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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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Quality of health economic evaluations submitted to the Italian Medicines Agency: current state and future actions. Int J Technol Assess Health Care 2020; 36:560-568. [DOI: 10.1017/s0266462320000641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
ObjectivesThe purpose of this study was to evaluate the current state of health economic evaluations (HEEs) submitted by pharmaceutical companies to the Italian Medicines Agency (AIFA) as part of their pricing and reimbursement (P&R) dossiers, and to explore potential future actions in order to enhance their quality.MethodsAll company dossiers submitted from October 2016 to December 2018 were reviewed to select those containing pharmacoeconomic studies. The general characteristics of HEEs were described and their quality assessed based on a checklist adapted from Philips et al. (Review of guidelines for good practice in decision-analytic modelling in health technology assessment. Health Technol Assess. 2004;8: 1–158).ResultsOf the 299 dossiers submitted to AIFA, 105 included one or more pharmacoeconomic studies, of which fifty-three were cost-effectiveness analyses. Overall, the compliance of the HEEs with the quality checklist was highly variable: some studies reached high methodological standards whereas others had serious flaws (mean 59.22 percent, range 19.35–90.32 percent). The main weaknesses were the unjustified exclusion of relevant alternatives, poor description and justification of model data and assumptions, and insufficient exploration of uncertainty and study validity. Non-homogeneity across studies was found in study perspectives, discount rates, methods for costing, estimating quality-adjusted life-years and conducting sensitivity analyses.ConclusionsBased on the results of this study, the recommended actions for increasing the quality of HEEs within reimbursement submissions in Italy are twofold: first, to set methodological standards for conducting and reporting HEEs; second, to strengthen the internal assessment process, also through the acquisition of companies' models and re-evaluation of results. These actions will hopefully provide greater contribution to the evidence-based P&R decision making.
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Real-World Setting Cost-Effectiveness Analysis Comparing Three Therapeutic Schemes of One-Year Adjuvant Trastuzumab in HER2-Positive Early Breast Cancer from the Cyprus NHS Payer Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124339. [PMID: 32560485 PMCID: PMC7344736 DOI: 10.3390/ijerph17124339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 12/27/2022]
Abstract
Introduction: This study is one of the first real-world cost-effectiveness analyses of one-year adjuvant trastuzumab used in HER2-positive early female breast cancer in comparison to chemotherapy alone. It is just the second one in Europe, the first one in Cyprus, and the fourth one worldwide ever carried out using real-world data. Methods: Using a Markov model (four health states), a cost-effectiveness analysis was carried out both over 20 years and for a lifetime horizon. The sampling method used in this study was the randomized sampling of 900 women. Results: The findings for the 20-year horizon showed that all trastuzumab arms were more cost-effective, with a willingness-to-pay threshold of only €60,000 per quality-adjusted life year (QALY) [incremental cost-effectiveness ratios (ICER): €40,436.10/QALY]. For the lifetime horizon, with thresholds of €20,000, €40,000, and €60,000/QALY, all trastuzumab arms were found to be more cost-effective (ICER: €17,753.85/QALY). Moreover, for the 20-year and the lifetime horizons, with thresholds of €20,000/QALY, €40,000/QALY, and €60,000/QALY, the most cost-effective of the three subgroups (anthracyclines and then trastuzumab, no anthracyclines and then trastuzumab, and anthracyclines, taxanes, and trastuzumab) was that of anthracyclines and then trastuzumab (ICER: €18,301.55/QALY and €8954.97/QALY, respectively). Conclusions: The study revealed that adjuvant trastuzumab for one year in female HER2-positive early breast cancer can be considered cost-effective.
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Access to medicines - a systematic review of the literature. Res Social Adm Pharm 2019; 16:1166-1176. [PMID: 31839584 DOI: 10.1016/j.sapharm.2019.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 12/07/2019] [Accepted: 12/08/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Budgetary constraints and the rising cost of new innovative medicines are the key challenges for access to medicines. Multiple research studies explored diverse dimensions of this topic, however, a thorough and detailed review of existing literature on access to medicines in United Kingdom is lacking. Therefore, the objective of this systematic review of literature was to critically review and analyse the literature pertaining to original research on access to medicines issue in the United Kingdom. This review includes two types of studies: (a) UK centric studies (b) studies comparing UK with the other countries. METHODS A systematic search of articles published between Jan 2008 and October 12, 2018 was conducted according to PRISMA guidelines using the following databases: PubMed, Scopus, Science Direct, and specific journals including BMJ, Lancet, Value in Health, Pharmacoeconomics, Pharmacoeconomics Open, Journal of pharmaceutical policy and practice, Health Policy. RESULTS The searches across all databases and journals resulted in 53 relevant articles. The data extracted from the 53 articles generated key themes. These themes included: Access to Medicines, Health technology assessment (HTA), Pricing and Health technology assessment, Risk Sharing Agreements & Stakeholders involvement/views on reimbursement Process. Subthemes were added under the key themes where applicable. CONCLUSIONS This review systematically evaluated the current literature and identified variability in access to medicines across countries in UK &EU and across different categories of medicines. Medicine licensing and reimbursement environment is continuously evolving and there are challenges as well as opportunities for learning and collaboration among countries which are at different stages of advancement in their systems.
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Johannesen KM, Claxton K, Sculpher MJ, Wailoo AJ. How to design the cost-effectiveness appraisal process of new healthcare technologies to maximise population health: A conceptual framework. HEALTH ECONOMICS 2018; 27:e41-e54. [PMID: 28833844 DOI: 10.1002/hec.3561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 06/02/2017] [Accepted: 06/26/2017] [Indexed: 06/07/2023]
Abstract
This paper presents a conceptual framework to analyse the design of the cost-effectiveness appraisal process of new healthcare technologies. The framework characterises the appraisal processes as a diagnostic test aimed at identifying cost-effective (true positive) and non-cost-effective (true negative) technologies. Using the framework, factors that influence the value of operating an appraisal process, in terms of net gain to population health, are identified. The framework is used to gain insight into current policy questions including (a) how rigorous the process should be, (b) who should have the burden of proof, and (c) how optimal design changes when allowing for appeals, price reductions, resubmissions, and re-evaluations. The paper demonstrates that there is no one optimal appraisal process and the process should be adapted over time and to the specific technology under assessment. Optimal design depends on country-specific features of (future) technologies, for example, effect, price, and size of the patient population, which might explain the difference in appraisal processes across countries. It is shown that burden of proof should be placed on the producers and that the impact of price reductions and patient access schemes on the producer's price setting should be considered when designing the appraisal process.
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Affiliation(s)
- Kasper M Johannesen
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Karl Claxton
- Centre for Health Economics, University of York, York, UK
| | | | - Allan J Wailoo
- Health Economics and Decision Science, University of Sheffield, Sheffield, UK
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Copanitsanou P, Valkeapää K, Cabrera E, Katajisto J, Leino-Kilpi H, Sigurdardottir AK, Unosson M, Zabalegui A, Lemonidou C. Total Joint Arthroplasty Patients' Education on Financial Issues and Its Connection to Reported Out-of-Pocket Costs-A European Study. Nurs Forum 2016; 52:97-106. [PMID: 27441849 DOI: 10.1111/nuf.12171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Total joint arthroplasty is accompanied by significant costs. In nursing, patient education on financial issues is considered important. Our purpose was to examine the possible association between the arthroplasty patients' financial knowledge and their out-of-pocket costs. METHODS Descriptive correlational study in five European countries. Patient data were collected preoperatively and at 6 months postoperatively, with structured, self-administered instruments, regarding their expected and received financial knowledge and out-of-pocket costs. FINDINGS There were 1,288 patients preoperatively, and 352 at 6 months. Patients' financial knowledge expectations were higher than knowledge received. Patients with high financial knowledge expectations and lack of fulfillment of these expectations had lowest costs. CONCLUSION There is need to establish programs for improving the financial knowledge of patients. Patients with fulfilled expectations reported higher costs and may have followed and reported their costs in a more precise way. In the future, this association needs multimethod research.
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Affiliation(s)
| | - Kirsi Valkeapää
- Adjunct Professor, Department of Nursing Science, University of Turku, Turku, Finland and Lahti University of Applied Sciences, Lahti, Finland
| | - Esther Cabrera
- Director of Health Science School, Tecno Campus, Matarό-Maresme, Spain
| | - Jouko Katajisto
- Statistician, Department of Statistics, University of Turku, Turku, Finland
| | - Helena Leino-Kilpi
- Professor, Department of Nursing Science, University of Turku, Turku, Finland and Nurse Director, Turku University Hospital, Turku, Finland
| | | | - Mitra Unosson
- Professor, Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden
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Cerri KH, Knapp M, Fernandez JL. Untangling the Complexity of Funding Recommendations: A Comparative Analysis of Health Technology Assessment Outcomes in Four European Countries. Pharmaceut Med 2015. [DOI: 10.1007/s40290-015-0112-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Differences in cancer drug assessment between Spain and the United Kingdom. Eur J Cancer 2015; 51:1843-52. [DOI: 10.1016/j.ejca.2015.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 04/27/2015] [Accepted: 04/30/2015] [Indexed: 11/18/2022]
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Charokopou M, Majer IM, Raad JD, Broekhuizen S, Postma M, Heeg B. Which factors enhance positive drug reimbursement recommendation in Scotland? A retrospective analysis 2006-2013. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:284-91. [PMID: 25773564 DOI: 10.1016/j.jval.2014.12.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 11/13/2014] [Accepted: 12/02/2014] [Indexed: 05/20/2023]
Abstract
OBJECTIVES To identify the factors that influence the Scottish Medicines Consortium (SMC) in deciding whether to accept pharmaceutical technologies for use within the Scottish health care system. METHODS A database of SMC submissions between 2006 and 2013 was created, containing a range of clinical, economic, and other factors extracted from published health technology assessment reports. A binomial outcome variable was used, defined as the decision to "accept for use" or "not recommend" a technology. Univariate and multivariate analyses were conducted to assess the impact by means of odds ratios (ORs) of the submitted evidence on the recommendation decision. RESULTS Out of 463 applications, 265 were accepted for use (57%) and 198 (43%) were not recommended for use within National Health Service Scotland. Univariate analyses showed that 13 variables significantly affected the SMC decision. Of these 13 variables, 7 variables were shown to have a meaningful impact in the multivariate analysis. Four of these concerned the outcome of cost-effectiveness analyses; the fact that a submission was supported by a cost-minimization analysis was the strongest positive variable (OR = 10.30) and a submission showing a product not being cost-effective (i.e., incremental cost-effectiveness ratio above £30,000/quality-adjusted life-year gained) was the strongest negative predictor (OR = 0.47). The other variables concerned whether the submission was related to a product indicated for a nervous system disease (OR = 0.41), whether it was indicated for nonchronic use (OR = 1.66), and whether the submission was performed by a big company (OR = 2.83). CONCLUSIONS This study demonstrated that the outcome of cost-effectiveness analyses is an important factor affecting the SMC's reimbursement recommendation decision.
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Affiliation(s)
| | | | | | | | - Maarten Postma
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Bart Heeg
- Pharmerit BV, Rotterdam, The Netherlands
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Drummond M, de Pouvourville G, Jones E, Haig J, Saba G, Cawston H. A comparative analysis of two contrasting European approaches for rewarding the value added by drugs for cancer: England versus France. PHARMACOECONOMICS 2014; 32:509-20. [PMID: 24599784 DOI: 10.1007/s40273-014-0144-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Within Europe, contrasting approaches have emerged for rewarding the value added by new drugs. In Ireland, The Netherlands, Sweden and the UK, the price of, and access to, a new drug has to be justified by the health gain it delivers compared with current therapy, typically expressed in quality-adjusted life-years (QALYs) gained. By contrast, in France and Germany, the assessment of added benefit is expressed on an ordinal scale, based on an assessment of the clinical outcomes as compared with existing care. This assessment then influences price negotiations. The objective of this paper is to assess the pros and cons of each approach, both in terms of the assessments they produce and the efficiency and practical feasibility of the process. METHODS We reviewed the technology appraisals performed by the National Institute for Health and Care Excellence (NICE) relating to 49 anticancer drug decisions in the UK from September 2003 to January 2012. Estimates of the QALYs gained and incremental cost per QALY gained were then compared with the assessments of the Amélioration du Service Médical Rendu (ASMR) made by the Haute Autorité de Santé (HAS) in France for the same drugs in the same clinical indications. We also undertook a qualitative assessment of the two approaches, considering the resources required, timeliness, transparency, stakeholder engagement, and political acceptability. RESULTS In the UK, the estimates of QALYs gained ranged from 0.003 to 1.46 and estimates of incremental cost per QALY from £3,320 to £458,000. The estimate of cost per QALY gained was a good predictor of the level of restriction imposed on the use of the drug concerned. Patient access schemes, which normally imply price reductions, were proposed in 45 % of cases. In France, the distribution of ASMRs was I, 12 %; II, 18 %; III, 24 %; IV, 18 %; V, 22 %; and uncategorized/non-reimbursed, 4 %. Since ASMRs of IV and above signify minor or no improvement over existing therapy, these ratings imply that, in around 40 % of cases, the drugs concerned would face price controls. Overall, the assessments of value added in the two jurisdictions were very similar. A superior ASMR rating was associated with higher QALYs gained. However, a superior ASMR was not associated with a lower incremental cost per QALY. There are substantial differences in respect of the other attributes considered, but these mainly reflect the result of institutional choices in the jurisdictions concerned and it is not possible to conclude that one approach is universally superior to the other. CONCLUSIONS The two approaches produce very similar assessments of added value, but have different attributes in terms of cost, timeliness, transparency and political acceptability. How these considerations impact market access and prices is difficult to assess, because of the lack of transparency concerning prices in both countries and the fact that market access also depends on a broader range of factors. There is some evidence of convergence in the approaches, with the movement in France towards producing cost-effectiveness estimates and the movement in the UK towards negotiated prices.
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Affiliation(s)
- Michael Drummond
- Centre for Health Economics, University of York, Alcuin A Block, Heslington, York, YO10 5DD, UK,
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Decision making by NICE: examining the influences of evidence, process and context. HEALTH ECONOMICS POLICY AND LAW 2013; 9:119-41. [DOI: 10.1017/s1744133113000030] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThe National Institute for Health and Clinical Excellence (NICE) provides guidance to the National Health Service (NHS) in England and Wales on funding and use of new technologies. This study examined the impact of evidence, process and context factors on NICE decisions in 2004–2009. A data set of NICE decisions pertaining to pharmaceutical technologies was created, including 32 variables extracted from published information. A three-category outcome variable was used, defined as the decision to ‘recommend’, ‘restrict’ or ‘not recommend’ a technology. With multinomial logistic regression, the relative contribution of explanatory variables on NICE decisions was assessed. A total of 65 technology appraisals (118 technologies) were analysed. Of the technologies, 27% were recommended, 58% were restricted and 14% were not recommended by NICE for NHS funding. The multinomial model showed significant associations (p ⩽ 0.10) between NICE outcome and four variables: (i) demonstration of statistical superiority of the primary endpoint in clinical trials by the appraised technology; (ii) the incremental cost-effectiveness ratio (ICER); (iii) the number of pharmaceuticals appraised within the same appraisal; and (iv) the appraisal year. Results confirm the value of a comprehensive and multivariate approach to understanding NICE decision making. New factors affecting NICE decision making were identified, including the effect of clinical superiority, and the effect of process and socio-economic factors.
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Abstract
OBJECTIVE This review examines the impact of economic evaluation in informing national or local policies within both jurisdictions. We focus on the factors that have made the economic evaluation evolves differently in both settings. AREAS OF AGREEMENT Economic evaluation facilitates decision-making regarding the efficiency of interventions. The existence of national or local bodies regulating the process has contributed to increasing its use in decision-making and the development of its methods. AREAS OF CONTROVERSY Cost-effectiveness approach is based on the assumption of health maximization subject to a budget constraint. Decision-makers are not only interested in health maximization alone. This may result in policy-makers failing to consider economic evaluations into their allocation decisions. AREAS TO DEVELOP RESEARCH: Methods that incorporate wider decision-makers goals (mainly local) and research to study the real impact of economic evaluation in terms of improved efficiency and equity are particularly required.
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The role of health technology assessment in coverage decisions on newborn screening. Int J Technol Assess Health Care 2012; 27:313-21. [PMID: 22004771 DOI: 10.1017/s0266462311000468] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The role and impact of health technology assessment (HTA) in health policy has been widely discussed. Researchers have started to analyze how decisions on coverage of new technologies are made. Although the involvement of HTA may be an indicator of a well established decision process, this hypothesis requires validation. Also, it is not known whether HTA involvement is associated with other characteristics of decision making like participation or transparency. The primary objective of this study was to develop and test statements on the association between the publication of an HTA and coverage decision making for newborn screening tests in European Union countries. METHODS Five statements were defined on the relative role of HTA during the steps of decision processes: trigger, participation, publication, assessment, and appraisal. For this purpose, data on twenty-two decision processes in the area of newborn screening across Europe were analyzed, defined as a coverage decision for a given disorder in a specific country. Decision processes were compared by whether the decision was accompanied by the publication of an HTA report. To test differences, nonparametric statistical tests were used. RESULTS The decision steps of trigger, participation and publication differed between the HTA and the non-HTA groups. No clear association between HTA and assessment methods in coverage decision making was identified. CONCLUSIONS It appeared that there is an association between HTA and coverage decision processes that are more explicit, inclusive, and transparent. It is unclear whether HTA is associated with formal evidence reviews and economic evaluations.
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Decision-making in healthcare: a practical application of partial least square path modelling to coverage of newborn screening programmes. BMC Med Inform Decis Mak 2012; 12:83. [PMID: 22856325 PMCID: PMC3444310 DOI: 10.1186/1472-6947-12-83] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 07/28/2012] [Indexed: 01/25/2023] Open
Abstract
Background Decision-making in healthcare is complex. Research on coverage decision-making has focused on comparative studies for several countries, statistical analyses for single decision-makers, the decision outcome and appraisal criteria. Accounting for decision processes extends the complexity, as they are multidimensional and process elements need to be regarded as latent constructs (composites) that are not observed directly. The objective of this study was to present a practical application of partial least square path modelling (PLS-PM) to evaluate how it offers a method for empirical analysis of decision-making in healthcare. Methods Empirical approaches that applied PLS-PM to decision-making in healthcare were identified through a systematic literature search. PLS-PM was used as an estimation technique for a structural equation model that specified hypotheses between the components of decision processes and the reasonableness of decision-making in terms of medical, economic and other ethical criteria. The model was estimated for a sample of 55 coverage decisions on the extension of newborn screening programmes in Europe. Results were evaluated by standard reliability and validity measures for PLS-PM. Results After modification by dropping two indicators that showed poor measures in the measurement models’ quality assessment and were not meaningful for newborn screening, the structural equation model estimation produced plausible results. The presence of three influences was supported: the links between both stakeholder participation or transparency and the reasonableness of decision-making; and the effect of transparency on the degree of scientific rigour of assessment. Reliable and valid measurement models were obtained to describe the composites of ‘transparency’, ‘participation’, ‘scientific rigour’ and ‘reasonableness’. Conclusions The structural equation model was among the first applications of PLS-PM to coverage decision-making. It allowed testing of hypotheses in situations where there are links between several non-observable constructs. PLS-PM was compatible in accounting for the complexity of coverage decisions to obtain a more realistic perspective for empirical analysis. The model specification can be used for hypothesis testing by using larger sample sizes and for data in the full domain of health technologies.
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A COMPARISON OF PHARMACEUTICAL REIMBURSEMENT AGENCIES' PROCESSES AND METHODS IN FRANCE AND SCOTLAND. Int J Technol Assess Health Care 2012; 28:187-94. [DOI: 10.1017/s0266462312000104] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objectives:Pharmaceutical reimbursement agencies’ processes and methods of appraisal vary across countries. The objective of this study was to examine the contribution of formal health economic analysis in a process using such analysis in Scotland in comparison to a process not routinely using such analysis in France.Methods:A framework for classifying reimbursement systems was used to analyze the two systems. A typology of recommendation was defined and a qualitative analysis of decisions on a sample of medicines appraised by both reimbursement agencies was conducted. Reasons for differences in recommendations were analyzed and case studies selected to illustrate the common reasons.Results:Thirty-nine common medicines appraised by both agencies were identified between 2005 and 2010, treating a variety of diseases for which the Scottish Medicines Consortium tended to provide more restrictive, or did not recommend, listing. Similarities in clinical evidence submitted to the respective reimbursement committees were observed. Differences in recommendation can be explained by a combination of the manufacturer's freedom to set price and the incentives provided by the consideration of health economic analysis and quality of life, alongside differences in relevant comparators, relevant outcomes, treatment guidelines, and the propensity to use network meta-analysis, in decision making.Conclusions:This study provides some explanations and hypotheses for the differences observed in recommendations for a selected sample of medicines with regards to differences in appraisal processes and methods adopted. Further research using larger datasets may allow stakeholders to assess the impact of such differences on the efficient use of health resources.
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Kolasa K, Schubert S, Manca A, Hermanowski T. A review of Health Technology Assessment (HTA) recommendations for drug therapies issued between 2007 and 2009 and their impact on policymaking processes in Poland. Health Policy 2012; 102:145-51. [PMID: 21641074 DOI: 10.1016/j.healthpol.2011.05.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Revised: 03/26/2011] [Accepted: 05/04/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The primary objective of this study was to critically review and analyze the Polish Health Technology Assessment (AHTAPol) agency's health technology drug recommendations (HTA activity), in order to ascertain to what extent HTA findings have been incorporated into national drug reimbursement decisions (HTA impact). METHODOLOGY HTA recommendations issued between 2007 and 2009 were studied. Positive recommendations were classified into three categories: recommendations with major restrictions; minor restrictions; and without restrictions. Definitions of clinical and non-clinical reasons were drawn ups for negative recommendations. The study examined how many different drug technologies assessed by AHTAPol were included in reimbursement lists. RESULTS In terms of HTA activity, 63 negative and 83 positive HTA recommendations were issued. While clinical arguments were the most prevalent reason for negative HTA recommendations, major restrictions were most common in the positive guidance group. In terms of HTA impact, the results revealed 30 drugs with positive HTA recommendations and four with negative HTA recommendations were included on the reimbursement lists. CONCLUSIONS Most of AHTAPol's recommendations have a positive outcome for the drug being appraised. The study revealed room for further enhancement of HTA impact. Three key areas that need future attention were identified: consistency, credibility; and pragmatism.
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Affiliation(s)
- Katarzyna Kolasa
- Department of Pharmacoeconomics, Medical University of Warsaw, 3a Pawinskiego St., 02-106 Warsaw, Poland.
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Ford JA, Waugh N, Sharma P, Sculpher M, Walker A. NICE guidance: a comparative study of the introduction of the single technology appraisal process and comparison with guidance from Scottish Medicines Consortium. BMJ Open 2012; 2:e000671. [PMID: 22290398 PMCID: PMC3269048 DOI: 10.1136/bmjopen-2011-000671] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objectives To compare the timelines and recommendations of the Scottish Medicines Consortium (SMC) and National Institute of Health and Clinical Excellence (NICE), in particular since the single technology assessment (STA) process was introduced in 2005. Design Comparative study of drug appraisals published by NICE and SMC. Setting NICE and SMC. Participants All drugs appraised by SMC and NICE, from establishment of each organisation until August 2010, were included. Data were gathered from published reports on the NICE website, SMC annual reports and European Medicines Agency website. Primary and secondary outcome measures Primary outcome was time from marketing authorisation until publication of first guidance. The final outcome for each drug was documented. Drug appraisals by NICE (before and after the introduction of the STA process) and SMC were compared. Results NICE and SMC appraised 140 drugs, 415 were appraised by SMC alone and 102 by NICE alone. NICE recommended, with or without restriction, 90% of drugs and SMC 80%. SMC published guidance more quickly than NICE (median 7.4 compared with 21.4 months). Overall, the STA process reduced the average time to publication compared with multiple technology assessments (median 16.1 compared with 22.8 months). However, for cancer medications, the STA process took longer than multiple technology assessment (25.2 compared with 20.0 months). Conclusions Proportions of drugs recommended for NHS use by SMC and NICE are similar. SMC publishes guidance more quickly than NICE. The STA process has improved the time to publication but not for cancer drugs. The lengthier time for NICE guidance is partly due to measures to provide transparency and the widespread consultation during the NICE process.
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Affiliation(s)
- John A Ford
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Kaltenthaler E, Papaioannou D, Boland A, Dickson R. The National Institute for Health and Clinical Excellence Single Technology Appraisal process: lessons from the first 4 years. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:1158-65. [PMID: 22152188 DOI: 10.1016/j.jval.2011.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 05/08/2011] [Accepted: 06/09/2011] [Indexed: 05/20/2023]
Abstract
OBJECTIVES The National Institute for Health and Clinical Excellence (NICE) Single Technology Appraisal (STA) process in the United Kingdom was established in 2005 in order to provide guidance on new technologies as close to their launch as possible. The NICE recommended timeframe for completion of an STA is 34 weeks. The purpose of this study was to map the first 95 STAs to collect information on a range of issues including timelines and appraisal decisions. METHODS A mapping tool was devised to collect information from the NICE Web site. Data were analyzed by calculating frequencies. Simple descriptive statistics were applied where appropriate. RESULTS Ninety-five STAs were included in the analysis. Almost one-third (30/95) initially identified topics did not go on to be appraised often due to licensing issues. Timelines were measured for 29 completed STAs. Eight (28%) of these were completed by 37 weeks and 20 (69%) by 42 weeks. When STAs with appeals were excluded, 31% (8/26) were completed by 37 weeks and 85% (22/26) by 42 weeks. The incremental cost-effectiveness ratios reported by manufacturers were consistently lower than those estimated by the evidence review groups. In all, 76% (38/50) of the completed STAs resulted in an approval. CONCLUSIONS The NICE Web site enabled access to almost all necessary information, although electronic documents were sometimes difficult to locate. One-third of the referred topics were suspended or terminated. The NICE STA process is slower than initially anticipated and this is primarily due to events outside of NICE's direct control.
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Affiliation(s)
- Eva Kaltenthaler
- ScHARR, University of Sheffield, Sheffield, South Yorkshire, UK.
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A thematic analysis of the strengths and weaknesses of manufacturers' submissions to the NICE Single Technology Assessment (STA) process. Health Policy 2011; 102:136-44. [PMID: 21763025 DOI: 10.1016/j.healthpol.2011.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 04/19/2011] [Accepted: 06/19/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The NICE Single Technology Appraisal (STA) process in the UK has been underway for five years. Evidence Review Groups (ERGs) critically appraise submissions from manufacturers on the clinical and cost effectiveness of new technologies. This study analysed the ERGs' assessment of the strengths and weaknesses of 30 manufacturers' submissions to the STA process. METHODS Thematic analysis was performed on the textual descriptions of the strengths and weakness of manufacturer submissions, as outlined by the ERGs in their reports. FINDINGS Various themes emerged from the data. These themes related to the processes applied in the submissions; the content of the submission (e.g. the amount and quality of evidence); the reporting of the submissions' review and analysis processes; the reliability and validity of the submissions' findings; and how far the submission had satisfied the STA process objectives. CONCLUSIONS STA submissions could be improved if attention were paid to transparency in the reporting, conduct and justification of review and modelling processes and analyses, as well as greater robustness in the choice of data and closer adherence to the scope or decision problem. Where this adherence is not possible, more detailed justification of the choice of evidence or data is required.
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Bujkiewicz S, Jones HE, Lai MCW, Cooper NJ, Hawkins N, Squires H, Abrams KR, Spiegelhalter DJ, Sutton AJ. Development of a transparent interactive decision interrogator to facilitate the decision-making process in health care. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:768-776. [PMID: 21839417 PMCID: PMC3161376 DOI: 10.1016/j.jval.2010.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 11/11/2010] [Accepted: 12/12/2010] [Indexed: 05/30/2023]
Abstract
BACKGROUND Decisions about the use of new technologies in health care are often based on complex economic models. Decision makers frequently make informal judgments about evidence, uncertainty, and the assumptions that underpin these models. OBJECTIVES Transparent interactive decision interrogator (TIDI) facilitates more formal critique of decision models by decision makers such as members of appraisal committees of the National Institute for Health and Clinical Excellence in the UK. By allowing them to run advanced statistical models under different scenarios in real time, TIDI can make the decision process more efficient and transparent, while avoiding limitations on pre-prepared analysis. METHODS TIDI, programmed in Visual Basic for applications within Excel, provides an interface for controlling all components of a decision model developed in the appropriate software (e.g., meta-analysis in WinBUGS and the decision model in R) by linking software packages using RExcel and R2WinBUGS. TIDI's graphical controls allow the user to modify assumptions and to run the decision model, and results are returned to an Excel spreadsheet. A tool displaying tornado plots helps to evaluate the influence of individual parameters on the model outcomes, and an interactive meta-analysis module allows the user to select any combination of available studies, explore the impact of bias adjustment, and view results using forest plots. We demonstrate TIDI using an example of a decision model in antenatal care. CONCLUSION Use of TIDI during the NICE appraisal of tumor necrosis factor-alpha inhibitors (in psoriatic arthritis) successfully demonstrated its ability to facilitate critiques of the decision models by decision makers.
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Affiliation(s)
- Sylwia Bujkiewicz
- Department of Health Sciences, University of Leicester, Leicester, UK.
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Drummond M, Jönsson B, Rutten F, Stargardt T. Reimbursement of pharmaceuticals: reference pricing versus health technology assessment. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2011; 12:263-71. [PMID: 20803050 PMCID: PMC3078322 DOI: 10.1007/s10198-010-0274-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 08/10/2010] [Indexed: 05/16/2023]
Abstract
Reference pricing and health technology assessment are policies commonly applied in order to obtain more value for money from pharmaceuticals. This study focussed on decisions about the initial price and reimbursement status of innovative drugs and discussed the consequences for market access and cost. Four countries were studied: Germany, The Netherlands, Sweden and the United Kingdom. These countries have operated one, or both, of the two policies at certain points in time, sometimes in parallel. Drugs in four groups were considered: cholesterol-lowering agents, insulin analogues, biologic drugs for rheumatoid arthritis and "atypical" drugs for schizophrenia. Compared with HTA, reference pricing is a relatively blunt instrument for obtaining value for money from pharmaceuticals. Thus, its role in making reimbursement decisions should be limited to drugs which are therapeutically equivalent. HTA is a superior strategy for obtaining value for money because it addresses not only price but also the appropriate indications for the use of the drug and the relation between additional value and additional costs. However, given the relatively higher costs of conducting HTAs, the most efficient approach might be a combination of both policies.
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Affiliation(s)
- Michael Drummond
- Centre for Health Economics, Alcuin A Block, University of York, Heslington, York, YO10 5DD, UK.
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Sculpher M. Single technology appraisal at the UK National Institute for Health and clinical excellence: a source of evidence and analysis for decision making internationally. PHARMACOECONOMICS 2010; 28:347-9. [PMID: 20402539 DOI: 10.2165/11535680-000000000-00000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
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Drummond M, Sorenson C. Nasty or nice? A perspective on the use of health technology assessment in the United Kingdom. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12 Suppl 2:S8-S13. [PMID: 19523188 DOI: 10.1111/j.1524-4733.2009.00552.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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