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Wouters OJ, Naci H, Papanicolas I. Health Technology Assessment in the US-A Word of Caution-Reply. JAMA Intern Med 2024:2818633. [PMID: 38767909 DOI: 10.1001/jamainternmed.2024.1461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Olivier J Wouters
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Irene Papanicolas
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- Department of Health Services, Policy and Practice, Brown School of Public Health, Providence, Rhode Island
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Farah L, Borget I, Martelli N, Vallee A. Suitability of the Current Health Technology Assessment of Innovative Artificial Intelligence-Based Medical Devices: Scoping Literature Review. J Med Internet Res 2024; 26:e51514. [PMID: 38739911 PMCID: PMC11130781 DOI: 10.2196/51514] [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: 08/02/2023] [Revised: 12/17/2023] [Accepted: 12/28/2023] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Artificial intelligence (AI)-based medical devices have garnered attention due to their ability to revolutionize medicine. Their health technology assessment framework is lacking. OBJECTIVE This study aims to analyze the suitability of each health technology assessment (HTA) domain for the assessment of AI-based medical devices. METHODS We conducted a scoping literature review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. We searched databases (PubMed, Embase, and Cochrane Library), gray literature, and HTA agency websites. RESULTS A total of 10.1% (78/775) of the references were included. Data quality and integration are vital aspects to consider when describing and assessing the technical characteristics of AI-based medical devices during an HTA process. When it comes to implementing specialized HTA for AI-based medical devices, several practical challenges and potential barriers could be highlighted and should be taken into account (AI technological evolution timeline, data requirements, complexity and transparency, clinical validation and safety requirements, regulatory and ethical considerations, and economic evaluation). CONCLUSIONS The adaptation of the HTA process through a methodological framework for AI-based medical devices enhances the comparability of results across different evaluations and jurisdictions. By defining the necessary expertise, the framework supports the development of a skilled workforce capable of conducting robust and reliable HTAs of AI-based medical devices. A comprehensive adapted HTA framework for AI-based medical devices can provide valuable insights into the effectiveness, cost-effectiveness, and societal impact of AI-based medical devices, guiding their responsible implementation and maximizing their benefits for patients and health care systems.
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Affiliation(s)
- Line Farah
- Innovation Center for Medical Devices Department, Foch Hospital, Suresnes, France
- Groupe de Recherche et d'accueil en Droit et Economie de la Santé Department, University Paris-Saclay, Orsay, France
| | - Isabelle Borget
- Groupe de Recherche et d'accueil en Droit et Economie de la Santé Department, University Paris-Saclay, Orsay, France
- Department of Biostatistics and Epidemiology, Gustave Roussy, University Paris-Saclay, Villejuif, France
- Oncostat U1018, Inserm, Équipe Labellisée Ligue Contre le Cancer, University Paris-Saclay, Villejuif, France
| | - Nicolas Martelli
- Groupe de Recherche et d'accueil en Droit et Economie de la Santé Department, University Paris-Saclay, Orsay, France
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
| | - Alexandre Vallee
- Department of Epidemiology and Public Health, Foch Hospital, Suresnes, France
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Bharmal M, Katsoulis I, Chang J, Graham A, Stavropoulou A, Jhingran P, Pashos CL. Real-world evidence in the reassessment of oncology therapies: payer perceptions from five countries. Future Oncol 2024:1-12. [PMID: 38573230 DOI: 10.2217/fon-2023-1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/26/2024] [Indexed: 04/05/2024] Open
Abstract
Aim: This study explored the perceived value of real-world evidence (RWE) in the reassessment of oncology therapies by collecting the perspectives of health technology assessment/payer decision-makers. Materials & methods: A web-based survey was conducted using the Market Access Transformation Rapid Payer Response online portal. 30 participants from France, Germany, Spain, the UK and the USA were recruited based on their expertise. Results: Participants agreed that the most common uses of RWE are to confirm efficacy and safety results from randomized controlled trials and to reevaluate the projected utilization of an oncology therapy. We found variability in other reported uses of RWE. Conclusion: The organizations developing RWE should ensure that their plans recognize the heterogeneity in payer perceptions.
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Affiliation(s)
- Murtuza Bharmal
- Global Evidence & Value Development Oncology, EMD Serono, Inc., Rockland, MA 02370, USA, an affiliate of Merck KGaA
| | | | - Jane Chang
- Value & Evidence, Pfizer, New York, NY 10001-2192, USA
| | - Alex Graham
- Market Access Transformation, Fleet, GU51 2UJ, UK
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Madrid Paredes J, Versteeg JW, Vreman RA, Bloem LT. Agreement about Availability of Alternative Treatments for Innovative Drugs Assessed by the EMA and HTA Organizations. Clin Pharmacol Ther 2024. [PMID: 38505926 DOI: 10.1002/cpt.3252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 03/02/2024] [Indexed: 03/21/2024]
Abstract
The European Medicines Agency (EMA) and European national/regional health technology assessment (HTA) organizations consider the availability of existing treatments when evaluating a new drug. Since disagreement about the availability of alternative treatments may impact patient access to new drugs, this study aimed to investigate whether the EMA and HTA organizations agreed on the availability of alternative treatments and whether a lack of alternative treatments was associated with HTA organizations' added benefit assessment outcomes. For 97 innovative drugs authorized in 2019-2021 (excluding vaccines and diagnostic tools), assessments by the EMA and AEMPS (Spain), AIFA (Italy), HAS (France), IQWiG/G-BA (Germany), NICE (England and Wales), and ZIN (the Netherlands) were identified. Until 1 June 2022, 429 HTA drug-indication combinations were identified for these 97 drugs, of which 205 exactly matched the EMA's indication. For those, the overall agreement between the EMA and HTA organizations on whether alternative treatments were available was 87%. The agreement of HTA organizations with the EMA on whether available treatments were either pharmacological on-label, pharmacological off-label, or non-pharmacological was 87%, 21%, and 57%, respectively. For all 429 HTA drug-indication combinations, absence of alternative treatments as considered by HTA organizations was associated with a higher chance to provide added benefit: risk ratio 1.8 (95%-CI 1.4-2.3). In conclusion, although there was high overall agreement between the EMA and HTA organizations about whether alternative treatments exist, there were differences in the types of treatment considered. Parallel joint scientific consultations could inform drug developers about relevant alternative treatments to facilitate patient access to innovative drugs.
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Affiliation(s)
- Jorge Madrid Paredes
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jan-Willem Versteeg
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Rick A Vreman
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Lourens T Bloem
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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Brinkhuis F, Goettsch WG, Mantel-Teeuwisse AK, Bloem LT. Added benefit and revenues of oncology drugs approved by the European Medicines Agency between 1995 and 2020: retrospective cohort study. BMJ 2024; 384:e077391. [PMID: 38418086 PMCID: PMC10899806 DOI: 10.1136/bmj-2023-077391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVES To evaluate the added benefit and revenues of oncology drugs, explore their association, and investigate potential discrepancies between added benefit and revenues across different approval pathways of the European Medicines Agency (EMA). DESIGN Retrospective cohort study. SETTING Oncology drugs and their indications approved by the EMA between 1995 and 2020. MAIN OUTCOME MEASURES Added benefit was evaluated using ratings published by seven organisations: health technology assessment agencies from the United States, France, Germany, and Italy, two medical oncology societies, and a drug bulletin. All retrieved ratings were recategorised using a four point ranking scale to indicate negative or non-quantifiable, minor, substantial, or major added benefit. Revenue data were extracted from publicly available financial reports and compared with published estimates of research and development (R&D) costs. Finally, the association between added benefit and revenue was evaluated. All analyses were performed within the overall study cohort, and within subgroups based on the EMA approval pathway: standard marketing authorisation, conditional marketing authorisation, and authorisation under exceptional circumstances. RESULTS 131 oncology drugs with 166 indications were evaluated for their added benefit by at least one organisation within the required timeframe, yielding a total of 458 added benefit ratings; 189 (41%) were negative or non-quantifiable. The median time to offset the median R&D costs ($684m, £535m, €602m, adjusted to 2020 values) was three years; 50 of 55 (91%) drugs recovered these costs within eight years. Drugs with higher added benefit ratings generally had greater revenues. Negative or non-quantifiable added benefit ratings were more frequent for conditional marketing authorisations and authorisations under exceptional circumstances than for standard marketing authorisations (relative risk 1.53, 95% confidence interval 1.23 to 1.89). Conditional marketing authorisations generated lower revenues and took longer to offset R&D costs than standard marketing authorisations (four years compared with three years). CONCLUSIONS While revenues seem to align with added benefit, most oncology drugs recover R&D costs within a few years despite providing little added benefit. This is particularly true for drugs approved through conditional marketing authorisations, which inherently appear to lack comprehensive evidence. Policy makers should evaluate whether current regulatory and reimbursement incentives effectively promote development of the most effective drugs for patients with the greatest needs.
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Affiliation(s)
- Francine Brinkhuis
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Wim G Goettsch
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- National Health Care Institute, Diemen, The Netherlands
| | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Lourens T Bloem
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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Mela A, Lis D, Rdzanek E, Jaroszyński J, Furtak-Niczyporuk M, Drop B, Blicharski T, Niewada M. AOTMiT reimbursement recommendations compared to other HTA agencies. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-023-01655-x. [PMID: 38261131 DOI: 10.1007/s10198-023-01655-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 11/24/2023] [Indexed: 01/24/2024]
Abstract
Our objective was to compare AOTMiT (Polish: Agencja Oceny Technologii Medycznych i Taryfikacji) recommendations to other HTA (Health Technology Assessment) agencies for newly registered drugs and new registration indications issued by the European Medicines Agency between 2014 and 2019. The study aims to assess the consistency and justifications of AOTMiT recommendations compared to that of other HTA agencies in 11 countries. A total of 2494 reimbursement recommendations published by 12 HTA agencies for 464 medicinal products and 525 indications were analyzed. Our analysis confirmed that the Polish AOTMiT agency seems to bear the closest resemblance to the corresponding HTA agencies from Canada (CADTH) and New Zealand (PHARMAC), when it comes to the outcome of HTA recommendations (positive or negative). Poland had a general scheme for justifying recommendations, similar to that of Ireland-four aspects (i.e., clinical efficacy, safety profile, cost-effectiveness, and impact on the payer's budget) are important for Poland when formulating the final decision. Compared to other countries, Poland shows a noticeably different pattern of justifying reimbursement recommendations, as revealed primarily in terms of budget impact and somewhat less so for cost-effectiveness rationales.
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Affiliation(s)
- Aneta Mela
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, Banacha 1B, 02-097, Warsaw, Poland.
| | - Dorota Lis
- HealthQuest Sp z o.o. Sp. K, 01-625, Warsaw, Poland
| | - Elżbieta Rdzanek
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, Banacha 1B, 02-097, Warsaw, Poland
| | - Janusz Jaroszyński
- Department of Administrative Procedure, Faculty of Law and Administration, Maria Curie-Skłodowska University of Lublin, Marii Curie-Skłodowskiej 5, 20-031, Lublin, Poland
| | | | - Bartłomiej Drop
- Department of Information Technology and Medical Statistics, Faculty of Health Sciences, Medical University of Lublin, 20-093, Lublin, Poland
| | - Tomasz Blicharski
- Department of Orthopeadics and Rehabilitation, Medical University of Lublin, K. Jaczewskiego 8, 20-090, Lublin, Poland
| | - Maciej Niewada
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, Banacha 1B, 02-097, Warsaw, Poland
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Schweitzer MK, Dold MN, Genet A, Gossens K, Klein-Hessling T, Löffler N, Rabel M, Rasch A, Reuter EM, Schmelcher J, Wolfram N, Werner S. Shaping a suitable EU HTA dossier template: why the German template is not fit for purpose. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023:10.1007/s10198-023-01631-5. [PMID: 37843703 DOI: 10.1007/s10198-023-01631-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/11/2023] [Indexed: 10/17/2023]
Abstract
From 2025, Health Technology Developers (HTDs) have to submit EU HTA dossiers. The joint clinical assessment (JCA) aims to streamline HTA processes and access to medicinal products across Europe. Currently, German HTA bodies IQWiG and G-BA actively shape the JCA methodology. Here we examine if German HTA dossier requirements are suitable for the JCA. We compare the number of safety endpoint and subgroup analyses in German dossiers with analyses considered in IQWIG's benefit assessment and evaluate if these analyses were considered by the G-BA. We further investigated how the number of analyses was affected by the latest change in the German dossier template. With the current template, HTDs report in median 2.6 times more analyses on adverse events (AE) and 1.1 times more subgroup categories than in the previous template. IQWiG does not consider 33% of AE analyses and 73% of the subgroup categories presented by the HTD under the current template. G-BA considered the same AE as IQWiG in 76% of cases. Subgroups were uncommented by G-BA in most cases, independent of the template (previous: 93%, current 85%) and unconsidered in the conclusion on additional benefit (previous: 77%, current 69%). Thus, changes in the dossier template drastically increased HTD workload, but additional analyses seem unconsidered by the HTA bodies. With a broader scope in JCA, this effect could be amplified. To mitigate duplicative efforts and ensure prompt availability of medicinal products as envisioned by the HTAR, we suggest well-chosen and precise dossier requirements, early consultations, and early HTD engagement.
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Affiliation(s)
| | - Manuel Nico Dold
- AMS Advanced Medical Services GmbH, Am Exerzierplatz 2, 68167, Mannheim, Germany
| | - Astrid Genet
- Pfizer Deutschland GmbH, Linkstraße 10, 10785, Berlin, Germany
| | - Klaus Gossens
- AbbVie Deutschland, GmbH & Co. KG, Mainzer Straße 81, 65189, Wiesbaden, Germany
| | | | - Nils Löffler
- Pfizer Deutschland GmbH, Linkstraße 10, 10785, Berlin, Germany
| | - Matthias Rabel
- AMS Advanced Medical Services GmbH, Rosa-Bavarese-Str. 5, 80639, Munich, Germany
| | - Andrej Rasch
- Verband Forschender Arzneimittelhersteller e.V., Hausvogteiplatz 13, 10117, Berlin, Germany
| | - Eva-Maria Reuter
- AMS Advanced Medical Services GmbH, Rosa-Bavarese-Str. 5, 80639, Munich, Germany
| | - Jessica Schmelcher
- AMS Advanced Medical Services GmbH, Rosa-Bavarese-Str. 5, 80639, Munich, Germany
| | - Natalia Wolfram
- AbbVie Deutschland, GmbH & Co. KG, Mainzer Straße 81, 65189, Wiesbaden, Germany
| | - Sebastian Werner
- Verband Forschender Arzneimittelhersteller e.V., Hausvogteiplatz 13, 10117, Berlin, Germany.
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Mela A, Rdzanek E, Jaroszyński J, Furtak-Niczyporuk M, Jabłoński M, Niewada M. Reimbursement decision-making system in Poland systematically compared to other countries. Front Pharmacol 2023; 14:1153680. [PMID: 37900165 PMCID: PMC10611478 DOI: 10.3389/fphar.2023.1153680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 08/24/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction: Our objective was to analyze and compare systematically and structurally reimbursement systems in Poland and other countries. Methods: The systems were selected based on recommendations issued by the Polish Agency for Health Technology Assessment and Tariffication (AHTAPol), which explicitly referred to other countries and agencies). Consequently, apart from Poland, the countries included in the analysis were England, Scotland, Wales, Ireland, France, Netherlands, Germany, Norway, Sweden, Canada, Australia and New Zealand. Relevant information and data were collected through a systematic search of PubMed (Medline), Embase and The Cochrane Library as well as competent authority websites and grey literature sources. Results and discussion: In most of the countries, the submission of a reimbursement application is initiated by a pharmaceutical company, and only a few countries allow it before a product is approved for marketing. All of the agencies analyzed are independent and some have regulatory function of reimbursement decision making body. A key criterion differentiating the various agencies in terms of HTA is the cost-effectiveness threshold. Most of the countries have specific mechanisms to improve access to expensive specialty drugs, including cancer drugs and those used for rare diseases. Reimbursement systems often lack consistency in appreciating the same stages, leading to heterogeneous decision-making processes. The analysis of recommendations issued in different countries for the same medicinal product will allow a better understanding of the relations between the reimbursement system, HTA assessment, stakeholders involvement and decision on reimbursement of innovative drugs.
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Affiliation(s)
- Aneta Mela
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, Warsaw, Poland
| | - Elżbieta Rdzanek
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, Warsaw, Poland
| | - Janusz Jaroszyński
- Department of Administrative Proceedings, Faculty of Law and Administration, Marie Curie-Sklodowska University, Lublin, Poland
| | | | - Mirosław Jabłoński
- Department of Orthopeadics and Rehabilitation, Medical University of Lublin, Lublin, Poland
| | - Maciej Niewada
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, Warsaw, Poland
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Ramagopalan SV, Treharne C, Pearson-Stuttard J, Subbiah V. For what it's worth: the complex area of medicine value assessment. J Comp Eff Res 2023; 12:e230120. [PMID: 37515489 PMCID: PMC10690441 DOI: 10.57264/cer-2023-0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/31/2023] Open
Affiliation(s)
- Sreeram V Ramagopalan
- Lane, Clark & Peacock, London, UK
- Centre for Pharmaceutical Medicine Research, King's College London, UK
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Sola-Morales O, Curtis LH, Heidt J, Walsh L, Casso D, Oliveria S, Saunders-Hastings P, Song Y, Mercado T, Zusterzeel R, Mastey V, Harnett J, Quek RGW. Effectively Leveraging RWD for External Controls: A Systematic Literature Review of Regulatory and HTA Decisions. Clin Pharmacol Ther 2023; 114:325-355. [PMID: 37079433 DOI: 10.1002/cpt.2914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023]
Abstract
Real-world data (RWD)-derived external controls can be used to contextualize efficacy findings for investigational therapies evaluated in uncontrolled trials. As the number of submissions to regulatory and health technology assessment (HTA) bodies using external controls rises, and in light of recent regulatory and HTA guidance on the appropriate use of RWD, there is a need to address the operational and methodological challenges impeding the quality of real-world evidence (RWE) generation and the consistency in evaluation of RWE across agencies. This systematic review summarizes publicly available information on the use of external controls to contextualize outcomes from uncontrolled trials for all indications from January 1, 2015, through August 20, 2021, that were submitted to the European Medicines Agency, the US Food and Drug Administration, and/or select major HTA bodies (National Institute for Health and Care Excellence (NICE), Haute Autorité de Santé (HAS), Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG), and Gemeinsamer Bundesausschuss (G-BA)). By systematically reviewing submissions to regulatory and HTA bodies in the context of recent guidance, this study provides quantitative and qualitative insights into how external control design and analytic choices may be viewed by different agencies in practice. The primary operational and methodological aspects identified for discussion include, but are not limited to, engagement of regulators and HTA bodies, approaches to handling missing data (a component of data quality), and selection of real-world endpoints. Continued collaboration and guidance to address these and other aspects will inform and assist stakeholders attempting to generate evidence using external controls.
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Affiliation(s)
- Oriol Sola-Morales
- Fundació Health Innovation Technology Transfer and International, University of Catalonia, Barcelona, Spain
| | - Lesley H Curtis
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Julien Heidt
- IQVIA, Regulatory Science and Strategy, Falls Church, Virginia, USA
| | - Laura Walsh
- IQVIA, Epidemiology and Drug Safety Practice, Boston, Massachusetts, USA
| | - Deborah Casso
- IQVIA, Epidemiology and Drug Safety Practice, Seattle, Washington, USA
| | - Susan Oliveria
- IQVIA, Epidemiology and Drug Safety Practice, New York, New York, USA
| | | | - Yufei Song
- IQVIA, Epidemiology and Drug Safety Practice, Beijing, China
| | - Tiffany Mercado
- IQVIA, Regulatory Science and Strategy, Falls Church, Virginia, USA
| | | | - Vera Mastey
- Regeneron Pharmaceuticals Inc., Health Economics & Outcomes Research, Tarrytown, New York, USA
| | - James Harnett
- Regeneron Pharmaceuticals Inc., Health Economics & Outcomes Research, Tarrytown, New York, USA
| | - Ruben G W Quek
- Regeneron Pharmaceuticals Inc., Health Economics & Outcomes Research, Tarrytown, New York, USA
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11
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Kanavos P, Visintin E, Gentilini A. Algorithms and heuristics of health technology assessments: A retrospective analysis of factors associated with HTA outcomes for new drugs across seven OECD countries. Soc Sci Med 2023; 331:116045. [PMID: 37450991 DOI: 10.1016/j.socscimed.2023.116045] [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: 05/08/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
CONTEXT Positive health technology assessment (HTA) outcomes can have important implications for equity, efficiency and timely patient access to novel therapies. Several outcomes and dimensions of benefit beyond utility feed into HTA processes. OBJECTIVE We analyse a proprietary dataset of HTA outcomes in 7 countries, to (a) test whether HTA decision-making is grounded in welfarist or extra-welfarist approaches; and (b) empirically determine the factors associated with positive HTA outcomes, the time to achieve these and establish the magnitude of inter-country differences in assessment processes. METHODS Data were extracted from publicly available HTA reports on drugs that received marketing authorisation between 2009 and 2018 (N = 1415). The outcomes of interest were the probability of positive HTA outcomes and the time-to-HTA outcome; these were examined with respect to clinical, regulatory, product- and disease-related, evidence uncertainty and contextual variables. Econometric models utilising survival analysis and multinomial logistic regression were specified. FINDINGS Positive HTA outcomes accounted for 87.3% of the sample (n = 1235), of which 71% (n = 1004) were restricted. Drugs with positive HTA outcomes were subject to clinical restrictions (n = 652, 46%), financial risk-sharing (n = 439, 31%) or had been rejected at least once (n = 282, 20%). Significant predictors of positive HTA outcomes were orphan drugs with cancer indications, high quality of evidence linked to clinical and economic evidence uncertainties which had been overcome, and contextual considerations, particularly innovativeness and unmet need. Comparative analyses revealed systematic differences between countries in their propensity to accept the same drugs, particularly oncology and orphan drugs. CONCLUSIONS Our results are contextual and reinforce arguments in favour of explicitly accounting for social value judgements, establishing separate assessment frameworks for highly uncertain products, adopting risk mitigation strategies for novel therapies with early phase evidence, and sharing of HTA practices across settings. Lastly, HTA agencies have adopted an extra-welfarist approach to value assessment and resource allocation.
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Affiliation(s)
- Panos Kanavos
- Department of Health Policy and LSE Health - Medical Technology Research Group, London School of Economics and Political Science, UK.
| | - Erica Visintin
- Department of Health Policy and LSE Health - Medical Technology Research Group, London School of Economics and Political Science, UK
| | - Arianna Gentilini
- Department of Health Policy and LSE Health - Medical Technology Research Group, London School of Economics and Political Science, UK
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12
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Mills M. HTA Barriers for Conditional Approval Drugs. PHARMACOECONOMICS 2023; 41:529-545. [PMID: 36821044 DOI: 10.1007/s40273-023-01248-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Conditional approval pathways facilitate accelerated marketing authorisation based on immature clinical evidence for drugs that address an unmet medical need in a life-threatening or chronically debilitating condition. Lowering evidence requirements for marketing authorisation results in higher clinical uncertainty, which may present challenges for the health technology assessment (HTA) of these products. OBJECTIVES The objective of this study is to assess whether conditionally approved drugs face higher probabilities of HTA rejection or delays in HTA approval relative to drugs with standard marketing authorisation. METHODS This paper adopts a mixed-methods approach to provide a meta-analysis of HTA outcomes across 80 drug-indication pairs in France, England, Scotland and Canada. Differences in the characteristics (i.e. disease rarity and clinical trial design) of conditionally approved drugs and drugs with standard marketing authorisation and drivers of HTA outcomes are assessed through logistics regressions. Delays in HTA approval are assessed through a survival analysis. RESULTS Relative to standard approval drugs, conditionally approved drugs are less likely to include phase III trial designs, less likely to include clinical endpoints and less likely to include an active comparator. Uncertainties in clinical and economic evidence are raised more frequently by HTA agencies for conditionally approved drugs, which have a marginally lower probability of receiving HTA approval relative to drugs with standard approval. Conditionally approved drugs face moderate delays (an average of 6 months) in receiving HTA approval relative to standard approval drugs. CONCLUSIONS Overall, conditionally approved drugs likely face increased barriers at the HTA level.
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Affiliation(s)
- Mackenzie Mills
- Medical Technology Research Group, Department of Health Policy and LSE Health, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
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13
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Hogervorst MA, Vreman RA, Zawada A, Zielińska M, Dawoud DM, de Jong BA, Mantel-Teeuwisse AK, Goettsch WG. Synergy between health technology assessments and clinical guidelines for multiple sclerosis. Clin Transl Sci 2023; 16:835-849. [PMID: 36855929 PMCID: PMC10175979 DOI: 10.1111/cts.13492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 03/02/2023] Open
Abstract
Decision-making for reimbursement and clinical guidelines (CGs) serves different purposes although the decision-criteria and required evidence largely overlap. This study aimed to assess similarities and discrepancies between health technology assessment (HTA) reports as compared to CGs for multiple sclerosis (MS) medicines. All HTA reports and corresponding CGs for MS from the UK, France, Germany, the Netherlands, Poland, Sweden, and the European Union were assessed to identify synergies in recommendations for MS medicines (approved 1995-2020). A content analysis of HTA reports and CGs was performed to identify similarities and discrepancies in wording of treatment recommendations across documents. We assessed 132 HTA reports and 9 CGs for 16 MS treatments. Final recommendations for reimbursement and inclusion in CGs were mostly similar (90%), albeit with considerable differences in treatment lines and subindications. Since 2010, HTA reports refer to the use of CGs in 42% (55/132) and to consultations with clinicians in 43% (57/132) of cases. Six of nine CGs referred to HTA reports and two referred to HTA consultations, in one case having a formal relation to the HTA organization. CGs referenced pharmacoeconomic studies (4/9) for costs and cost-effectiveness. To date, not all new HTA recommendations for MS treatments are included in CGs. Some synergy exists between treatment recommendations in HTA reports and CGs, although discrepancies were seen in timelines and in recommended treatment lines and subindications. More stakeholder dialogue and/or consultation of each other's publications may further improve synergy, facilitate transparency, and enhance patient access.
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Affiliation(s)
- Milou A Hogervorst
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.,National Health Care Institute (ZIN), Diemen, The Netherlands
| | - Rick A Vreman
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.,National Health Care Institute (ZIN), Diemen, The Netherlands
| | - Anna Zawada
- Department of Pharmacoeconomics, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Zielińska
- Department of Pharmacoeconomics, Medical University of Warsaw, Warsaw, Poland
| | - Dalia M Dawoud
- National Institute for Health and Care Excellence (NICE), London, UK.,Faculty of Pharmacy, Clinical Pharmacy Department, Cairo University, Cairo, Egypt
| | - Brigit A de Jong
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam, The Netherlands
| | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Wim G Goettsch
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.,National Health Care Institute (ZIN), Diemen, The Netherlands
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14
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Rosenberg N, van den Berg S, Stolwijk NN, Jacobs BAW, Post HC, Pasmooij AMG, de Visser SJ, Hollak CEM. Access to medicines for rare diseases: A European regulatory roadmap for academia. Front Pharmacol 2023; 14:1142351. [PMID: 36925633 PMCID: PMC10012277 DOI: 10.3389/fphar.2023.1142351] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/08/2023] [Indexed: 03/08/2023] Open
Abstract
Background: Novel or repurposed medicines for rare diseases often emerge from fundamental research or empirical findings in academia. However, researchers may be insufficiently aware of the possibilities and requirements to bring novel medicinal treatment options to the patient. This paper aims to provide an easily applicable, comprehensive roadmap designed for academic researchers to make medicines for rare diseases available for patients by addressing the relevant regulatory frameworks, including marketing authorization and alternative routes. Methods: Key points of the regulatory chapters "Placing on the Market" and "Scope" of Directive 2001/83/EC relating to medicinal products for human use were summarized. Provisions in EU directives regarding blood products, radiopharmaceuticals, and herbal and homeopathic medicinal products were excluded. Cross-referencing to other provisions was included. European case-law was retrieved from the InfoCuria database to exemplify the implications of alternative routes. Results: Medicines may only be placed on the market with a valid marketing authorization. To obtain such authorization in Europe, a "Common Technical Document" comprising reports on quality and non-clinical and clinical studies must be submitted to a "competent authority", a national medicine agency or the European Medicines Agency. Timely interaction of academic researchers with regulators via scientific advice may lead to better regulatory alignment and subsequently a higher chance for approval of academic inventions. Furthermore, reimbursement by national payers could be essential to ensure patient access. Apart from the marketing authorization route, we identified multiple alternative routes to provide (early) access. These include off-label use, named-patient basis, compassionate use, pharmacy compounding, and hospital exemption for Advanced Therapy Medicinal Products. Discussion: Aligning academic (non-)clinical studies on rare diseases with regulatory and reimbursement requirements may facilitate fast and affordable access. Several alternative routes exist to provide (early) pharmaceutical care at a national level, but case-law demonstrates that alternative routes should be interpreted strictly and for exceptional situations only. Academics should be aware of these routes and their requirements to improve access to medicines for rare diseases.
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Affiliation(s)
- Noa Rosenberg
- Medicine for Society, Platform at Amsterdam UMC-University of Amsterdam, Amsterdam, Netherlands.,Expertise Center for Inborn Errors of Metabolism, Department of Endocrinology and Metabolism, Amsterdam UMC, Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, MetabERN, University of Amsterdam, Amsterdam, Netherlands
| | - Sibren van den Berg
- Medicine for Society, Platform at Amsterdam UMC-University of Amsterdam, Amsterdam, Netherlands.,Expertise Center for Inborn Errors of Metabolism, Department of Endocrinology and Metabolism, Amsterdam UMC, Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, MetabERN, University of Amsterdam, Amsterdam, Netherlands
| | - Nina N Stolwijk
- Medicine for Society, Platform at Amsterdam UMC-University of Amsterdam, Amsterdam, Netherlands.,Expertise Center for Inborn Errors of Metabolism, Department of Endocrinology and Metabolism, Amsterdam UMC, Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, MetabERN, University of Amsterdam, Amsterdam, Netherlands
| | - Bart A W Jacobs
- Medicine for Society, Platform at Amsterdam UMC-University of Amsterdam, Amsterdam, Netherlands.,Department of Pharmacy, Amsterdam UMC-University of Amsterdam, Amsterdam, Netherlands.,Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Hendrika C Post
- Medicine for Society, Platform at Amsterdam UMC-University of Amsterdam, Amsterdam, Netherlands.,Department of Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Anna M G Pasmooij
- Dutch Medicines Evaluation Board, Utrecht, Netherlands.,Center for Blistering Diseases, European Reference Network-Skin Reference Center (ERN-Skin), University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Saco J de Visser
- Medicine for Society, Platform at Amsterdam UMC-University of Amsterdam, Amsterdam, Netherlands.,Centre for Future Affordable & Sustainable Therapy Development (FAST), The Hague, Netherlands
| | - Carla E M Hollak
- Medicine for Society, Platform at Amsterdam UMC-University of Amsterdam, Amsterdam, Netherlands.,Expertise Center for Inborn Errors of Metabolism, Department of Endocrinology and Metabolism, Amsterdam UMC, Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, MetabERN, University of Amsterdam, Amsterdam, Netherlands
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15
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Ferrell PB, Fillit H, Neumann PJ, Wall JK, Murray JF. Toward comprehensive value assessment for Alzheimer's disease innovations. Alzheimers Dement 2022; 19:1558-1567. [PMID: 36427013 DOI: 10.1002/alz.12874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/10/2022] [Accepted: 10/17/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Assessing medical technologies for Alzheimer's disease (AD) creates challenges for current methods of value assessment. New value assessment approaches for AD are also needed. METHODS We adapted concepts from health economics to help guide decision makers to more informed decisions about AD therapies and diagnostics. RESULTS We propose a value framework based on five categories: perspective, value elements, analysis, reporting, and decision making. AD value assessments should include the perspective of the patient-caregiver dyad. We propose a broader array of value elements than currently used. Analytics and decision methods can synthesize evidence for all elements of value. Decisions should use a "deliberative appraisal" approach informed by the composite evidence and be transparently reported. DISCUSSION Using the proposed framework, the value of forthcoming innovations for AD may be more thoroughly assessed for and by all stakeholders. It can guide decision makers to carefully consider all relevant elements of value contributing to more holistic and transparent decision making. RESEARCH HIGHLIGHTS Alzheimer's disease challenges common methods of evaluating medical technology. Using current methods, new AD innovations might not be appropriately valued. Poor value assessments will adversely affect patient access to AD innovations. A full AD value framework expands perspective, elements, analysis, decision-making, reporting.
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Affiliation(s)
| | - Howard Fillit
- Alzheimer's Drug Discovery Foundation and Icahn School of Medicine at Mount Sinai New York New York USA
| | - Peter J. Neumann
- Center for the Evaluation of Value and Risk in Health Tufts Medical Center Boston Massachusetts USA
| | - J. K. Wall
- Eli Lilly and Company Lilly Corporate Center Indianapolis Indiana USA
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16
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Ball G, Levine MAH, Thabane L, Tarride JE. Appraisals by Health Technology Assessment Agencies of Economic Evaluations Submitted as Part of Reimbursement Dossiers for Oncology Treatments: Evidence from Canada, the UK, and Australia. Curr Oncol 2022; 29:7624-7636. [PMID: 36290879 PMCID: PMC9600934 DOI: 10.3390/curroncol29100602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/07/2022] [Accepted: 10/08/2022] [Indexed: 11/23/2022] Open
Abstract
Publicly funded healthcare systems, including those in Canada, the United Kingdom (UK), and Australia, often use health technology assessment (HTA) to inform drug reimbursement decision-making, based on dossiers submitted by manufacturers, and HTA agencies issue publicly available reports to support funding recommendations. However, the level of information reported by HTA agencies in these reports may vary. To provide insights on this issue, we describe and assess the reporting of economic methods in recent oncology HTA recommendations from the Canadian Agency for Drugs and Technologies in Health (CADTH), National Institute for Health and Care Excellence (NICE), and Pharmaceutical Benefits Advisory Committee (PBAC). Publicly available HTA recommendations and reports for oncology drugs issued by CADTH over a 2-year period, 2019-2020, were identified and compared with the corresponding HTA documents from NICE and the PBAC. Reporting of key model characteristics and attributes, survival analysis methods, methodological criticisms, and re-assessment of the economic results were characterized using descriptive statistics. Dichotomous differences in the methodological criticisms observed between the three agencies were assessed using Cochran's Q tests and substantiated using pairwise McNemar tests. Chi-squared tests were used to assess the dichotomous differences in the reporting of methods and explore the potential relationships between categorical variables, where appropriate. HTAs published by CADTH, NICE, and the PBAC consistently reported a broad spectrum of descriptive information on the economic models submitted by manufacturers. While common economic evaluation attributes were well-reported across the three HTA agencies, significant differences in the reporting of survival analysis methods and methodological criticisms were observed. NICE consistently reported more comprehensive information, compared to either CADTH or PBAC. Despite these differences, broadly similar recommendation rates were observed between CADTH and NICE. The PBAC was found to be more restrictive. Based on our 2-year sample of oncology, the HTAs published by CADTH matched with the corresponding HTAs from NICE and PBAC; we observed important variations in the reporting of economic evidence, especially technical aspects, such as survival analysis, across the three agencies. In addition to guidelines for HTA submissions by manufacturers, the community of HTA agencies should also have common standards for reporting the results of their assessments, though the information and opinions reported may differ.
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Affiliation(s)
- Graeme Ball
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada
- Correspondence:
| | - Mitchell A. H. Levine
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada
- The Research Institute of St. Joe’s Hamilton, St. Joseph’s Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada
- The Research Institute of St. Joe’s Hamilton, St. Joseph’s Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada
- The Research Institute of St. Joe’s Hamilton, St. Joseph’s Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
- McMaster Chair in Health Technology Management, McMaster University, Hamilton, ON L8S 4L8, Canada
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17
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Garattini L, Bozzetto M, Nobili A, Mannucci PM. Health technology assessment for pharmaceuticals in the European Union: what lessons after two decades? Intern Emerg Med 2022; 17:1251-1253. [PMID: 35674925 DOI: 10.1007/s11739-022-03008-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/16/2022] [Indexed: 11/05/2022]
Affiliation(s)
- L Garattini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - M Bozzetto
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - A Nobili
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - P M Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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18
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Fontrier AM. Market access for medicines treating rare diseases: Association between specialised processes for orphan medicines and funding recommendations. Soc Sci Med 2022; 306:115119. [PMID: 35700552 DOI: 10.1016/j.socscimed.2022.115119] [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: 01/25/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 11/25/2022]
Abstract
Access to medicines treating rare diseases ('orphan medicines') has proven challenging due to high prices and clinical uncertainty. To optimise market access to these medicines, some healthcare systems are implementing specialised pathways and/or processes during marketing authorisation (MA) and/or health technology assessment (HTA). Comparing one setting where these medicines are classed as "orphan" (Scotland) to another where they considered "non-orphan" (Canada), this study aims to explore whether the presence of specialised pathways and processes at MA and HTA levels is associated with more favourable funding recommendations and faster time to market access. A matched sample of 116 medicine-indication pairs with MA approval from 2001 to 2019 in Europe and Canada was identified, and publicly available sources were used for data extraction. Descriptive statistics were used for data analysis. All medicines were commercially marketed in both countries, except one instance in Scotland. In Scotland, more orphan medicines (68.1%) had a favourable HTA recommendation than in Canada (60.4%), while Canada issued more negative HTA recommendations (20.7%) than Scotland (15.5%). Low levels of agreement on HTA recommendations and the main reasons driving recommendations were found between settings. In both countries, medicines with specialised MA approval were less likely to receive negative HTA recommendations than medicines with standard MA. Time to market access was faster in Canada than Scotland, though medicines with specialised MA approval had slower timelines than medicines with standard MA approval in both countries. However, it is unclear whether the presence of orphan designation and HTA specialised processes alone could result in favourable funding recommendations without accounting for other healthcare system-related factors and differences in the decision-making processes across settings. Holistic approaches and better alignment of evidentiary requirements across regulators are needed to optimise access to orphan medicines.
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Affiliation(s)
- Anna-Maria Fontrier
- Department of Health Policy and LSE Health-Medical Technology Research Group (MTRG), London School of Economics and Political Science, UK.
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19
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Fontrier AM, Visintin E, Kanavos P. Similarities and Differences in Health Technology Assessment Systems and Implications for Coverage Decisions: Evidence from 32 Countries. PHARMACOECONOMICS - OPEN 2022; 6:315-328. [PMID: 34845671 PMCID: PMC9043057 DOI: 10.1007/s41669-021-00311-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 06/05/2023]
Abstract
Health technology assessment (HTA) systems across countries vary in the way they are set up, according to their role and based on how funding decisions are reached. Our objective was to study the characteristics of these systems and their likely impact on the funding of technologies undergoing HTA. Based on a literature review, we created a conceptual framework that captures key operating features of HTA systems. We used this framework to map current HTA activities across 32 countries in the European Union, the UK, Canada and Australia. Evidence was collected through a systematic search of competent authority websites and grey literature sources. Primary data collection through expert consultation validated our findings and further complemented the analysis. Sixty-three HTA bodies were identified. Most have a national scope (76%), are independent (73%), have an advisory role (52%), evaluate pharmaceuticals predominantly or exclusively (76%), assess health technologies based on their clinical and cost-effectiveness (73%) and involve various stakeholders as members of the HTA committee (94%) and/or through external consultation (76%). The majority of HTA outcomes are not legally binding (81%). Although all study countries implement HTA, the way it fits into decision-making, negotiation processes, and coverage and funding decisions differs significantly across countries. HTA is a dynamic and transformative process and there is a need for transparency to investigate whether evidence-based information influences coverage decisions.
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Affiliation(s)
- Anna-Maria Fontrier
- Department of Health Policy, LSE Health-Medical Technology Research Group (MTRG), Cowdray House, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | - Erica Visintin
- Department of Health Policy, LSE Health-Medical Technology Research Group (MTRG), Cowdray House, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Panos Kanavos
- Department of Health Policy, LSE Health-Medical Technology Research Group (MTRG), Cowdray House, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
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20
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Schoot RA, Otth MA, Frederix GW, Leufkens HG, Vassal G. Market access to new anticancer medicines for children and adolescents with cancer in Europe. Eur J Cancer 2022; 165:146-153. [DOI: 10.1016/j.ejca.2022.01.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/06/2022] [Accepted: 01/17/2022] [Indexed: 11/24/2022]
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21
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Cram P, Selker H, Carnahan J, Romero-Brufau S, Fischer MA. Getting to 100%: Research Priorities and Unanswered Questions to Inform the US Debate on Universal Health Insurance Coverage. J Gen Intern Med 2022; 37:949-953. [PMID: 35060003 PMCID: PMC8904700 DOI: 10.1007/s11606-021-07234-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/19/2021] [Indexed: 10/19/2022]
Abstract
A majority of Americans favor universal health insurance, but there is uncertainty over how best to achieve this goal. Whatever the insurance design that is implemented, additional details that must be considered include breadth of services covered, restrictions and limits on volumes of services, cost-sharing for individuals, and pricing. In the hopes that research can inform this ongoing debate, we review evidence supporting different models for achieving universal coverage in the US and identify areas where additional research and stakeholder input is needed. Key areas in need of further research include how care should be organized, how costs can be reduced, and what healthcare services universal insurance should cover.
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Affiliation(s)
- Peter Cram
- Department of Internal Medicine, Medical Branch, University of Texas, 301 University Blvd, Galveston, TX, 77555, USA. .,Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
| | - Harry Selker
- Institute for Clinical Research and Health Policy Studies, Tufts University School of Medicine, Boston, MA, USA
| | - Jennifer Carnahan
- Indiana University School of Medicine, Indianapolis, IN, USA.,Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, IN, USA
| | - Santiago Romero-Brufau
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael A Fischer
- Division of Pharmacoepidemiology, Brigham and Women's Hospital, Boston, MA, USA
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22
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Addressing uncertainty in relative effectiveness assessments by HTA organizations. Int J Technol Assess Health Care 2022; 38:e17. [DOI: 10.1017/s026646232100177x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
This study outlines the ways in which different health technology assessment (HTA) organizations deal with uncertainty in relative effectiveness assessments (REAs), using the GRADE framework as a common reference. Guidelines regarding REA and uncertainty assessment methods and three most recent HTA reports (as of April 2020) of seven HTA organizations in Germany, England and Wales, France, the Netherlands, Europe (EUnetHTA), the USA, and Canada were included. First, it was analyzed how each organization addressed uncertainty on the following levels of evidence: (i) individual studies, (ii) body of evidence for one outcome, (iii) body of evidence across all outcomes, and (iv) added net benefit. Second, the extent to which HTA organizations considered the eight domains of certainty of evidence defined by GRADE was assessed. For individual studies, checklists were the most common approach to express uncertainty (4/7 organizations). Uncertainty in the body of evidence for all outcomes and in added benefit was combined in a single conclusion by five organizations. All organizations reported on at least 4/5 downgrading domains of GRADE, while the three upgrading domains were reported less. The operationalization of the assessment of multiple domains was unclear due to vague or absent guidelines. HTA organizations consider most domains of the GRADE framework, but approaches to assess uncertainty within REAs on different levels of evidence differ substantially between organizations. More alignment and guidance on the best methods to deal with uncertainty within HTA could lead to more clarity for stakeholders and to more aligned reimbursement recommendations.
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23
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Promoting innovation while controlling cost: The UK's approach to health technology assessment. Health Policy 2022; 126:224-233. [DOI: 10.1016/j.healthpol.2022.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 12/28/2022]
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24
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Gordon J, Stainthorpe A, Jones B, Jacob I, Hertel N, Diaz J, Yuan Y, Borrill J. Non-Price-Related Determinants of Value and Access for Novel Non-small Cell Lung Cancer Treatments: A Cross-Country Review of HTA Decision Making. PHARMACOECONOMICS - OPEN 2021; 5:701-713. [PMID: 34216002 PMCID: PMC8611140 DOI: 10.1007/s41669-021-00279-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Access and funding for newly approved treatments for non-small cell lung cancer (NSCLC) are often dependent on Health Technology Assessment (HTA) involving cost-effectiveness analysis. Whilst methods used by HTA agencies share many similarities, final decisions may differ. This may be the result, not just of price considerations, but also of variation in value judgements by different agencies. The aim of this study was to review international HTA evaluations to identify determinants of value and access for NSCLC treatments. METHODS A targeted review and analysis was undertaken of published HTAs for NSCLC across HTA agencies in six countries (Australia, Canada, England, France, Ireland and Scotland). Analysis of extracted data consisted of three stages: descriptive analysis, bivariate analysis and multivariable analysis. RESULTS The analysis included 163 HTAs that assessed oncological treatments for NSCLC from 2003 to 2019. The majority of HTA decisions (67.5%) were positive. However, some evidence of heterogeneity in HTA decisions and the factors informing them were identified. The most influential factors included in the multivariate model related to the HTA agency conducting the appraisal, the year of market authorisation, treatment type and the line of treatment. CONCLUSION Heterogenous decision-making frameworks can present a challenge to developing HTA submissions. This research contributes to understanding decision-making factors and why countries make different decisions.
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Affiliation(s)
- Jason Gordon
- Health Economics and Outcomes Research Ltd, Rhymney House, Unit A Copse Walk, Cardiff Gate Business Park, Cardiff, CF23 8RB, UK.
| | - Angela Stainthorpe
- Health Economics and Outcomes Research Ltd, Rhymney House, Unit A Copse Walk, Cardiff Gate Business Park, Cardiff, CF23 8RB, UK
| | - Beverley Jones
- Health Economics and Outcomes Research Ltd, Rhymney House, Unit A Copse Walk, Cardiff Gate Business Park, Cardiff, CF23 8RB, UK
| | - Ian Jacob
- Health Economics and Outcomes Research Ltd, Rhymney House, Unit A Copse Walk, Cardiff Gate Business Park, Cardiff, CF23 8RB, UK
| | | | - Jose Diaz
- Bristol Myers Squibb, WW HEOR, Uxbridge, UK
| | - Yong Yuan
- Bristol Myers Squibb, WW HEOR, Lawrenceville, USA
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25
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Choudhary P, Bellido V, Graner M, Altpeter B, Cicchetti A, Durand-Zaleski I, Kristensen FB. The Challenge of Sustainable Access to Telemonitoring Tools for People with Diabetes in Europe: Lessons from COVID-19 and Beyond. Diabetes Ther 2021; 12:2311-2327. [PMID: 34390477 PMCID: PMC8363869 DOI: 10.1007/s13300-021-01132-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/26/2021] [Indexed: 01/08/2023] Open
Abstract
Telemedicine in diabetes care has been evolving over several years, particularly since the advent of cloud-connected technologies for diabetes management, such as glucose monitoring devices, including continuous glucose monitoring (CGM) systems, that facilitate sharing of glucose data between people with diabetes and their healthcare professionals in near-real time. Extreme social distancing and shielding in place for vulnerable patients during the COVID-19 pandemic has created both the challenge and the opportunity to provide care at a distance on a large scale. Available evidence suggests that glucose control has in fact improved during this period for people with diabetes who are able to use CGM devices for remote glucose monitoring. The development of telemedicine as part of the standard of care in diabetes faces significant challenges in the European context, particularly in terms of providing consistent and effective care at a distance to large populations of patients while using robust systems that can be supported by large regional and national healthcare services. These challenges include a fragmented approach to healthcare technology assessment and reimbursement, lack of eHealth education and literacy, particularly amongst healthcare professionals, lack of data integration, as well as concerns about electronic health records, patient consent and privacy. Here we review the benefits of and challenges to wider application of telemedicine and telemonitoring in the post-pandemic future, with the aim to ensure that the value of these eHealth services is provided to patients, healthcare providers and health systems.
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Affiliation(s)
- Pratik Choudhary
- Leicester Diabetes Centre (Bloom), Leicester General Hospital, University of Leicester, Leicester, UK.
| | - Virginia Bellido
- Department of Endocrinology and Nutrition, Virgen del Rocío University Hospital, Seville, Spain
| | | | - Bernd Altpeter
- Digital Health Groupe and German Institute of Telemedicine, Frankfurt, Germany
| | - Americo Cicchetti
- School of Healthcare Systems, Economics and Management, Universita Cattolica del Sacro Cuore, Rome, Italy
| | | | - Finn Børlum Kristensen
- Danish Centre for Health Economics (DaCHE), Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Howell S, Yin PT, Robinson JC. Quantifying The Economic Burden Of Drug Utilization Management On Payers, Manufacturers, Physicians, And Patients. Health Aff (Millwood) 2021; 40:1206-1214. [PMID: 34339243 DOI: 10.1377/hlthaff.2021.00036] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The continuing launch of innovative but high-price drugs has intensified efforts by payers to manage use and spending and by pharmaceutical manufacturers to support patient access and sales. Payers are restricting drug formularies, requiring more stringent prior authorizations, and raising patient cost-sharing requirements. Manufacturers are investing in programs that help patients and physician practices navigate administrative controls and help patients meet cost-sharing obligations. Based on a compilation and analysis of the existing peer-reviewed and professional literature, this article estimates that payers, manufacturers, physicians, and patients together incur approximately $93.3 billion in costs annually on implementing, contesting, and navigating utilization management. Payers spend approximately $6.0 billion annually administering drug utilization management, and manufacturers spend approximately $24.8 billion supporting patient access in response. Physicians devote approximately $26.7 billion in time spent navigating utilization management, whereas patients spend approximately $35.8 billion annually in drug cost sharing, even after taking advantage of manufacturer and philanthropic sources of financial support. All stakeholders in the US pharmaceutical system would benefit from a deescalation of utilization management, combining lower drug prices with lower barriers to patient access.
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Affiliation(s)
- Scott Howell
- Scott Howell is the chief strategy officer, US Pharmaceuticals, at Novartis Pharmaceuticals Corporation, in East Hanover, New Jersey
| | - Perry T Yin
- Perry T. Yin is the director of Market Access Innovation, US Pharmaceuticals, at Novartis Pharmaceuticals Corporation
| | - James C Robinson
- James C. Robinson is the Leonard D. Schaeffer Professor of Health Economics in the Division of Health Policy and Management, School of Public Health, University of California Berkeley, in Berkeley, California. He is a Health Affairs contributing editor
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Dintsios CM. A decade of early benefit assessment of ophthalmic drugs in Germany: success story or not? Expert Rev Pharmacoecon Outcomes Res 2021; 22:283-297. [PMID: 33999735 DOI: 10.1080/14737167.2021.1930532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To analyze how ophthalmic drugs fared in the early benefit assessment (EBA) after its introduction in Germany up to 2020 and to quantify its impact on their negotiated prices. METHODS Relevant documents were screened and essential content on added benefit outcomes and the underlying evidence was extracted next to pricing information. In addition to descriptive statistics, cross-stakeholder analyses and agreement statistics were implemented. RESULTS Thirteen completed EBA were identified involving eight drugs. Only four drugs (30.8%) received an added benefit. The OR for no added benefit of ophthalmic drugs versus all other drugs was 2.971 (0.902-9.781). The agreement between manufacturers' claims and decision-maker appraisals is fair (kappa 0.435). In all cases, evidence was derived for RCTs, but for different reasons, not all of them allowed direct comparisons with the comparator as defined by the decision-maker. The negotiated rebates on manufacturer's selling prices varied from 6.8% up to 47.4%. Nevertheless, the rebates for ophthalmic drugs (median 14.5%) were lower than those for all negotiated drugs (median 24%). CONCLUSION Over the past decade, the EBA of ophthalmic drugs was not necessarily a success story, but in most of the cases, the drugs were successful in the market.
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Affiliation(s)
- Charalabos-Markos Dintsios
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, German Diabetes Center at the Heinrich-Heine-University, Leibniz-Center for Diabetes Research, Düsseldorf, Germany
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Bloem LT, Vreman RA, Peeters NWL, Hoekman J, van der Elst ME, Leufkens HGM, Klungel OH, Goettsch WG, Mantel-Teeuwisse AK. Associations between uncertainties identified by the European Medicines Agency and national decision making on reimbursement by HTA agencies. Clin Transl Sci 2021; 14:1566-1577. [PMID: 33786991 PMCID: PMC8301545 DOI: 10.1111/cts.13027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/02/2021] [Accepted: 03/09/2021] [Indexed: 11/30/2022] Open
Abstract
We aimed to determine whether uncertainties identified by the European Medicines Agency (EMA) were associated with negative relative effectiveness assessments (REAs) and negative overall reimbursement recommendations by national health technology assessment (HTA) agencies. Therefore, we identified all HTA reports from Haute Autorité de Santé (HAS; France), National Institute for Health and Care Excellence (NICE; England/Wales), Scottish Medicine Consortium (SMC; Scotland), and Zorginstituut Nederland (ZIN; The Netherlands) for a cohort of innovative medicines that the EMA had approved in 2009 to 2010 (excluding vaccines). Uncertainty regarding pivotal trial methodology, clinical outcomes, and their clinical relevance were combined to reflect a low, medium, or high level of uncertainty. We assessed associations by calculating risk ratios (RRs) and 95% confidence intervals (CIs), and agreement between REA and overall reimbursement recommendation outcomes. We identified 36 medicines for which 121 reimbursement recommendations had been issued by the HTA agencies between September 2009 and July 2018. High versus low uncertainty was associated with an increased risk for negative REAs and negative overall reimbursement recommendations: RRs 1.9 (95% CI 0.9-3.9) and 1.6 (95% CI 0.7-3.5), respectively, which was supported by further sensitivity analyses. We identified a lack of agreement between 33 (27%) REA and overall reimbursement recommendation outcomes, which were mostly restricted recommendations that followed on negative REAs in case of low or medium uncertainty. In conclusion, high uncertainty identified by the EMA was associated with negative REAs and negative overall reimbursement recommendations. To reduce uncertainty and ultimately facilitate efficient patient access, regulators, HTA agencies, and other stakeholders should discuss how uncertainties should be weighed and addressed early in the drug life cycle of innovative treatments.
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Affiliation(s)
- Lourens T Bloem
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | - Rick A Vreman
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,National Healthcare Institute, Diemen, The Netherlands
| | - Niels W L Peeters
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jarno Hoekman
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Innovation Studies, Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands
| | | | - Hubert G M Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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Wang T, McAuslane N, Liberti L, Gardarsdottir H, Goettsch W, Leufkens H. Companies' Health Technology Assessment Strategies and Practices in Australia, Canada, England, France, Germany, Italy and Spain: An Industry Metrics Study. Front Pharmacol 2021; 11:594549. [PMID: 33390978 PMCID: PMC7775670 DOI: 10.3389/fphar.2020.594549] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/05/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Health technology assessment (HTA) has increased in importance in supporting payer decision making by assessing the relative effectiveness and cost effectiveness of new medicines. Thus, pharmaceutical companies need to address the HTA requirements early during development to improve reimbursement outcomes. Currently, there is a lack of research to assess the impact of HTA on development and jurisdictional outcome from companies’ perspectives. This study aimed to assess companies’ HTA strategy and characterise HTA practice in seven jurisdictions. Methods: A multi-year, annual study collected information for individual products, focusing on development activities regarding inclusion of HTA requirements and selection of global comparators. The generation of local contextual information, submission strategies and predictability of HTA outcomes was examined jurisdictionally in Australia, Canada, England, France, Germany, Italy and Spain. The study questionnaire was built into a secure online data collection platform and data were provided annually by participating companies. Results: Data for 169 compounds were provided by nine international companies between 2014 and 2018. HTA requirements were implemented in evidence generation plan for 63% of products during development. Global comparators were accepted by HTA bodies for more than half of studied products; Spain showed the highest acceptance rate (85%). Companies took advantages of parallel process in Australia and Canada to shorten product rollout time. Australia demonstrated general consistency in HTA review time, and England had the longest variation (interquartile range, 216 days). Requirements for additional information after submission occurred at all HTA bodies. Germany and Italy showed the highest percentage of products being reimbursed as per regulatory label (80 and 68%, respectively). Canada was the most predictable jurisdiction, with the highest proportion of review outcome (90%) that met companies’ expectations. Conclusion: Companies are addressing HTA requirements during development for many products; however, they are challenged by varying requirements and practices and product success ultimately depends on how HTA organisations and payers assess added value in the context of the national healthcare systems. This ongoing study created a baseline to help capture fact-based changes for company HTA strategies and HTA body practices.
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Affiliation(s)
- Ting Wang
- Centre for Innovation in Regulatory Science (CIRS), London, United Kingdom.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Neil McAuslane
- Centre for Innovation in Regulatory Science (CIRS), London, United Kingdom
| | - Lawrence Liberti
- Centre for Innovation in Regulatory Science (CIRS), London, United Kingdom
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Wim Goettsch
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.,National Health Care Institute, Diemen, Netherlands
| | - Hubert Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
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30
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Annemans L, Beutels P, Bloom DE, De Backer W, Ethgen O, Luyten J, Van Wilder P, Willem L, Simoens S. Economic Evaluation of Vaccines: Belgian Reflections on the Need for a Broader Perspective. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:105-111. [PMID: 33431141 DOI: 10.1016/j.jval.2020.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 08/25/2020] [Accepted: 09/08/2020] [Indexed: 05/21/2023]
Abstract
OBJECTIVES The standard framework of economic evaluation of health programs, which is increasingly used for policy funding decisions, is insufficiently equipped to reflect the full range of health and economic benefits conferred by vaccines and thus undervalues vaccination. METHODS In 2019, a group of Belgian health economic and clinical experts, supported by 2 senior international vaccination experts (1 American, 1 Belgian), convened 4 roundtable meetings to highlight which particular value elements of vaccination remain neglected in economic evaluations. RESULTS They concluded that the standard economic evaluation framework fails to reflect the full value of vaccination with respect to prevention of complications linked to some vaccine-preventable diseases, health gains for caregivers, herd effects, changes in exposure to and distribution of serotypes, the effect on antimicrobial resistance, productivity gains for caregivers and patients, and the distributive implications of vaccination programs. CONCLUSIONS Here, suggestions are made regarding how these shortcomings can be addressed in future economic evaluations of vaccines and how a more level playing field between vaccines and other health programs can be created.
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Affiliation(s)
- Lieven Annemans
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Philippe Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - David E Bloom
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Olivier Ethgen
- Department of Public Health, Epidemiology and Health Economics, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Jeroen Luyten
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | | | - Lander Willem
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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31
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A Vreman R, F Broekhoff T, GM Leufkens H, K Mantel-Teeuwisse A, G Goettsch W. Application of Managed Entry Agreements for Innovative Therapies in Different Settings and Combinations: A Feasibility Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228309. [PMID: 33182732 PMCID: PMC7698033 DOI: 10.3390/ijerph17228309] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 12/28/2022]
Abstract
The reimbursement of expensive, innovative therapies poses a challenge to healthcare systems. This study investigated the feasibility of managed entry agreements (MEAs) for innovative therapies in different settings and combinations. First, a systematic literature review included studies describing used or conceptual agreements between payers and manufacturers (i.e., MEAs). Identical and similar MEAs were clustered and data were extracted on their benefits and limitations. A feasibility assessment was performed for each individual MEA based on how it could be applied (financial/outcome-based), on what level (individual patients/target population), in which payment setting (centralized pricing and reimbursement authority yes/no), for what type of therapies (one-time/chronic), within what payment structures, and whether combinations with other MEAs were feasible. The literature search ultimately included 82 papers describing 117 MEAs. After clustering, 15 unique MEAs remained, each describing one or multiple similar agreements. Four of those entailed payment structures, while eleven entailed agreements between payers and manufacturers regarding price, usage, and/or evidence generation. The feasibility assessment indicated that most agreements could be applied throughout the different settings that were assessed and could be applied in different payment structures and in combination with multiple other agreements. The potential to combine multiple agreements leads to a multitude of different reimbursement mechanisms that may manage the price, usage, payment structure, and additional conditions for an innovative therapy. This overview of the feasibility of combinations of MEAs can help decision-makers construct a reimbursement mechanism most suited to their preferences, the type of therapy under evaluation, and the applicable healthcare system.
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Affiliation(s)
- Rick A Vreman
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584 CG Utrecht, The Netherlands; (R.A.V.); (T.F.B.); (H.G.M.L.); (A.K.M.-T.)
- National Health Care Institute (ZIN), 1112 ZA Diemen, The Netherlands
| | - Thomas F Broekhoff
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584 CG Utrecht, The Netherlands; (R.A.V.); (T.F.B.); (H.G.M.L.); (A.K.M.-T.)
| | - Hubert GM Leufkens
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584 CG Utrecht, The Netherlands; (R.A.V.); (T.F.B.); (H.G.M.L.); (A.K.M.-T.)
| | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584 CG Utrecht, The Netherlands; (R.A.V.); (T.F.B.); (H.G.M.L.); (A.K.M.-T.)
| | - Wim G Goettsch
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584 CG Utrecht, The Netherlands; (R.A.V.); (T.F.B.); (H.G.M.L.); (A.K.M.-T.)
- National Health Care Institute (ZIN), 1112 ZA Diemen, The Netherlands
- Correspondence:
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32
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Smith A, Barry M. Combining health technology assessment and health technology management to deliver cost-effective prescribing and cost containment - the Irish experience. Expert Rev Pharmacoecon Outcomes Res 2020; 20:431-436. [PMID: 32909850 DOI: 10.1080/14737167.2020.1822739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Health technology assessment (HTA) is a widely used process to systematically evaluate the properties, effects, and impacts of health technology, with the main purpose of informing policymaking in healthcare. However, to ensure optimal use of scarce healthcare budgets, there is a need to look beyond HTA - to post-reimbursement health technology management (HTM). AREAS COVERED This review aims to describe the significant impact HTA, in combination with HTM, has made to the cost-effective prescribing and cost-containment in Ireland. This review will cover a number of specific examples, such as; specific reimbursement criteria for sacubitril/valsartan (Entresto®) and evolocumab (Repatha®), the introduction of a reimbursement application system for lidocaine 5% medicated plaster (Versatis®), and the introduction of 'preferred' biosimilars for patent-expired biologic medicines. EXPERT OPINION Healthcare payers are increasingly recognizing the benefits of HTM particularly when used in conjunction with HTA. This review highlights several examples whereby significant cost-savings can be made through HTM of not only new drugs but also drugs which are already available on the market.
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Affiliation(s)
- Amelia Smith
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Centre for Health Sciences, St. James' Hospital , Dublin 8, Ireland.,Medicines Management Programme, Health Service Executive, St. James' Hospital , Dublin 8, Ireland
| | - Michael Barry
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Centre for Health Sciences, St. James' Hospital , Dublin 8, Ireland.,Medicines Management Programme, Health Service Executive, St. James' Hospital , Dublin 8, Ireland
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Torbica A. HTA Around the World: Broadening Our Understanding of Cross-Country Differences. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1-2. [PMID: 31952663 DOI: 10.1016/j.jval.2019.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Aleksandra Torbica
- Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy.
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