 2022; 10:922708. [PMID: 35968493 PMCID: PMC9371596 DOI: 10.3389/fpubh.2022.922708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/13/2022] [Indexed: 12/03/2022] Open
Abstract
Patients' perspectives are important to identify preferences, estimate values and appreciate unmet medical needs in the process of research and development and subsequent assessment of new health technologies. Patient and public involvement in health technology assessment (HTA) is essential in understanding and assessing wider implications of coverage and reimbursement decisions for patients, their relatives, caregivers, and the general population. There are two approaches to incorporating the patients' voice in HTA, preferably used in a mix. In the first one, patients, caregivers and/or their representatives directly participate at discussions in different stages of the HTA process, often at the same table with other stakeholders. Secondly, patient involvement activities can be supported by evidence on patient value and experience collected directly from patients, caregivers and/or their representatives often by patient groups Patient involvement practices, however, are limited in Central and Eastern European (CEE) countries without clear methodology or regulatory mechanisms to guide patient involvement in the HTA process. This poses the question of transferability of practices used in other countries, and might call for the development of new CEE-specific guidelines and methods. In this study we aim to map potential barriers of patient involvement in HTA in countries of the CEE region.
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Affiliation(s)
- Maria Dimitrova
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
- *Correspondence: Maria Dimitrova
| | - Ivett Jakab
- Syreon Research Institute, Budapest, Hungary
| | - Zornitsa Mitkova
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Maria Kamusheva
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | | | | | - Antal Zemplenyi
- Syreon Research Institute, Budapest, Hungary
- Center for Health Technology Assessment and Pharmacoeconomics Research, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Dalia Dawoud
- National Institute for Health and Care Excellence, London, United Kingdom
- Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Diana M. J. Delnoij
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, Netherlands
- National Health Care Institute (Zorginstituut Nederland), Diemen, Netherlands
| | - François Houýez
- EURORDIS: Eurordis, European Organization for Rare Diseases, Paris, France
| | - Zoltan Kalo
- Syreon Research Institute, Budapest, Hungary
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
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Schurer M, Matthijsse SM, Vossen CY, van Keep M, Horscroft J, Chapman AM, Akehurst RL. Varying Willingness to Pay Based on Severity of Illness: Impact on Health Technology Assessment Outcomes of Inpatient and Outpatient Drug Therapies in The Netherlands. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:91-103. [PMID: 35031104 DOI: 10.1016/j.jval.2021.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/23/2021] [Accepted: 08/06/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Since 2015, Zorginstituut Nederland (ZIN) has linked disease severity ranges of 0.10 to 0.40, 0.41 to 0.70, and 0.71 to 1.00 with willingness-to-pay (WTP) reference values of €20 000, €50 000, and €80 000 per quality-adjusted life year gained, respectively. We sought to review whether these changes have affected ZIN health technology assessment (HTA) outcomes for specialist and outpatient drugs. METHODS ZIN recommendations for specialist and outpatient drugs published between January 1, 2012, and December 31, 2020, that included a pharmacoeconomic report were reviewed. Data were extracted on disease severity, proportional shortfall calculation, reported WTP reference value, outcomes related to the cost-effectiveness of the product, budget impact, and ZIN's recommendation including rationale for their advice. RESULTS A total of 51 HTAs were included. Of the 20 HTAs published before June 2015, a total of 9 received positive recommendations, 7 were conditionally reimbursed, and 4 received negative recommendations. None reported WTP reference values. Of the 31 evaluations published after June 2015, a total of 4 products received positive recommendations, 1 was conditionally approved, and 26 received negative recommendations initially. Most products (65%) reported disease severity to be >0.70. CONCLUSIONS Since 2015, most products have fallen within the highest category of disease severity. Although pre-2015 outcomes were varied, post-2015 products overwhelmingly received negative recommendations, and the proportion of products for which price negotiations were recommended has increased. These differences in outcomes may result from the introduction of an explicit WTP reference value, whether or not in combination with the severity-adjusted ranges, but may also reflect other national policy changes in 2015.
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Syeed MS, Poudel N, Ngorsuraches S, Diaz J, Chaiyakunapruk N. Measurement and valuation of the attributes of innovation of healthcare technologies: a systematic review. J Med Econ 2022; 25:1176-1184. [PMID: 36346390 DOI: 10.1080/13696998.2022.2143170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Innovative technologies (e.g. treatments) play a pivotal role in improving patient's well-being and in consequence population health outcomes. However, there is lack of consensus and comprehensive summary what constitutes innovation. Additionally, valuing them using traditional cost-effectiveness analysis is unlikely to capture the full range of benefits of these innovative technologies. This review aims to understand how innovation attributes were measured and/or valued in healthcare. MATERIALS AND METHODS We systemically searched four databases, PubMed, Embase, PsycINFO, and Econlit, from inception to April 2021. Studies were included if they measured and/or valued the attributes of innovation for healthcare identified in our previous systematic review. Any other potential recommended methods to measure and/or value the innovation attributes were also extracted. RESULTS Of 546 articles, a total of 17 articles were finally included in this review. If attributes were measured and traded-off relative to costs, then it was considered as valuation of those attributes. Two specific attributes of innovation, i.e. substantial benefits and convenience and/or adherence were measured using adherence rate and life year or QALY gain. When innovation attribute was non-specific it was described as "overall innovation" and measured using overall innovativeness scale (e.g. point/binary scale). QALY-based cost-effectiveness analysis (CEA) was commonly used to assess and value substantial benefit attribute. Other valuation approaches were (i) rating, (ii) the economic value of life year gain, (iii) multiple criteria decision analysis (MCDA), (iv) incremental net health benefit (INHB), and (v) quality-adjusted cost of care (QACC). ICER threshold adjustment and multiple-criteria decision analysis (MCDA) are two common recommended approaches to capture the innovation comprehensively. We found that MCDA approaches often promoted and discussed but were sub-optimally used to incorporate different value attributes into decision-making. CONCLUSIONS Existing methods used by payers to measure and value the innovation component of a new product do not reflect the full range of health and cost impacts. They generally do not consider the alternative perspectives of patients, providers, caregivers, and society. Key challenges remain to appropriately measure and value innovation attributes and incorporate them into HTA decision making.
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Affiliation(s)
- M Sakil Syeed
- Department of Pharmacotherapy, The University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | - Nabin Poudel
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | - Surachat Ngorsuraches
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | - Jose Diaz
- HEOR, Bristol Myers Squibb, Uxbridge, UK
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, The University of Utah College of Pharmacy, Salt Lake City, UT, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
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Beall RF, Hollis A, Kesselheim AS, Spackman E. Reimagining Pharmaceutical Market Exclusivities: Should the Duration of Guaranteed Monopoly Periods Be Value Based? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1328-1334. [PMID: 34452713 DOI: 10.1016/j.jval.2021.04.1277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To describe the main features of a pharmaceutical market in which the duration of guaranteed monopoly periods would correspond to a new pharmaceutical product's value. METHODS After reviewing patent and regulatory exclusivity-based mechanisms for protecting prescription drug markets from competition to incentivize drug innovation in developed countries, we model market protection mechanisms within the current framework to give the longest-lasting market protections to drug developers that bring the most affordable products to market with highest public health and clinical value. RESULTS An approach tying pharmaceutical market exclusivity to value would have 3 main features. First, it would be based on regulatory exclusivity (ie, the drug regulator refrains from authorizing generic entry for a certain amount of time), rather than patents. Second, the duration of exclusivity period would be pegged to the magnitude of a product's anticipated health impact and its proposed price by using modified methods from the field of health technology assessment. Third, the duration of the value-based exclusivity period would be reassessed routinely 3 years after the product's launch to account for its real-world effectiveness. CONCLUSIONS Linking a drug's proposed price to the duration of its regulatory-based exclusivities would both incentivize the development of high impact, low-cost products and motivate drug developers to introduce these products at lower prices.
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Affiliation(s)
- Reed F Beall
- Department of Community Health Sciences, Cummings School of Medicine and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Program on Regulation, Therapeutics, And Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Aidan Hollis
- Department of Economics, University of Calgary, Calgary, Alberta, Canada
| | - Aaron S Kesselheim
- Program on Regulation, Therapeutics, And Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eldon Spackman
- Department of Community Health Sciences, Cummings School of Medicine and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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Vassolo RS, Mac Cawley AF, Tortorella GL, Fogliatto FS, Tlapa D, Narayanamurthy G. Hospital Investment Decisions in Healthcare 4.0 Technologies: Scoping Review and Framework for Exploring Challenges, Trends, and Research Directions. J Med Internet Res 2021; 23:e27571. [PMID: 34435967 PMCID: PMC8430851 DOI: 10.2196/27571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/11/2021] [Accepted: 07/05/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Alternative approaches to analyzing and evaluating health care investments in state-of-the-art technologies are being increasingly discussed in the literature, especially with the advent of Healthcare 4.0 (H4.0) technologies or eHealth. Such investments generally involve computer hardware and software that deal with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision-making. Besides, the use of these technologies significantly increases when addressed in bundles. However, a structured and holistic approach to analyzing investments in H4.0 technologies is not available in the literature. OBJECTIVE This study aims to analyze previous research related to the evaluation of H4.0 technologies in hospitals and characterize the most common investment approaches used. We propose a framework that organizes the research associated with hospitals' H4.0 technology investment decisions and suggest five main research directions on the topic. METHODS To achieve our goal, we followed the standard procedure for scoping reviews. We performed a search in the Crossref, PubMed, Scopus, and Web of Science databases with the keywords investment, health, industry 4.0, investment, health technology assessment, healthcare 4.0, and smart in the title, abstract, and keywords of research papers. We retrieved 5701 publications from all the databases. After removing papers published before 2011 as well as duplicates and performing further screening, we were left with 244 articles, from which 33 were selected after in-depth analysis to compose the final publication portfolio. RESULTS Our findings show the multidisciplinary nature of the research related to evaluating hospital investments in H4.0 technologies. We found that the most common investment approaches focused on cost analysis, single technology, and single decision-maker involvement, which dominate bundle analysis, H4.0 technology value considerations, and multiple decision-maker involvement. CONCLUSIONS Some of our findings were unexpected, given the interrelated nature of H4.0 technologies and their multidimensional impact. Owing to the absence of a more holistic approach to H4.0 technology investment decisions, we identified five promising research directions for the topic: development of economic valuation methodologies tailored for H4.0 technologies; accounting for technology interrelations in the form of bundles; accounting for uncertainties in the process of evaluating such technologies; integration of administrative, medical, and patient perspectives into the evaluation process; and balancing and handling complexity in the decision-making process.
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Affiliation(s)
- Roberto Santiago Vassolo
- IAE Business School, Universidad Austral, Pilar, Argentina.,Department of Industrial and Systems Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Guilherme Luz Tortorella
- IAE Business School, Universidad Austral, Pilar, Argentina.,Department of Mechanical Engineering, University of Melbourne, Melbourne, Australia.,Universidade Federal de Santa Catarina, Florianopolis, Brazil
| | - Flavio Sanson Fogliatto
- Departamento de Engenharia de Produção, Universidade Federal do Rio Grande do Sul, Escola de Engenharia, Porto Alegre, Brazil
| | - Diego Tlapa
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California - Campus Ensenada, Baja California, Mexico
| | - Gopalakrishnan Narayanamurthy
- Department of Operations and Supply Chain Management, University of Liverpool Management School, Liverpool, United Kingdom
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Zimmermann BM, Eichinger J, Baumgartner MR. A systematic review of moral reasons on orphan drug reimbursement. Orphanet J Rare Dis 2021; 16:292. [PMID: 34193232 PMCID: PMC8247078 DOI: 10.1186/s13023-021-01925-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/20/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The number of market approvals of orphan medicinal products (OMPs) has been increasing steadily in the last 3 decades. While OMPs can offer a unique chance for patients suffering from rare diseases, they are usually very expensive. The growing number of approved OMPs increases their budget impact despite their low prevalence, making it pressing to find solutions to ethical challenges on how to fairly allocate scarce healthcare resources under this context. One potential solution could be to grant OMPs special status when considering them for reimbursement, meaning that they are subject to different, and less stringent criteria than other drugs. This study aims to provide a systematic analysis of moral reasons for and against such a special status for the reimbursement of OMPs in publicly funded healthcare systems from a multidisciplinary perspective. RESULTS With a systematic review of reasons, we identified 39 reasons represented in 243 articles (scientific and grey literature) for and against special status for the reimbursement of OMPs, then categorized them into nine topics. Taking a multidisciplinary perspective, we found that most articles came from health policy (n = 103) and health economics (n = 49). More articles took the position for a special status of OMPs (n = 97) than those against it (n = 31) and there was a larger number of reasons identified in favour (29 reasons) than against (10 reasons) this special status. CONCLUSION Results suggest that OMP reimbursement issues should be assessed and analysed from a multidisciplinary perspective. Despite the higher occurrence of reasons and articles in favour of a special status, there is no clear-cut solution for this ethical challenge. The binary perspective of whether or not OMPs should be granted special status oversimplifies the issue: both OMPs and rare diseases are too heterogeneous in their characteristics for such a binary perspective. Thus, the scientific debate should focus less on the question of disease prevalence but rather on how the important variability of different OMPs concerning e.g. target population, cost-effectiveness, level of evidence or mechanism of action could be meaningfully addressed and implemented in Health Technology Assessments.
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Affiliation(s)
- Bettina M Zimmermann
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
- Institute for History and Ethics in Medicine, Technical University of Munich School of Medicine, Technical University of Munich, Munich, Germany.
| | - Johanna Eichinger
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
- Institute for History and Ethics in Medicine, Technical University of Munich School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias R Baumgartner
- Division of Metabolism and Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
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Patient and public involvement in health technology assessment: update of a systematic review of international experiences. Int J Technol Assess Health Care 2021; 37:e36. [PMID: 33541449 DOI: 10.1017/s0266462321000064] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To summarize current evidence on patient and public involvement (PPI) in health technology assessment (HTA) in order to synthesize the barriers and facilitators, and to propose a framework to assess its impact. METHODS We conducted an update of a systematic review published in 2011 considering the recent scientific literature (qualitative, quantitative, and mixed-methods studies). We searched papers published between March 2009 (end of the initial search) and December 2019 in five databases using specific search strategies. We identified other publications through citation tracking and contacting authors of previous related studies. Reviewers independently selected relevant studies based on prespecified inclusion and exclusion criteria. We extracted information using a pre-established grid. RESULTS We identified a total of 7872 publications from the main search strategy. Ultimately, thirty-one distinct new studies met the inclusion criteria, whereas seventeen studies were included in the previous systematic review. PPI is realized through two main strategies: (i) patients and public members participate directly in decision-making processes (participation) and (ii) patients or public perspectives are solicited to inform decisions (consultation or indirect participation). This review synthesizes the barriers and facilitators to PPI in HTA, and a framework to assess its impact is proposed. CONCLUSION The number of studies on patients or public involvement in HTA has dramatically increased in recent years. Findings from this updated systematic review show that PPI is done mostly through consultation and that direct involvement is less frequent. Several barriers to PPI in HTA exist, notably the lack of information to patients and public about HTA and the lack of guidance and policies to support PPI in HTA.
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Drummond M, Torbica A, Tarricone R. Should health technology assessment be more patient centric? If so, how? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:1117-1120. [PMID: 32301000 DOI: 10.1007/s10198-020-01182-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Michael Drummond
- Centre for Health Economics, University of York, York, UK.
- SDA Bocconi School of Management, Bocconi University, Milan, Italy.
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Aballéa S, Thokagevistk K, Velikanova R, Simoens S, Annemans L, Antonanzas F, Auquier P, François C, Fricke FU, Malone D, Millier A, Persson U, Petrou S, Dabbous O, Postma M, Toumi M. Health economic evaluation of gene replacement therapies: methodological issues and recommendations. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2020; 8:1822666. [PMID: 33144927 PMCID: PMC7580851 DOI: 10.1080/20016689.2020.1822666] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 05/08/2023]
Abstract
Objective: To provide recommendations for addressing previously identified key challenges in health economic evaluations of Gene Replacement Therapies (GRTs), including: 1) the assessment of clinical effectiveness; 2) the valuation of health outcomes; 3) the time horizon and extrapolation of effects beyond trial duration; 4) the estimation of costs; 5) the selection of appropriate discount rates; 6) the incorporation of broader elements of value; and 7) affordability. Methods: A literature review on economic evaluations of GRT was performed. Interviews were conducted with 8 European and US health economic experts with experience in evaluations of GRT. Targeted literature reviews were conducted to investigate further potential solutions to specific challenges. Recommendations: Experts agreed on factors to be considered to ensure the acceptability of historical cohorts by HTA bodies. Existing prospective registries or, if not available, retrospective registries, may be used to analyse different disease trajectories and inform extrapolations. The importance of expert opinion due to limited data was acknowledged. Expert opinion should be obtained using structured elicitation techniques. Broader elements of value, beyond health gains directly related to treatment, can be considered through the application of a factor to inflate the quality-adjusted life years (QALYs) or a higher cost-effectiveness threshold. Additionally, the use of cost-benefit analysis and saved young life equivalents (SAVE) were proposed as alternatives to QALYs for the valuations of outcomes of GRT as they can incorporate broader elements of value and avoid problems of eliciting utilities for paediatric diseases. Conclusions: While some of the limitations of economic evaluations of GRT are inherent to limited clinical data and lack of experience with these treatments, others may be addressed by methodological research to be conducted by health economists.
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Affiliation(s)
| | | | - Rimma Velikanova
- Groningen Research Institute of Pharmacy, PharmacoTherapy, Epidemiology & Economics, University of Groningen, Groningen, Netherlands
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Lieven Annemans
- Department of Public Health, Ghent University, Ghent, Belgium
| | | | - Pascal Auquier
- CEReSS - Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Clément François
- Creativ-Ceutical, HEOR, Paris, France
- Public Health Department - Research Unit, Aix-Marseille University, Marseille, France
| | | | - Daniel Malone
- Pharmacotherapy Faculty, College of Pharmacy, University of Utah, Salt Lake City, USA
| | | | - Ulf Persson
- The Swedish Institute for Health Economics (IHE), Lund, Sweden
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Omar Dabbous
- Global Health Economics and Outcomes Research and Real World EvidenceAveXis Inc, Novartis Gene Therapies, Bannockburn, IL, USA
| | - Maarten Postma
- Groningen Research Institute of Pharmacy, PharmacoTherapy, Epidemiology & Economics, University of Groningen, Groningen, Netherlands
| | - Mondher Toumi
- Creativ-Ceutical, HEOR, Paris, France
- Public Health Department - Research Unit, Aix-Marseille University, Marseille, France
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Mercer RE, Chambers A, Mai H, McDonald V, McMahon C, Chan KKW. Are We Making a Difference? A Qualitative Study of Patient Engagement at the pan-Canadian Oncology Drug Review: Perspectives of Patient Groups. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1157-1162. [PMID: 32940233 DOI: 10.1016/j.jval.2020.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/07/2020] [Accepted: 06/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Despite wide support for patient involvement in health technology assessments (HTA), determining meaningful engagement is complex. This article explores experiences and perceptions among patient groups participating in the Canadian Agency for Drugs and Technologies in Health (CADTH)'s pan-Canadian Oncology Drug Review (pCODR) process. METHODS We created a qualitative interview study comprising 22 semi-structured telephone interviews with individuals representing 21 different patient groups registered with the pCODR process. The analysis used a qualitative descriptive approach employing techniques from grounded theory. RESULTS Patient groups view the ability to make submissions to the pCODR process as a meaningful activity closely aligned with organizational priorities. Concurrently, they face substantial resource challenges to prepare submissions, including high opportunity costs and difficulty accessing needed literature and finding relevant patients. Although patient groups felt that CADTH is committed to transparency, they expressed considerable uncertainty around the direct impact of their submissions and desired additional avenues for engagement. CONCLUSIONS This study suggests a strong commitment by patient groups to participate in the pCODR process despite uncertainty about how their submissions are used to inform HTA recommendations. Identifying opportunities to provide both financial and nonfinancial resources to patient groups is crucial to encouraging and supporting their meaningful participation in HTA processes.
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Affiliation(s)
- Rebecca E Mercer
- Canadian Centre for Applied Research in Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Alexandra Chambers
- pan-Canadian Oncology Drug Review, Canadian Agency for Drugs and Technologies in Health, Toronto, Ontario, Canada
| | - Helen Mai
- pan-Canadian Oncology Drug Review, Canadian Agency for Drugs and Technologies in Health, Toronto, Ontario, Canada
| | - Valerie McDonald
- pan-Canadian Oncology Drug Review, Canadian Agency for Drugs and Technologies in Health, Toronto, Ontario, Canada
| | - Carole McMahon
- pan-Canadian Oncology Drug Review, Canadian Agency for Drugs and Technologies in Health, Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Canadian Centre for Applied Research in Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Pouwels XGLV, Ramaekers BLT, Geurts SME, Erdkamp F, Vriens BEPJ, Aaldering KNA, van de Wouw AJ, Dercksen MW, Smilde TJ, Peters NAJB, van Riel JMGH, Pepels MJ, Heijnen-Mommers J, Tjan-Heijnen VCG, de Boer M, Joore MA. An economic evaluation of eribulin for advanced breast cancer treatment based on the Southeast Netherlands advanced breast cancer registry. Acta Oncol 2020; 59:1123-1130. [PMID: 32544366 DOI: 10.1080/0284186x.2020.1775289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: In 2013, eribulin was reimbursed under a coverage with evidence development (CED) as third or later chemotherapy line for advanced breast cancer (ABC) patients in the Netherlands because of uncertain cost effectiveness. In 2016, the final decision of reimbursing eribulin was taken without considering the evidence collected during CED research. We analysed the cost effectiveness of eribulin versus non-eribulin chemotherapy, using real-world data.Methods: A three health states (progression-free, progressed disease, dead) partitioned survival model was developed. The SOuth East Netherlands Advanced BREast Cancer (SONABRE) registry informed the effectiveness and costs inputs. Health state utility values were obtained from the literature. Incremental cost-effectiveness ratio (ICER) between the eribulin and matched non-eribulin chemotherapy was estimated. Deterministic and probabilistic sensitivity analyses and scenario analyses were performed. The financial risk (i.e., the expected value of perfect information (EVPI) plus the expected monetary loss (eML) associated with reimbursing eribulin) and budget impact associated with reimbursing eribulin were calculated.Results: Eribulin led to higher health benefits (0.07 quality-adjusted life year (QALY)) and costs (€15,321) compared with non-eribulin chemotherapy. This resulted in an ICER of €220,608. At a €80,000 per QALY threshold, the risk of reimbursing eribulin was €9,791 per patient (EVPI €13, eML €9,778). Scaled up to the Dutch population, the estimated annual budget impact was €1.9 million and the annual risk of reimbursing eribulin was €2.7 million.Conclusion: From a Dutch societal perspective, eribulin is not cost effective when considering its list price as third and later chemotherapy line for ABC patients.
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Affiliation(s)
- Xavier G. L. V. Pouwels
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre +, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- School of Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
| | - Bram L. T. Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Sandra M. E. Geurts
- School of Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Frans Erdkamp
- Department of Internal Medicine, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | | | | | | | - M. W. Dercksen
- Department of Internal Medicine, Máxima Medical Centre, Eindhoven, The Netherlands
| | - Tineke J. Smilde
- Department of Internal Medicine, Jeroen Bosch Hospital, Hertogenbosch, The Netherlands
| | | | - J. M. G. H. van Riel
- Department of Internal Medicine, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Manon J. Pepels
- Department of Internal Medicine, Elkerliek Hospital, Helmond, The Netherlands
| | - Jose Heijnen-Mommers
- School of Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Vivianne C. G. Tjan-Heijnen
- School of Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Maaike de Boer
- School of Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Manuela A. Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre +, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Pinto D, Garnier M, Barbas J, Chang SH, Charlifue S, Field-Fote E, Furbish C, Tefertiller C, Mummidisetty CK, Taylor H, Jayaraman A, Heinemann AW. Budget impact analysis of robotic exoskeleton use for locomotor training following spinal cord injury in four SCI Model Systems. J Neuroeng Rehabil 2020; 17:4. [PMID: 31924224 PMCID: PMC6954546 DOI: 10.1186/s12984-019-0639-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 12/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We know little about the budget impact of integrating robotic exoskeleton over-ground training into therapy services for locomotor training. The purpose of this study was to estimate the budget impact of adding robotic exoskeleton over-ground training to existing locomotor training strategies in the rehabilitation of people with spinal cord injury. METHODS A Budget Impact Analysis (BIA) was conducted using data provided by four Spinal Cord Injury (SCI) Model Systems rehabilitation hospitals. Hospitals provided estimates of therapy utilization and costs about people with spinal cord injury who participated in locomotor training in the calendar year 2017. Interventions were standard of care walking training including body-weight supported treadmill training, overground training, stationary robotic systems (i.e., treadmill-based robotic gait orthoses), and overground robotic exoskeleton training. The main outcome measures included device costs, training costs for personnel to use the device, human capital costs of locomotor training, device demand, and the number of training sessions per person with SCI. RESULTS Robotic exoskeletons for over-ground training decreased hospital costs associated with delivering locomotor training in the base case analysis. This analysis assumed no difference in intervention effectiveness across locomotor training strategies. Providing robotic exoskeleton overground training for 10% of locomotor training sessions over the course of the year (range 226-397 sessions) results in decreased annual locomotor training costs (i.e., net savings) between $1114 to $4784 per annum. The base case shows small savings that are sensitive to parameters of the BIA model which were tested in one-way sensitivity analyses, scenarios analyses, and probability sensitivity analyses. The base case scenario was more sensitive to clinical utilization parameters (e.g., how often devices sit idle and the substitution of high cost training) than device-specific parameters (e.g., robotic exoskeleton device cost or device life). Probabilistic sensitivity analysis simultaneously considered human capital cost, device cost, and locomotor device substitution. With probabilistic sensitivity analysis, the introduction of a robotic exoskeleton only remained cost saving for one facility. CONCLUSIONS Providing robotic exoskeleton for over-ground training was associated with lower costs for the locomotor training of people with SCI in the base case analyses. The analysis was sensitive to parameter assumptions.
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Affiliation(s)
- Daniel Pinto
- Department of Physical Therapy, College of Health Sciences, Marquette University, Milwaukee, USA.
- Department of Medical and Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, USA.
| | | | - Jason Barbas
- Shirley Ryan Ability Lab, Chicago, USA
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - Shuo-Hsiu Chang
- Department of Physical Medicine and Rehabilitation McGovern Medical School, University of Texas Health Science Center at Houston, Houston, USA
| | - Susan Charlifue
- SCI Research, Craig Hospital, Englewood, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado, Denver, USA
| | - Edelle Field-Fote
- Spinal Cord Injury Research at the Shepherd Center, Atlanta, Georgia
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Catherine Furbish
- Spinal Cord Injury Research at the Shepherd Center, Atlanta, Georgia
| | | | - Chaithanya K Mummidisetty
- Max Nader Center for Rehabilitation Technologies & Outcomes Research, Chicago, USA
- Office of Translational Research, Shirley Ryan Ability Lab, Chicago, USA
| | - Heather Taylor
- Spinal Cord Injury and Disability Research, TIRR Memorial Herman, Houston, USA
- Pediatrics and Physical Medicine and Rehabilitation McGovern Medical School, University of Texas Health Science Center, Houston, USA
| | - Arun Jayaraman
- Office of Translational Research, Shirley Ryan Ability Lab, Chicago, USA
- Northwestern University, Evanston, USA
| | - Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Department of PM&R, Feinberg School of Medicine, Northwestern University, Evanston, USA
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Huls SPI, Whichello CL, van Exel J, Uyl-de Groot CA, de Bekker-Grob EW. What Is Next for Patient Preferences in Health Technology Assessment? A Systematic Review of the Challenges. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1318-1328. [PMID: 31708070 DOI: 10.1016/j.jval.2019.04.1930] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Integrating patient preferences in Health Technology Assessment (HTA) is argued to improve uptake, adherence, and patient satisfaction. However, how to elicit and incorporate these preferences in HTA in a systematic and scientifically valid manner is subject to debate. OBJECTIVE This article provides a systematic review of the challenges to integrating patient preferences in HTA that have been raised in the literature about patient preferences in HTA. METHODS A systematic review of articles published between 2013 and 2017 addressing challenges to the integration of patient preferences in HTA was conducted in 7 databases. All issues with respect to the integration of patient preferences in HTA were extracted and divided into 5 categories: conceptual, normative, procedural, methodological, and practical issues. The issues were ranked according to how often they were mentioned. RESULTS Of 2147 retrieved articles, 67 were included in the analysis. Thirty-seven unique research issues were identified. In the majority of the articles, methodological issues were posed (82%), followed by procedural (73%), normative (51%), practical (24%), and conceptual (9%) issues. Frequently posed methodological issues concerned preference heterogeneity and choice of method. Common procedural issues concerned how to evaluate the impact of preference studies and their degree of being evidence based. CONCLUSIONS This article provides an overview of issues with respect to the integration of patient preferences in HTA procedures. Most issues were of a methodological or procedural nature; yet, the large number of different issues points to the overall importance of further researching the different aspects concerned with patient preferences in HTA. Through its ranking of how many articles mention particular issues, this article proposes an implicit research agenda.
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Affiliation(s)
- Samare P I Huls
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Chiara L Whichello
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Job van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Esther W de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Multiple Criteria Decision Analysis for HTA across four EU Member States: Piloting the Advance Value Framework. Soc Sci Med 2019; 246:112595. [PMID: 31874372 DOI: 10.1016/j.socscimed.2019.112595] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/29/2019] [Accepted: 10/10/2019] [Indexed: 12/15/2022]
Abstract
Multiple Criteria Decision Analysis (MCDA) has emerged as a methodology for Health Technology Assessment (HTA). However, limited empirical evidence is available on its use by decision-makers; where available, it only comes from single-setting exercises, while cross-country comparative studies are unavailable. This study applies the Advance Value Framework (AVF), an MCDA methodology for HTA based on multi-attribute value theory, through a series of case studies with decision-makers in four countries, to explore its feasibility and compare decision-makers' value preferences and results. The AVF was applied in the evaluation of three drugs for metastatic, castrate resistant, prostate cancer (abiraterone, cabazitaxel and enzalutamide) in the post-chemotherapy indication. Decision conferences were organised in four European countries in collaboration with their HTA or health insurance organisations by involving relevant assessors and experts: Sweden (TLV), Andalusia/Spain (AETSA), Poland (AOTMiT) and Belgium (INAMI-RIZIV). Participants' value preferences, including performance scoring and criteria weighting, were elicited through a facilitated decision-analysis modelling approach using the MACBETH technique. Between 6 and 11 criteria were included in each jurisdiction's value model, allocated across four criteria domains; Therapeutic Benefit criteria consistently ranked first in relative importance across all countries. Consistent drug rankings were observed in all settings, with enzalutamide generating the highest overall weighted preference value (WPV) score, followed by abiraterone and cabazitaxel. Dividing drugs' overall WPV scores by their costs produced the lowest "cost per unit of value" for enzalutamide, followed by abiraterone and cabazitaxel. These results come in contrast with the actual country HTA recommendations and pricing decisions. Overall, although some differences in value preferences were observed between countries, drug rankings remained the same. The MCDA methodology employed could act as a decision support tool in HTA, due to the transparency in the construction of value preferences in a collaborative manner.
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Oliveira MD, Mataloto I, Kanavos P. Multi-criteria decision analysis for health technology assessment: addressing methodological challenges to improve the state of the art. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:891-918. [PMID: 31006056 PMCID: PMC6652169 DOI: 10.1007/s10198-019-01052-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/14/2019] [Indexed: 05/11/2023]
Abstract
BACKGROUND Multi-criteria decision analysis (MCDA) concepts, models and tools have been used increasingly in health technology assessment (HTA), with several studies pointing out practical and theoretical issues related to its use. This study provides a critical review of published studies on MCDA in the context of HTA by assessing their methodological quality and summarising methodological challenges. METHODS A systematic review was conducted to identify studies discussing, developing or reviewing the use of MCDA in HTA using aggregation approaches. Studies were classified according to publication time and type, country of study, technology type and study type. The PROACTIVE-S approach was constructed and used to analyse methodological quality. Challenges and limitations reported in eligible studies were collected and summarised; this was followed by a critical discussion on research requirements to address the identified challenges. RESULTS 129 journal articles were eligible for review, 56% of which were published in 2015-2017; 42% focused on pharmaceuticals; 36, 26 and 18% reported model applications, issues regarding MCDA implementation analyses, and proposing frameworks, respectively. Poor compliance with good methodological practice (< 25% complying studies) was found regarding behavioural analyses, discussion of model assumptions and uncertainties, modelling of value functions, and dealing with judgment inconsistencies. The five most reported challenges related to evidence and data synthesis; value system differences and participant selection issues; participant difficulties; methodological complexity and resource balance; and criteria and attributes modelling. A critical discussion on ways to address these challenges ensues. DISCUSSION Results highlight the need for advancement in robust methodologies, procedures and tools to improve methodological quality of MCDA in HTA studies. Research pathways include developing new model features, good practice guidelines, technologies to enable participation and behavioural research.
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Affiliation(s)
- Mónica D Oliveira
- CEG-IST, Universidade de Lisboa, Avenida Rovisco Pais, 1049-001, Lisbon, Portugal.
| | - Inês Mataloto
- CEG-IST, Universidade de Lisboa, Avenida Rovisco Pais, 1049-001, Lisbon, Portugal
| | - Panos Kanavos
- Department of Health Policy and Medical Technology Research Group, LSE Health London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
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Wadmann S, Kjellberg J. New model for prioritised adoption and use of hospital medicine in Denmark since 2017: Challenges and perspectives. Health Policy 2019; 123:606-610. [PMID: 31122758 DOI: 10.1016/j.healthpol.2019.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/31/2019] [Accepted: 05/06/2019] [Indexed: 11/28/2022]
Abstract
Technological innovation creates new treatment opportunities, while also putting healthcare budgets under strain. To deal with the rising costs of hospital medicines, the regional governments in Denmark have developed a new model for prioritising the adoption and use of hospital medicine. Marking a shift from previous policies, the new model formalises the evaluation of clinical benefit, adds an assessment of treatment costs and ensures a relatively high degree of direct stakeholder involvement. In international comparison, the new model is ambitious in terms of stakeholder involvement and adherence with principles advocated to ensure procedural justice and fair decision-making processes. However, these procedural innovations have also created new challenges. Notably, the newly formed assessment body, the Danish Medicines Council, is faced with a very high caseload and limited options to prioritise the use of its analytical resources.
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Affiliation(s)
- Sarah Wadmann
- The Danish Center for Social Science Research, Herluf Trolles Gade 11, DK-1052 Copenhagen, Denmark.
| | - Jakob Kjellberg
- The Danish Center for Social Science Research, Herluf Trolles Gade 11, DK-1052 Copenhagen, Denmark.
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Timely, consistent, transparent assessment of market access evidence: implementing tools based on the HTA Core Model® in a pharmaceutical company. Int J Technol Assess Health Care 2019; 35:10-16. [PMID: 30789111 PMCID: PMC6521787 DOI: 10.1017/s0266462318003653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objectives Evidence requirements and assessment methods access differ between health technology assessment (HTA) agencies. The HTA Core Model® provides a standardized approach to HTA, targeting evidence sharing and collaboration between participating HTA bodies. It is fit for purpose from an industry perspective and was used by pharmaceutical company Roche to develop a framework for internal assessment of evidence required for market access and coverage/reimbursement (“access evidence”). Methods Tools were developed to systematically scope, assess, plan, and summarize access evidence generation. The tools were based mainly on the first four HTA Core Model® domains and rolled-out in selected development teams in 2017. Five months after full implementation, the impact of tools was assessed in an internal survey. Results Systematic access evidence generation started with the Access Evidence Questionnaire, to scope evidence requirements and identify evidence gaps. Findings were summarized in the Access Evidence Metric, which assessed the alignment of available/planned evidence against HTA bodies’ requirements and developed scope mitigation strategies. The Access Evidence Plan was then used to plan and document (additional) evidence generation. Once generated, evidence was summarized in the Access Evidence Dossier. A survey of twenty-seven Roche employees involved in evidence generation showed that the tools made discussions around access strategies and evidence more efficient and transparent. Conclusions The HTA Core Model® provided a useful framework around which to optimize internal evidence generation and assessment. The benefits of using a standardized HTA approach in industry mirror those expected from implementing the HTA Core Model® in HTA agencies.
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Yan C, Zheng Y, Hill MD, Mann B, Jeerakathil T, Kamal N, Amlani S, Chuck AW. Health Technology Optimization Analysis: Conceptual Approach and Illustrative Application. MDM Policy Pract 2018; 3:2381468318774804. [PMID: 30288446 PMCID: PMC6157433 DOI: 10.1177/2381468318774804] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 04/06/2018] [Indexed: 01/19/2023] Open
Abstract
We present a conceptual approach to determine the optimal solution to delivering
a health technology, consistent with the objective of maximizing patient
outcomes subject to resources available to a publicly funded health system. The
article addresses two key policy questions: 1) adding system values through
appropriate planning of health services delivery and 2) considering the tradeoff
between patient outcomes and costs to the health system through appropriate use
of health technologies for conditions with time-dependent treatment outcomes. We
develop a health technology optimization framework that considers geographical
variation and searches for the best delivery method through a pairwise
comparison of all possible strategies, factoring in controlled variables
including disease epidemiology, time or distance to hospitals, available medical
services, treatment eligibility, treatment efficacy, and costs. Taking
variations of these factors into account would help support a more efficient
allocation of health resources. Drawing identified strategies together then
creates a map of optimal strategies. We apply the proposed method to a
policy-relevant health technology assessment of endovascular therapy (EVT) for
treating acute ischemic stroke. The best strategy for providing EVT relies on
the geographical location of stroke onset and the decision maker’s preference
for either patient outcomes or economic efficiency. The proposed method produced
an optimization map showing the optimal strategy for EVT delivery, which
maximizes patient outcomes while minimizing health system costs. In the
illustrative case study, there were no tradeoffs between health outcomes and
costs, meaning that the delivery strategies that were clinically optimal for
patients were also the most cost-effective. In conclusion, the health technology
optimization approach is a useful tool for informing implementation decisions
and coordinating the delivery of complex health services such as EVT.
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Affiliation(s)
- Charles Yan
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Yufei Zheng
- Institute of Health Economics, Edmonton, Alberta, Canada
| | | | - Balraj Mann
- Cardiovascular Health & Stroke SCN, Alberta Health Services, Alberta, Canada
| | | | | | - Shy Amlani
- Alberta Health Services, Edmonton, Alberta, Canada
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Higher Sustainability and Lower Opportunistic Behaviour in Healthcare: A New Framework for Performing Hospital-Based Health Technology Assessment. SUSTAINABILITY 2018. [DOI: 10.3390/su10103550] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Innovative health technology deployment represents the primary challenge within the sustainability of public health systems. On one hand, new technologies may potentially improve access to care and the quality of services. On the other hand, their rapid evolution and broad implications on existing procedures increase the risk to adopt technologies that are not value for money. As a consequence, Health Technology Assessment (HTA) is a critical process at each level of the National Health System. Focusing on the organisational level, this paper explores the current practices of Hospital-Based HTA (HB-HTA) in terms of management, control and behaviours of various actors involved. Among several tasks, decision-makers are appointed at managing the conflict of interest around health technology development, that could pave the way for corruption or other misleading behaviours. Accordingly, the purpose of the study is proposing a new strategic framework, named Health Technology Balanced Assessment (HTBA), to foster hospital-based health technology management aimed to align strategy and actions. The conceptual model is developed on three perspectives (clinical, economic and organisational) to make the actors involved in the assessment (clinicians, health professionals, hospital managers and patients) aware of the impact of new technology on the value chain. Besides supporting the decision-making process, such a tool represents support for the internal control system as a whole. By promoting structured evaluation, it increases transparency and accountability of public health organisations. Moreover, in the long run, the framework proposed will be useful to reach selected United Nations Sustainable Development Goals (UN SDGs) to enhance the quality of healthcare in the future.
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Angelis A. Evaluating the Benefits of New Drugs in Health Technology Assessment Using Multiple Criteria Decision Analysis: A Case Study on Metastatic Prostate Cancer With the Dental and Pharmaceuticals Benefits Agency (TLV) in Sweden. MDM Policy Pract 2018; 3:2381468318796218. [PMID: 35187241 PMCID: PMC8855406 DOI: 10.1177/2381468318796218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 07/17/2018] [Indexed: 12/18/2022] Open
Abstract
Background. Multiple criteria decision analysis (MCDA) has been identified as a prospective methodology for assisting decision makers in evaluating the benefits of new medicines in health technology assessment (HTA); however, limited empirical evidence exists from real-world applications. Objective. To test in practice a recently developed MCDA methodological framework for HTA, the Advance Value Framework, in a proof-of-concept case study with decision makers. Methods. A multi-attribute value theory methodology was adopted applying the MACBETH questioning protocol through a facilitated decision-analysis modelling approach as part of a decision conference with four experts. Settings. The remit of the Swedish Dental and Pharmaceutical Benefits Agency (Tandvårds- och läkemedelsförmånsverket [TLV]) was adopted but in addition supplementary value dimensions were considered. Patients. Metastatic castrate-resistant prostate cancer patients were considered having received prior chemotherapy. Interventions. Abiraterone, cabazitaxel, and enzalutamide were evaluated as third-line treatments. Measurements. Participants’ value preferences were elicited involving criteria selection, options scoring, criteria weighting, and their aggregation. Results. Eight criteria attributes were finally included in the model relating to therapeutic impact, safety profile, socioeconomic impact, and innovation level with relative importance weights 44.5%, 33.3%, 14.8%, and 7.4% per cluster, respectively. Enzalutamide scored the highest overall weighted preference value score, followed by abiraterone and cabazitaxel. Dividing treatments’ overall weighted preference value scores by their costs derived “costs per unit of value” for ranking the treatments based on value-for-money grounds. Limitations. Study limitations included lack of comparative clinical effects across treatments and the small sample of participants. Conclusion. The Advance Value Framework has the prospects of facilitating the evaluation process in HTA and health care decision making; additional research is recommended to address technical challenges and optimize the use of MCDA for policy making.
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Affiliation(s)
- Aris Angelis
- Medical Technology Research Group, LSE Health and Department of Health Policy, London School of Economics and Political Science, London, UK
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Pierce GF, Iorio A. Past, present and future of haemophilia gene therapy: From vectors and transgenes to known and unknown outcomes. Haemophilia 2018; 24 Suppl 6:60-67. [DOI: 10.1111/hae.13489] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 01/19/2023]
Affiliation(s)
- G. F. Pierce
- World Federation of Hemophilia; Montreal QC Canada
- World Federation of Hemophilia; Third Rock Ventures; San Francisco CA USA
| | - A. Iorio
- McMaster University; Hamilton ON Canada
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29
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Patients’ Associations and HTA for medicines: actual and future role in Italy. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2018. [DOI: 10.1177/2284240318770966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Campillo-Artero C, Puig-Junoy J, Culyer AJ. Does MCDA Trump CEA? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:147-151. [PMID: 29468578 DOI: 10.1007/s40258-018-0373-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Carlos Campillo-Artero
- Center for Research in Health and Economics, Pompeu Fabra University, carrer Ramon Trias Fargas 25-27, 08005, Barcelona, Spain
| | - Jaume Puig-Junoy
- Center for Research in Health and Economics, Pompeu Fabra University, carrer Ramon Trias Fargas 25-27, 08005, Barcelona, Spain.
- Department of Economics and Business, Pompeu Fabra University, Ramon Trias Fargas 25-27, 08005, Barcelona, Spain.
| | - Anthony J Culyer
- Center for Health Economics, Department of Economics and Related Studies, University of York, York, YO10 5DD, UK
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Downey L, Rao N, Guinness L, Asaria M, Prinja S, Sinha A, Kant R, Pandey A, Cluzeau F, Chalkidou K. Identification of publicly available data sources to inform the conduct of Health Technology Assessment in India. F1000Res 2018; 7:245. [PMID: 29770210 PMCID: PMC5930391 DOI: 10.12688/f1000research.14041.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Health technology assessment (HTA) provides a globally-accepted and structured approach to synthesising evidence for cost and clinical effectiveness alongside ethical and equity considerations to inform evidence-based priorities. India is one of the most recent countries to formally commit to institutionalising HTA as an integral component of the heath resource allocation decision-making process. The effective conduct of HTA depends on the availability of reliable data. Methods: We draw from our experience of collecting, synthesizing, and analysing health-related datasets in India and internationally, to highlight the complex requirements for undertaking HTA, and explore the availability of such data in India. We first outlined each of the core data components required for the conduct of HTA, and their availability in India, drawing attention to where data can be accessed, and different ways in which researchers can overcome the challenges of missing or low quality data. Results: We grouped data into the following categories: clinical efficacy; cost; epidemiology; quality of life; service use/consumption; and equity. We identified numerous large local data sources containing epidemiological information. There was a marked absence of other locally-collected data necessary for informing HTA, particularly data relating to cost, service use, and quality of life. Conclusions: The introduction of HTA into the health policy space in India provides an opportunity to comprehensively assess the availability and quality of health data capture across the country. While epidemiological information is routinely collected across India, other data inputs necessary for HTA are not readily available. This poses a significant bottleneck to the efficient generation and deployment of HTA into the health decision space. Overcoming these data gaps by strengthening the routine collection of comprehensive and verifiable health data will have important implications not only for embedding economic analyses into the priority setting process, but for strengthening the health system as a whole.
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Affiliation(s)
- Laura Downey
- Institute of Global Health Innovation, Imperial College London, London, W2 1NY, UK.,International Decision Support Initative, London, W2 1NY, UK
| | - Neethi Rao
- Institute of Global Health Innovation, Imperial College London, London, W2 1NY, UK.,International Decision Support Initative, London, W2 1NY, UK
| | - Lorna Guinness
- Institute of Global Health Innovation, Imperial College London, London, W2 1NY, UK.,International Decision Support Initative, London, W2 1NY, UK
| | - Miqdad Asaria
- Institute of Global Health Innovation, Imperial College London, London, W2 1NY, UK.,International Decision Support Initative, London, W2 1NY, UK
| | - Shankar Prinja
- Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Anju Sinha
- Indian Council of Medical Research, New Delhi, 110029, India
| | - Rajni Kant
- Indian Council of Medical Research, New Delhi, 110029, India
| | - Arvind Pandey
- National Institute of Medical Statistics , New Delhi, 110058, India
| | - Francoise Cluzeau
- Institute of Global Health Innovation, Imperial College London, London, W2 1NY, UK.,International Decision Support Initative, London, W2 1NY, UK
| | - Kalipso Chalkidou
- Institute of Global Health Innovation, Imperial College London, London, W2 1NY, UK.,International Decision Support Initative, London, W2 1NY, UK.,Centre for Global Development , London, SW1Y 4TE, UK
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Downey L, Rao N, Guinness L, Asaria M, Prinja S, Sinha A, Kant R, Pandey A, Cluzeau F, Chalkidou K. Identification of publicly available data sources to inform the conduct of Health Technology Assessment in India. F1000Res 2018; 7:245. [PMID: 29770210 PMCID: PMC5930391 DOI: 10.12688/f1000research.14041.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2018] [Indexed: 07/30/2023] Open
Abstract
Background: Health technology assessment (HTA) provides a globally-accepted and structured approach to synthesising evidence for cost and clinical effectiveness alongside ethical and equity considerations to inform evidence-based priorities. India is one of the most recent countries to formally commit to institutionalising HTA as an integral component of the heath resource allocation decision-making process. The effective conduct of HTA depends on the availability of reliable data. Methods: We draw from our experience of collecting, synthesizing, and analysing health-related datasets in India and internationally, to highlight the complex requirements for undertaking HTA, and explore the availability of such data in India. We first outlined each of the core data components required for the conduct of HTA, and their availability in India, drawing attention to where data can be accessed, and different ways in which researchers can overcome the challenges of missing or low quality data. Results: We grouped data into the following categories: clinical efficacy; cost; epidemiology; quality of life; service use/consumption; and equity. We identified numerous large local data sources containing epidemiological information. There was a marked absence of other locally-collected data necessary for informing HTA, particularly data relating to cost, service use, and quality of life. Conclusions: The introduction of HTA into the health policy space in India provides an opportunity to comprehensively assess the availability and quality of health data capture across the country. While epidemiological information is routinely collected across India, other data inputs necessary for HTA are not readily available. This poses a significant bottleneck to the efficient generation and deployment of HTA into the health decision space. Overcoming these data gaps by strengthening the routine collection of comprehensive and verifiable health data will have important implications not only for embedding economic analyses into the priority setting process, but for strengthening the health system as a whole.
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Affiliation(s)
- Laura Downey
- Institute of Global Health Innovation, Imperial College London, London, W2 1NY, UK
- International Decision Support Initative, London, W2 1NY, UK
| | - Neethi Rao
- Institute of Global Health Innovation, Imperial College London, London, W2 1NY, UK
- International Decision Support Initative, London, W2 1NY, UK
| | - Lorna Guinness
- Institute of Global Health Innovation, Imperial College London, London, W2 1NY, UK
- International Decision Support Initative, London, W2 1NY, UK
| | - Miqdad Asaria
- Institute of Global Health Innovation, Imperial College London, London, W2 1NY, UK
- International Decision Support Initative, London, W2 1NY, UK
| | - Shankar Prinja
- Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Anju Sinha
- Indian Council of Medical Research, New Delhi, 110029, India
| | - Rajni Kant
- Indian Council of Medical Research, New Delhi, 110029, India
| | - Arvind Pandey
- National Institute of Medical Statistics , New Delhi, 110058, India
| | - Francoise Cluzeau
- Institute of Global Health Innovation, Imperial College London, London, W2 1NY, UK
- International Decision Support Initative, London, W2 1NY, UK
| | - Kalipso Chalkidou
- Institute of Global Health Innovation, Imperial College London, London, W2 1NY, UK
- International Decision Support Initative, London, W2 1NY, UK
- Centre for Global Development , London, SW1Y 4TE, UK
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Richter T, Janoudi G, Amegatse W, Nester-Parr S. Characteristics of drugs for ultra-rare diseases versus drugs for other rare diseases in HTA submissions made to the CADTH CDR. Orphanet J Rare Dis 2018; 13:15. [PMID: 29386040 PMCID: PMC5793441 DOI: 10.1186/s13023-018-0762-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background It has been suggested that ultra-rare diseases should be recognized as distinct from more prevalent rare diseases, but how drugs developed to treat ultra-rare diseases (DURDs) might be distinguished from drugs for ‘other’ rare diseases (DORDs) is not clear. We compared the characteristics of DURDs to DORDs from a health technology assessment (HTA) perspective in submissions made to the CADTH Common Drug Review. We defined a DURD as a drug used to treat a disease with a prevalence ≤ 1 patient per 100,000 people, a DORD as a drug used to treat a disease with a prevalence > 1 and ≤ 50 patients per 100,000 people. We assessed differences in the level and quantity of evidence supporting each HTA submission, the molecular basis of treatment agents, annual treatment cost per patient, type of reimbursement recommendation made by CADTH, and reasons for negative recommendations. Results We analyzed 14 DURD and 46 DORD submissions made between 2004 and 2016. Compared to DORDs, DURDs were more likely to be biologic drugs (OR = 6.06, 95%CI 1.25 to 38.58), to have been studied in uncontrolled clinical trials (OR = 23.11, 95%CI 2.23 to 1207.19), and to have a higher annual treatment cost per patient (median difference = CAN$243,787.75, 95%CI CAN$83,396 to CAN$329,050). Also, submissions for DURDs were associated with a less robust evidence base versus DORDs, as DURD submissions were less likely to include data from at least one double-blinded randomized controlled trial (OR = 0.13, 95%CI 0.02 to 0.70) and have smaller patient cohorts in clinical trials (median difference = −108, 95%CI –234 to −50). Furthermore, DURDs are less likely to receive a positive reimbursement recommendation (OR = 0.22, 95%CI 0.05 to 0.91), and low level of evidence was the major contributor for a negative recommendation. Conclusions The results suggest that DURDs could be viewed as distinct category from an HTA perspective. Applying the same HTA decision-making framework to DURDs and DORDs might have contributed the higher rate of negative reimbursement recommendations made for DURDs. Recognition of DURDs as a distinct subgroup of DRDs by explicitly defining DURDs based on objective criteria may facilitate the implementation of HTA assessment process that accounts for the issues associated with DURD.
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Affiliation(s)
- Trevor Richter
- CADTH, 865 Carling Ave., Suite 600, Ottawa, ON, K1S 5S8, Canada
| | - Ghayath Janoudi
- CADTH, 865 Carling Ave., Suite 600, Ottawa, ON, K1S 5S8, Canada.
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Horgan D. Treatment Is Worth a Lot - But Just How Much. Biomed Hub 2017; 2:202-211. [PMID: 31988950 PMCID: PMC6945954 DOI: 10.1159/000481616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 09/19/2017] [Indexed: 11/23/2022] Open
Abstract
More than at any other time in history, science offers enormous potential to transform the prevention, diagnosis and treatment of many diseases. However, patients are urgently awaiting new therapies - and too often not getting them. And researchers and companies also face significant development obstacles as only one in ten drugs entering clinical trials ever makes it over the finish line. This article looks at the issues involved in bringing innovation into healthcare systems from a political and policy level. It takes a close look at Health Technology Assessment (HTA) across Member States, how it is working and, more to the point, how it isn't, and how it often serves to stymie the introduction of new medicines by undermining the European Medicines Agency (EMA). The article argues that the EU could strengthen HTA cooperation via a common framework, and promote higher quality and fairer assessments; while joint work could reduce duplication of efforts, and promote better synergies as well as better use of Member States' resources. The author also takes an in-depth look into criticism of private-sector pricing of innovative medicines in the light of discussions about what constitutes “value” in the context of new treatments - a discussion that shows no signs of abating - while advocating enhanced contact and the need for compromise between all stakeholders in the great value debate.
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Affiliation(s)
- Denis Horgan
- European Alliance for Personalised Medicine, Brussels, Belgium
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Angelis A, Montibeller G, Hochhauser D, Kanavos P. Multiple criteria decision analysis in the context of health technology assessment: a simulation exercise on metastatic colorectal cancer with multiple stakeholders in the English setting. BMC Med Inform Decis Mak 2017; 17:149. [PMID: 29073892 PMCID: PMC5658981 DOI: 10.1186/s12911-017-0524-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 08/10/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Multiple criteria decision analysis (MCDA) has appeared as a methodology to address limitations of economic evaluation in health technology assessment (HTA), however there are limited empirical evidence from real world applications. The aim of this study is to test in practice a recently developed MCDA methodological framework known as Advance Value Framework (AVF) through a proof-of-concept case study engaging multiple stakeholders. METHODS A multi-attribute value theory methodological process was adopted involving problem structuring, model building, model assessment and model appraisal phases. A facilitated decision analysis modelling approach was used as part of a decision conference with thirteen participants. An expanded scope of the National Institute for Health and Care Excellence (NICE) remit acted as the study setting with the use of supplementary value concerns. Second-line biological treatments were evaluated for metastatic colorectal cancer (mCRC) patients having received prior chemotherapy, including cetuximab monotherapy, panitumumab monotherapy and aflibercept in combination with FOLFIRI chemotherapy. Initially 18 criteria attributes were considered spanning four value domains relating to therapeutic impact, safety profile, innovation level and socioeconomic impact. RESULTS Nine criteria attributes were finally included. Cetuximab scored the highest overall weighted preference value score of 45.7 out of 100, followed by panitumumab with 42.3, and aflibercept plus FOLFIRI with 14.4. The relative weights of the two most important criteria (overall survival and Grade 4 adverse events) added up to more than the relative weight of all other criteria together (52.1%). Main methodological limitation was the lack of comparative clinical effects across treatments and challenges included the selection of "lower" and "higher" reference levels on criteria attributes, eliciting preferences across attributes where participants had less experience, and ensuring that all attributes possess the right decision theory properties. CONCLUSIONS This first application of AVF produced transparent rankings for three mCRC treatments based on their value, by assessing an explicit set of evaluation criteria while allowing for the elicitation and construction of participants' value preferences and their trade-offs. It proved it can aid the evaluation process and value communication of the alternative treatments for the group participants. Further research is needed to optimise its use as part of policy-making.
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Affiliation(s)
- Aris Angelis
- Department of Health Policy and Medical Technology Research Group, LSE Health, London School of Economics and Political Science, London, UK
| | - Gilberto Montibeller
- School of Business and Economics, Management Science and Operations Group, Loughborough University, London, UK
| | | | - Panos Kanavos
- Department of Health Policy and Medical Technology Research Group, LSE Health, London School of Economics and Political Science, London, UK
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Simoens S, Jacobs I, Popovian R, Isakov L, Shane LG. Assessing the Value of Biosimilars: A Review of the Role of Budget Impact Analysis. PHARMACOECONOMICS 2017; 35:1047-1062. [PMID: 28660473 PMCID: PMC5606961 DOI: 10.1007/s40273-017-0529-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Biosimilar drugs are highly similar to an originator (reference) biologic, with no clinically meaningful differences in terms of safety or efficacy. As biosimilars offer the potential for lower acquisition costs versus the originator biologic, evaluating the economic implications of the introduction of biosimilars is of interest. Budget impact analysis (BIA) is a commonly used methodology. This review of published BIAs of biosimilar fusion proteins and/or monoclonal antibodies identified 12 unique publications (three full papers and nine congress posters). When evaluated alongside professional guidance on conducting BIA, the majority of BIAs identified were generally in line with international recommendations. However, a lack of peer-reviewed journal articles and considerable shortcomings in the publications were identified. Deficiencies included a limited range of cost parameters, a reliance on assumptions for parameters such as uptake and drug pricing, a lack of expert validation, and a limited range of sensitivity analyses that were based on arbitrary ranges. The rationale for the methods employed, limitations of the BIA approach, and instructions for local adaptation often were inadequately discussed. To understand fully the potential economic impact and value of biosimilars, the impact of biosimilar supply, manufacturer-provided supporting services, and price competition should be included in BIAs. Alternative approaches, such as cost minimization, which requires evidence demonstrating similarity to the originator biologic, and those that integrate a range of economic assessment methods, are needed to assess the value of biosimilars.
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Affiliation(s)
- Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Ira Jacobs
- Global Medical Affairs, Pfizer Inc., 235 East 42nd Street, New York, NY, 10017-5755, USA.
| | | | | | - Lesley G Shane
- Outcomes and Evidence, Global Health and Value, Pfizer Inc., New York, NY, USA
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Janssen MP, van Hulst M, Custer B. An assessment of differences in costs and health benefits of serology and NAT screening of donations for blood transfusion in different Western countries. Vox Sang 2017. [DOI: 10.1111/vox.12543] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- M. P. Janssen
- Julius Center for Health Sciences and Primary Care; UMC Utrecht; Utrecht The Netherlands
- Transfusion Technology Assessment Department; Sanquin Research; Sanquin Blood Supply Foundation; Amsterdam The Netherlands
| | - M. van Hulst
- Department of Clinical Pharmacy and Toxicology; Martini Hospital; Groningen The Netherlands
- Department of PharmacoTherapy, -Epidemiology & -Economics; Department of Pharmacy; University of Groningen; Groningen The Netherlands
| | - B. Custer
- Blood Systems Research Institute; San Francisco CA USA
- Department of Laboratory Medicine; UCSF; San Francisco CA USA
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Castro R, Elias FTS. Envolvimento dos usuários de sistemas de saúde na Avaliação de Tecnologias em Saúde (ATS): uma revisão narrativa de estratégias internacionais. INTERFACE - COMUNICAÇÃO, SAÚDE, EDUCAÇÃO 2017. [DOI: 10.1590/1807-57622016.0549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
O objetivo foi descrever e analisar modelos e estratégias internacionais de envolvimento de usuários de sistemas de saúde nos processos de avaliação para incorporação de tecnologias de saúde registrados na literatura científica. Realizou-se levantamento da literatura em sete bases científicas, seleção de artigos, identificação e descrição dos modelos adotados em diferentes países. De 392 artigos identificados, oito foram selecionados segundo critérios de elegibilidade. As estratégias e modelos identificados foram classificados segundo o domínio do envolvimento; tipo de público e nível de envolvimento. A descrição dos modelos permitiu identificar uma ampla diversidade de experiências para envolvimento do público em processos de ATS. Os resultados apontam para a troca de conhecimentos e informações como forma de reduzir o distanciamento entre os usuários e os processos de avaliação mediante estratégias diversificadas de incentivo à participação.
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Abstract
OBJECTIVES Some countries make considerable effort to involve patients and patient groups in their health technology assessment (HTA) processes; others are only just considering or are yet to consider patient involvement in HTA. METHODS This commentary offers four arguments why patient involvement should be prioritized by those HTA agencies that do not yet involve patients: (1) from a patients' rights perspective, (2) based on patient and community values, (3) centering on evidentiary contributions, and (4) from a methodological perspective. RESULTS The first argument builds on the Alma-Ata Declaration, which holds that patients have a right and duty to have a say in the planning and delivery of their health care, individually and collectively. Where HTA is used to determine access to technologies and services, we argue that patients have a right to be heard. The second argues that decisions about treatments and services need to be aligned with the core values and morals of the patients whom the health system serves. The third argues that patients have unique knowledge and insights about living with a health condition and their needs for services and treatments regarding that condition, which can add to the knowledge base and value of the HTA process. The fourth argues that involvement of patients can facilitate methodological advancement of HTA, in areas such as early scientific advice and managed entry with evidence development. CONCLUSIONS An HTA process that includes patient perspectives can, therefore, provide added value to patients, policy makers and healthcare professionals alike.
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Varabyova Y, Blankart CR, Schreyögg J. The Role of Learning in Health Technology Assessments: An Empirical Assessment of Endovascular Aneurysm Repairs in German Hospitals. HEALTH ECONOMICS 2017; 26 Suppl 1:93-108. [PMID: 28139092 DOI: 10.1002/hec.3466] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 09/20/2016] [Accepted: 11/23/2016] [Indexed: 06/06/2023]
Abstract
Changes in performance due to learning may dynamically influence the results of a technology evaluation through the change in effectiveness and costs. In this study, we estimate the effect of learning using the example of two minimally invasive treatments of abdominal aortic aneurysms: endovascular aneurysm repair (EVAR) and fenestrated EVAR (fEVAR). The analysis is based on the administrative data of over 40,000 patients admitted with unruptured abdominal aortic aneurysm to more than 500 different hospitals over the years 2006 to 2013. We examine two patient outcomes, namely, in-hospital mortality and length of stay using hierarchical regression models with random effects at the hospital level. The estimated models control for patient and hospital characteristics and take learning interdependency between EVAR and fEVAR into account. In case of EVAR, we observe a significant decrease both in the in-hospital mortality and length of stay with experience accumulated at the hospital level; however, the learning curve for fEVAR in both outcomes is effectively flat. To foster the consideration of learning in health technology assessments of medical devices, a general framework for estimating learning effects is derived from the analysis. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Carl Rudolf Blankart
- Hamburg Center for Health Economics, Universität Hamburg, Hamburg, Germany
- Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, RI, USA
| | - Jonas Schreyögg
- Hamburg Center for Health Economics, Universität Hamburg, Hamburg, Germany
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Wirtz VJ, Hogerzeil HV, Gray AL, Bigdeli M, de Joncheere CP, Ewen MA, Gyansa-Lutterodt M, Jing S, Luiza VL, Mbindyo RM, Möller H, Moucheraud C, Pécoul B, Rägo L, Rashidian A, Ross-Degnan D, Stephens PN, Teerawattananon Y, 't Hoen EFM, Wagner AK, Yadav P, Reich MR. Essential medicines for universal health coverage. Lancet 2017; 389:403-476. [PMID: 27832874 PMCID: PMC7159295 DOI: 10.1016/s0140-6736(16)31599-9] [Citation(s) in RCA: 297] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 09/05/2016] [Accepted: 09/05/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Veronika J Wirtz
- Department of Global Health/Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA.
| | - Hans V Hogerzeil
- Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Andrew L Gray
- Division of Pharmacology, Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | | | | | | | | | - Sun Jing
- Peking Union Medical College School of Public Health, Beijing, China
| | - Vera L Luiza
- National School of Public Health Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Helene Möller
- United Nations Children's Fund, Supply Division, Copenhagen, Denmark
| | - Corrina Moucheraud
- UCLA Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Bernard Pécoul
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Lembit Rägo
- Regulation of Medicines and other Health Technologies, Geneva, Switzerland
| | - Arash Rashidian
- Department of Information, Evidence and Research, Eastern Mediterranean Region, World Health Organization, Cairo, Egypt; School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Dennis Ross-Degnan
- Research, Eastern Mediterranean Region, World Health Organization, Cairo, Egypt; Harvard Medical School, Boston, MA, USA; Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Thai Ministry of Public Health Nonthaburi, Thailand
| | - Ellen F M 't Hoen
- Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Anita K Wagner
- Research, Eastern Mediterranean Region, World Health Organization, Cairo, Egypt; Harvard Medical School, Boston, MA, USA
| | - Prashant Yadav
- William Davidson Institute at the University of Michigan, Ann Arbor, MI, USA
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Schey C, Krabbe PFM, Postma MJ, Connolly MP. Multi-criteria decision analysis (MCDA): testing a proposed MCDA framework for orphan drugs. Orphanet J Rare Dis 2017; 12:10. [PMID: 28095876 PMCID: PMC5240262 DOI: 10.1186/s13023-016-0555-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 12/14/2016] [Indexed: 11/10/2022] Open
Abstract
Background Since the introduction of the orphan drugs legislation in Europe, it has been suggested that the general method of assessing drugs for reimbursement is not necessarily suitable for orphan drugs. The National Institute for Health and Clinical Excellence indicated that several criteria other than cost and efficacy could be considered in reimbursement decisions for orphan drugs. This study sought to explore the multi-criteria decision analysis (MCDA) framework proposed by (Orphanet J Rare Dis 7:74, 2012) to a range of orphan drugs, with a view to comparing the aggregate scores to the average annual cost per patient for each product, and thus establishing the merit of MCDA as a tool for assessing the value of orphan drugs in relation to their pricings. Methods An MCDA framework was developed using the nine criteria proposed by (Orphanet J Rare Dis 7:74, 2012) for the evaluation of orphan drugs, using the suggested numerical scoring system on a scale of 1 to 3 for each criterion. Correlations between the average annual cost of the drugs and aggregate MCDA scores were tested and plotted graphically. Different weightings for each of the attributes were also tested. A further analysis was conducted to test the impact of including the drug cost as an attribute in the aggregate index scores. Results In the drugs studied, the R2, that statistically measures how close the data are to the fitted regression line was 0.79 suggesting a strong correlation between the drug scores and the average annual cost per patient. Conclusion Despite several limitations of the proposed model, this quantitative study provided insight into using MCDA and its relationship to the average annual costs of the products.
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Affiliation(s)
- C Schey
- Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands. .,Global Market Access Solutions (GMAS), St-Prex, Switzerland.
| | - P F M Krabbe
- Department of Epidemiology, (UMCG), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M J Postma
- Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Epidemiology, (UMCG), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Institute for Science in Healthy Aging & healthcaRE (SHARE), UMCg, University of Groningen, Groningen, The Netherlands
| | - M P Connolly
- Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,Global Market Access Solutions (GMAS), St-Prex, Switzerland
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PUBLIC AND PATIENT INVOLVEMENT IN HEALTH TECHNOLOGY ASSESSMENT: A FRAMEWORK FOR ACTION. Int J Technol Assess Health Care 2016; 32:256-264. [PMID: 27670693 DOI: 10.1017/s0266462316000362] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE As health technology assessment (HTA) organizations in Canada and around the world seek to involve the public and patients in their activities, frameworks to guide decisions about whom to involve, through which mechanisms, and at what stages of the HTA process have been lacking. The aim of this study was to describe the development and outputs of a comprehensive framework for involving the public and patients in a government agency's HTA process. METHODS The framework was informed by a synthesis of international practice and published literature, a dialogue with local, national and international stakeholders, and the deliberations of a government agency's public engagement subcommittee in Ontario, Canada. RESULTS The practice and literature synthesis failed to identify a single, optimal approach to involving the public and patients in HTA. Choice of methods should be considered in the context of each HTA stage, goals for incorporating societal and/or patient perspectives into the process, and relevant societal and/or patient values at stake. The resulting framework is structured around four actionable elements: (i) guiding principles and goals for public and patient involvement (PPI) in HTA, (ii) the establishment of a common language to support PPI efforts, (iii) a flexible array of PPI approaches, and (iv) on-going evaluation of PPI to inform adjustments over time. CONCLUSIONS A public and patient involvement framework has been developed for implementation in a government agency's HTA process. Core elements of this framework may apply to other organizations responsible for HTA and health system quality improvement.
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Pauwels K, Huys I, Casteels M, Simoens S. Industry Perspectives on Market Access of Innovative Drugs: The Relevance for Oncology Drugs. Front Pharmacol 2016; 7:144. [PMID: 27313529 PMCID: PMC4887481 DOI: 10.3389/fphar.2016.00144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/17/2016] [Indexed: 11/13/2022] Open
Abstract
Key Points- Representatives of the pharmaceutical industry call for a broader recognition of value within the assessment and appraisal of innovative drugs - Focus on value within the assessment and appraisal of drugs is jeopardized by financial drives as the side of industry and at the side of the payers - A well–considered value-framework, with attention for patient reported outcomes, societal preferences and dynamic approach on the drug life cycle, needs to be incorporated in assessment and appraisal at national and European level in order to coordinate the views of different stakeholders and allow efficient resource allocation
This study presents industry perspectives on the challenges related to market access of innovative drugs in general and oncology drugs in specific. Fifteen interviews were conducted with representatives of pharmaceutical companies and industry associations. Interviewees call for a broader recognition of value within the assessment and appraisal of drugs. According to interviewees, focus on value is jeopardized by the lack of a common value definition across Europe, poor availability and validity of value measures and cost-saving measures such as external reference price setting and cost-effectiveness analysis at the side of the payers. Centralized assessment of relative-effectiveness at European level would provide a common value estimate across member states, independent of financial drivers. Empirical evidence on PRO and societal preferences is however essential in the development of a value definition. Furthermore, value-based pricing would imply a dynamic approach where the price is differentiated across indications and across the lifecycle of the drug, especially in fields such as oncology. Financial drivers however also threat the application of value-based pricing at the side of the industry, making value-based profitability a more appropriate term.
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Affiliation(s)
- Kim Pauwels
- Department Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, Katholieke Universiteit Leuven Leuven, Belgium
| | - Isabelle Huys
- Department Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, Katholieke Universiteit Leuven Leuven, Belgium
| | - Minne Casteels
- Department Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, Katholieke Universiteit Leuven Leuven, Belgium
| | - Steven Simoens
- Department Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, Katholieke Universiteit Leuven Leuven, Belgium
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Introduction to Cost Analysis in IR: Challenges and Opportunities. J Vasc Interv Radiol 2016; 27:539-545.e1. [PMID: 26922978 DOI: 10.1016/j.jvir.2015.12.754] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/22/2015] [Accepted: 12/22/2015] [Indexed: 11/20/2022] Open
Abstract
Demonstration of value has become increasingly important in the current health care system. This review summarizes four of the most commonly used cost analysis methods relevant to IR that could be adopted to demonstrate the value of IR interventions: the cost minimization study, cost-effectiveness assessment, cost-utility analysis, and cost-benefit analysis. In addition, the issues of true cost versus hospital charges, modeling in cost studies, and sensitivity analysis are discussed.
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Berglas S, Jutai L, MacKean G, Weeks L. Patients' perspectives can be integrated in health technology assessments: an exploratory analysis of CADTH Common Drug Review. RESEARCH INVOLVEMENT AND ENGAGEMENT 2016; 2:21. [PMID: 29062521 PMCID: PMC5611639 DOI: 10.1186/s40900-016-0036-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 05/25/2016] [Indexed: 05/06/2023]
Abstract
PLAIN LANGUAGE SUMMARY In Canada, the CADTH Common Drug Review helps ensure that scarce health care resources are used to fund the most effective drugs. Clinicians, researchers, payers, and patients all have important, but potentially different, ideas on what should be considered, to determine a drug's value. Since 2010, CADTH has invited patient groups to contribute their perspectives to the Common Drug Review. We explored whether, and how, insights offered by patient groups are integrated into assessment reports and Recommendations by the CADTH Canadian Drug Expert Committee. After examining 30 completed drug assessments, we found that:Patient insights are used by CADTH reviewers to frame an assessment and are used by the expert committee to interpret the evidence.Drug trials do not always measure outcomes that patients consider important.Survival, symptom relief, the process of recovery, and maintaining health are all important aspects to consider when determining value during health technology assessments. ABSTRACT Background Since 2010, Canadian patient groups have contributed to the CADTH Common Drug Review (CDR). CADTH conducts health technology assessments of new drugs to support publicly funded drug plans' reimbursement decisions. We explored whether, and how, patient insights were integrated into assessment reports and Recommendations by the CADTH Canadian Drug Expert Committee (CDEC). Methods We descriptively analyzed 30 consecutive assessments. One researcher identified a set of issues, insights, and desired treatment outcomes provided by patient groups for each included drug assessment. We tracked the presence of each identified patient insight in the relevant assessment protocol, in clinical trials as reported in the assessment, and in the CDEC Recommendations. Additionally, patient insights were categorized by topic and grouped into a three-tier framework to explore the observed juxtaposition between immediate treatment outcomes as seen in clinical trials and the insights from patients living with a chronic condition. Results In 30 drug assessments, 119 patient insights were identified. Of these insights, 89 were included in assessment protocols; 61 in reported clinical trial data; and 67 insights were reflected upon within the CDEC Recommendations. Patient insights within the first framework tier (health status achieved) were frequently included in all aspects of CDR assessments. Within the second tier (progress of recovery), although two-thirds of patient insights were included in protocols, only one-third was reflected in reported trial data or in CDEC Recommendations. Insights within the third tier, which address the long-term consequences of illness and treatment, were even less frequently addressed in all aspects of CDR assessments. Conclusions Patients' perspectives need not be "considered" in isolation. Patient insights are used by CADTH reviewers to frame an assessment and used by CDEC to interpret the evidence. As health technology assessments should address the indirect and unintended consequences of a technology, as well as its direct and intended effects, drug assessments should consider the progress of recovery and sustainability of health, in addition to survival and immediate health achieved.
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Affiliation(s)
| | | | - Gail MacKean
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
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Tarricone R, Ricca G, Nyanzi-Wakholi B, Medina-Lara A. Impact of cancer anorexia-cachexia syndrome on health-related quality of life and resource utilisation: A systematic review. Crit Rev Oncol Hematol 2015; 99:49-62. [PMID: 26775729 DOI: 10.1016/j.critrevonc.2015.12.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 03/30/2015] [Accepted: 12/15/2015] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Cancer anorexia-cachexia syndrome (CACS) negatively impacts patients' quality of life (QoL) and increases the burden on healthcare resources. OBJECTIVES To review published CACS data regarding health-related QOL (HRQoL) and its economic impact on the healthcare system. METHODS Searches were conducted in MEDLINE, EMBASE, DARE, and NHS EED databases. RESULTS A total of 458 HRQoL and 189 healthcare resources utilisation abstracts were screened, and 42 and 2 full-text articles were included, respectively. The EORTC QLQ-C30 and FAACT instruments were most favoured for assessing HRQOL but none of the current tools cover all domains affected by CACS. Economic estimates for managing CACS are scarce, with studies lacking a breakdown of healthcare resource utilisation items. CONCLUSIONS HRQoL instruments that can better assess and incorporate all the domains affected by CACS are required. Rigorous assessment of costs and benefits of treatment are needed to understand the magnitude of the impact of CACS.
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Affiliation(s)
- Rosanna Tarricone
- Centre for Research on Health and Social Care Management (CERGAS), Milan, Italy; Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - Giada Ricca
- Centre for Research on Health and Social Care Management (CERGAS), Milan, Italy
| | | | - Antonieta Medina-Lara
- Centre for Research on Health and Social Care Management (CERGAS), Milan, Italy; Health Economics Group, University of Exeter Medical School, Exeter, UK.
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Fanourgiakis J, Kanoupakis E. Health technology assessment (HTA): a brief introduction of history and the current status in the field of cardiology under the economic crisis. J Evid Based Med 2015; 8:161-4. [PMID: 26291523 DOI: 10.1111/jebm.12171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/27/2014] [Indexed: 01/11/2023]
Abstract
In a time of economic recession health technology assessment is an established aid in decision making in many countries in order to identify cost-containment policy options. Moreover, as the volume, complexity, and cost of new medical technology increases, the need for evaluating benefits, risks and costs becomes increasingly important. In recent years there has been a proliferation of health technology assessment initiatives internationally, aimed in introducing rationality in the decision-making process, informing reimbursement, providing clinical guidance on the use of medical technologies across the world in an evidence-based decision-making environment and in pricing decisions.
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Affiliation(s)
- John Fanourgiakis
- Department of Accounting and Finance, School of Economics and Management, Technological Educational Institute, Crete, Greece
- Department of Business Administration, Technological Educational Institute, Crete, Greece
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Generali D, Fox SB, Cristofanilli M, Bianchini G, Zambelli A, Hatzis C, Barberis M, Tarricone R, Bottini A, Rossi C, Tringali M. Neoadjuvant Model in Cancer Treatment: From Clinical Opportunity to Health-Care Utility. J Natl Cancer Inst Monogr 2015; 2015:1-3. [PMID: 26063875 DOI: 10.1093/jncimonographs/lgv022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In the last few decades, research has demonstrated that cancer can be treated and cured if diagnosed at very early stage and a proper therapeutic strategy is adopted. Recent omics-based approaches have unveiled the molecular mechanisms of cancer tumorigenesis and have aided in identifying next-generation molecular markers for early diagnosis, prognosis, and targeted therapy. New tests based on genomic profiling, circulating tumor cells, or mutation profiling are appraised for purpose by Health Technology Assessment. The potential clinical utility of these tests lies on their ability to discriminate between patients who will benefit to a greater or lesser extent from a therapeutic intervention. Assessment of new technologies for the management of cancer could be of interest to other countries given the potentially high impact that they can have on the quality and cost of health care services.
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Affiliation(s)
- Daniele Generali
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica (DG, AB), Direzione Sanitaria (CR), A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, AB); Department of Anatomical Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF); Thomas Jefferson University Hospital, Philadelphia, PA (MC); San Raffaele - Scientific Institute, Milan, Italy (GB); Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy (AZ); Section of Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT (CH); Division of Pathology, European Institute of Oncology, Milan, Italy (MB); Department of Policy Analysis and Public Management, Research Center on Health and Social Care Management, CERGAS, SDA Bocconi School of Management, Bocconi University, Milan, Italy (RT); Health Technology Assessment - Regione Lombardia, Italy (MT).
| | - Stephen B Fox
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica (DG, AB), Direzione Sanitaria (CR), A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, AB); Department of Anatomical Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF); Thomas Jefferson University Hospital, Philadelphia, PA (MC); San Raffaele - Scientific Institute, Milan, Italy (GB); Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy (AZ); Section of Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT (CH); Division of Pathology, European Institute of Oncology, Milan, Italy (MB); Department of Policy Analysis and Public Management, Research Center on Health and Social Care Management, CERGAS, SDA Bocconi School of Management, Bocconi University, Milan, Italy (RT); Health Technology Assessment - Regione Lombardia, Italy (MT)
| | - Massimo Cristofanilli
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica (DG, AB), Direzione Sanitaria (CR), A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, AB); Department of Anatomical Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF); Thomas Jefferson University Hospital, Philadelphia, PA (MC); San Raffaele - Scientific Institute, Milan, Italy (GB); Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy (AZ); Section of Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT (CH); Division of Pathology, European Institute of Oncology, Milan, Italy (MB); Department of Policy Analysis and Public Management, Research Center on Health and Social Care Management, CERGAS, SDA Bocconi School of Management, Bocconi University, Milan, Italy (RT); Health Technology Assessment - Regione Lombardia, Italy (MT)
| | - Giampaolo Bianchini
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica (DG, AB), Direzione Sanitaria (CR), A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, AB); Department of Anatomical Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF); Thomas Jefferson University Hospital, Philadelphia, PA (MC); San Raffaele - Scientific Institute, Milan, Italy (GB); Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy (AZ); Section of Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT (CH); Division of Pathology, European Institute of Oncology, Milan, Italy (MB); Department of Policy Analysis and Public Management, Research Center on Health and Social Care Management, CERGAS, SDA Bocconi School of Management, Bocconi University, Milan, Italy (RT); Health Technology Assessment - Regione Lombardia, Italy (MT)
| | - Alberto Zambelli
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica (DG, AB), Direzione Sanitaria (CR), A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, AB); Department of Anatomical Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF); Thomas Jefferson University Hospital, Philadelphia, PA (MC); San Raffaele - Scientific Institute, Milan, Italy (GB); Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy (AZ); Section of Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT (CH); Division of Pathology, European Institute of Oncology, Milan, Italy (MB); Department of Policy Analysis and Public Management, Research Center on Health and Social Care Management, CERGAS, SDA Bocconi School of Management, Bocconi University, Milan, Italy (RT); Health Technology Assessment - Regione Lombardia, Italy (MT)
| | - Christos Hatzis
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica (DG, AB), Direzione Sanitaria (CR), A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, AB); Department of Anatomical Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF); Thomas Jefferson University Hospital, Philadelphia, PA (MC); San Raffaele - Scientific Institute, Milan, Italy (GB); Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy (AZ); Section of Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT (CH); Division of Pathology, European Institute of Oncology, Milan, Italy (MB); Department of Policy Analysis and Public Management, Research Center on Health and Social Care Management, CERGAS, SDA Bocconi School of Management, Bocconi University, Milan, Italy (RT); Health Technology Assessment - Regione Lombardia, Italy (MT)
| | - Massimo Barberis
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica (DG, AB), Direzione Sanitaria (CR), A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, AB); Department of Anatomical Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF); Thomas Jefferson University Hospital, Philadelphia, PA (MC); San Raffaele - Scientific Institute, Milan, Italy (GB); Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy (AZ); Section of Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT (CH); Division of Pathology, European Institute of Oncology, Milan, Italy (MB); Department of Policy Analysis and Public Management, Research Center on Health and Social Care Management, CERGAS, SDA Bocconi School of Management, Bocconi University, Milan, Italy (RT); Health Technology Assessment - Regione Lombardia, Italy (MT)
| | - Rosanna Tarricone
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica (DG, AB), Direzione Sanitaria (CR), A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, AB); Department of Anatomical Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF); Thomas Jefferson University Hospital, Philadelphia, PA (MC); San Raffaele - Scientific Institute, Milan, Italy (GB); Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy (AZ); Section of Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT (CH); Division of Pathology, European Institute of Oncology, Milan, Italy (MB); Department of Policy Analysis and Public Management, Research Center on Health and Social Care Management, CERGAS, SDA Bocconi School of Management, Bocconi University, Milan, Italy (RT); Health Technology Assessment - Regione Lombardia, Italy (MT)
| | - Alberto Bottini
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica (DG, AB), Direzione Sanitaria (CR), A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, AB); Department of Anatomical Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF); Thomas Jefferson University Hospital, Philadelphia, PA (MC); San Raffaele - Scientific Institute, Milan, Italy (GB); Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy (AZ); Section of Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT (CH); Division of Pathology, European Institute of Oncology, Milan, Italy (MB); Department of Policy Analysis and Public Management, Research Center on Health and Social Care Management, CERGAS, SDA Bocconi School of Management, Bocconi University, Milan, Italy (RT); Health Technology Assessment - Regione Lombardia, Italy (MT)
| | - Camillo Rossi
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica (DG, AB), Direzione Sanitaria (CR), A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, AB); Department of Anatomical Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF); Thomas Jefferson University Hospital, Philadelphia, PA (MC); San Raffaele - Scientific Institute, Milan, Italy (GB); Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy (AZ); Section of Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT (CH); Division of Pathology, European Institute of Oncology, Milan, Italy (MB); Department of Policy Analysis and Public Management, Research Center on Health and Social Care Management, CERGAS, SDA Bocconi School of Management, Bocconi University, Milan, Italy (RT); Health Technology Assessment - Regione Lombardia, Italy (MT)
| | - Michele Tringali
- U.O. Multidisciplinare di Patologia Mammaria, U.S Terapia Molecolare e Farmacogenomica (DG, AB), Direzione Sanitaria (CR), A.O. Istituti Ospitalieri di Cremona, Cremona, Italy (DG, AB); Department of Anatomical Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF); Thomas Jefferson University Hospital, Philadelphia, PA (MC); San Raffaele - Scientific Institute, Milan, Italy (GB); Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy (AZ); Section of Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT (CH); Division of Pathology, European Institute of Oncology, Milan, Italy (MB); Department of Policy Analysis and Public Management, Research Center on Health and Social Care Management, CERGAS, SDA Bocconi School of Management, Bocconi University, Milan, Italy (RT); Health Technology Assessment - Regione Lombardia, Italy (MT)
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Rocchi A, Chabot I, Glennie J. Evolution of health technology assessment: best practices of the pan-Canadian Oncology Drug Review. CLINICOECONOMICS AND OUTCOMES RESEARCH 2015; 7:287-98. [PMID: 26082654 PMCID: PMC4461134 DOI: 10.2147/ceor.s82549] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background In 2007, Canada chose to develop a separate and distinct path for oncology drug health technology assessment (HTA). In 2013, the decision was made to transfer the pan-Canadian Oncology Drug Review (pCODR) to the Canadian Agency for Drugs and Technologies in Health (CADTH), to align the pCODR and CADTH Common Drug Review processes while building on the best practices of both. The objective of this research was to conduct an examination of the best practices established by the pCODR. Methods A qualitative research approach was taken to assess the policies, processes, and practices of the pCODR, based on internationally accepted best practice “principles” in HTA, with a particular focus on stakeholder engagement. Publicly available information regarding the approach of the pCODR was used to gauge the agency’s performance against these principles. In addition, stakeholder observations and real-world experiences were gathered through key informant interviews to be inclusive of perspectives from patient advocacy groups, provincial and/or cancer agency decision-makers, community and academic oncologists, industry, expert committee members, and health economists. Results This analysis indicated that, through the pCODR, oncology stakeholders have had a voice in and have come to trust the quality and relevance of oncology HTA as a vital tool to ensure the best decisions for Canadians with cancer and their health care system. It could be expected that adoption of the principles and processes of the pCODR would bring a similar level of engagement and trust to other HTA organizations in Canada and elsewhere. Conclusion The results of this research led to recommendations for improvement and potential extrapolation of these best practices to other HTA organizations worldwide, along with suggestions for continued evolution of the pCODR in conjunction with its integration into the CADTH. It is clear that the transition of the pCODR to CADTH provides an opportunity for practices initiated by the pCODR to become the standard for these newly amalgamated HTA agencies in Canada.
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