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Baltes N, Icks A, Dintsios CM. Treatment response in hemato-oncology in the context of the German early benefit assessment of drugs compared to clinical practice. J Evid Based Med 2023; 16:451-454. [PMID: 38130148 DOI: 10.1111/jebm.12575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Nannette Baltes
- Medical Faculty, Institute for Health Services Research and Health Economics, Heinrich Heine University Düsseldorf, North Rhine Westphalia, Germany
| | - Andrea Icks
- Medical Faculty, Institute for Health Services Research and Health Economics, Heinrich Heine University Düsseldorf, North Rhine Westphalia, Germany
| | - Charalabos-Markos Dintsios
- Medical Faculty, Institute for Health Services Research and Health Economics, Heinrich Heine University Düsseldorf, North Rhine Westphalia, Germany
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Dintsios CM, Chernyak N. How Far is Germany From Value-Based Pricing 10 Years After the Introduction of AMNOG? Appl Health Econ Health Policy 2022; 20:287-290. [PMID: 34964091 PMCID: PMC9021141 DOI: 10.1007/s40258-021-00712-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/05/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Charalabos-Markos Dintsios
- Institute for Health Services Research and Health Economics, Medical Faculty, Heinrich Heine University, Building 17.11, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Nadja Chernyak
- Institute for Health Services Research and Health Economics, Medical Faculty, Heinrich Heine University, Building 17.11, Moorenstr. 5, 40225 Düsseldorf, Germany
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Gandjour A. Cost-effectiveness of sofosbuvir in hepatitis C genotype 1 infection in Germany: A reanalysis of published results. PLoS One 2020; 15:e0236543. [PMID: 33006987 PMCID: PMC7531817 DOI: 10.1371/journal.pone.0236543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 07/08/2020] [Indexed: 01/03/2023] Open
Abstract
Objectives Recently, the results of two economic evaluations were published both of which seemingly demonstrate the cost-effectiveness of sofosbuvir-based regimens for the treatment of chronic hepatitis C genotype 1 infection in Germany. Both analyses were sponsored by the manufacturer of sofosbuvir and use a different methodology: Whereas one evaluation is based on a conventional cost-utility analysis, the other rests upon the efficiency-frontier method used by the German Institute for Quality and Efficiency in Health Care (IQWiG). The purpose of this study is to reanalysis the results of both economic evaluations in combination. Design Reanalysis of published decision modelling results. Setting Primary care in Germany. Participants Patients with chronic hepatitis C genotype 1 infection (treatment-naïve and -experienced, cirrhotic and non-cirrhotic). Interventions Sofosbuvir, other anti-hepatitis C virus drugs, and no treatment. Primary and secondary outcome measures Cost per unit of health benefit and cost per quality-adjusted life year. Results Reanalysis of the results of both economic evaluations in combination reveals an unclear rationale for choosing the selected cost-effectiveness methods as well as a potential publication bias, favoring the product of the manufacturer. Based on the reanalysis, sofosbuvir is not cost-effective in treatment-experienced non-cirrhotic patients, potentially lacks cost-effectiveness in treatment-experienced cirrhotic patients, and is only partially cost-effective in treatment-naïve non-cirrhotic patients. Taken together, these results indicate a lack of cost-effectiveness in three quarters of the German patient population. Conclusions Two economic evaluations on sofosbuvir suggest, in combination, that sofosbuvir cannot be considered a cost-effective treatment in three quarters of the German patient population.
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Affiliation(s)
- Afschin Gandjour
- Frankfurt School of Finance & Management, Frankfurt, Germany
- * E-mail:
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Gandjour A, Schüßler S, Hammerschmidt T, Dintsios CM. Predictors of negotiated prices for new drugs in Germany. Eur J Health Econ 2020; 21:1049-1057. [PMID: 32451745 PMCID: PMC7423852 DOI: 10.1007/s10198-020-01201-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 05/13/2020] [Indexed: 05/25/2023]
Abstract
INTRODUCTION In Germany, all new, innovative medicines are subject to an early benefit assessment by the German Federal Joint Committee with subsequent price negotiation and optional arbitration. The purpose of this study was to identify drivers of negotiated (including arbitrated) prices of new, non-orphan innovative medicines in Germany. METHODS The analysis considered all non-orphan drugs that underwent a benefit appraisal between January 2011 and June 2016, and displayed a reimbursement price in the German Drug Directory (Lauer-Taxe®) in November 2017. Negotiated annual treatment costs were analyzed with respect to 11 explanatory variables in regression models. RESULTS The total sample included 106 non-orphan drugs. The analysis showed a significant and positive association of log-transformed negotiated annual treatment cost of new medicines with log-transformed annual treatment cost of its comparator(s), extent of added benefit, and log-transformed size of the target population. Analyzing the effects of specific endpoints instead of the overall added benefit revealed that the single endpoint with the largest impact on price is adverse events (AEs). Surprisingly, an increase in AEs significantly increased the price. Various subgroup and sensitivity analyses demonstrated the robustness of the results. The adjusted R squared for all models was above 80%. CONCLUSIONS The analysis was able to confirm that variables whose consideration is mandated by law are, in fact, the key drivers of negotiated prices. Somewhat puzzling, the analysis also found an increase in AEs to move prices significantly upward.
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Affiliation(s)
- Afschin Gandjour
- Frankfurt School of Finance and Management, Frankfurt am Main, Germany
| | - Sofia Schüßler
- Frankfurt School of Finance and Management, Frankfurt am Main, Germany
| | - Thomas Hammerschmidt
- Faculty of Applied Health and Social Sciences, Technical University of Applied Sciences Rosenheim, Rosenheim, Germany
| | - Charalabos-Markos Dintsios
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Gebäude 12.49, Moorenstraße 5, 40225 Düsseldorf, Germany
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Gandjour A. Willingness to pay for new medicines: a step towards narrowing the gap between NICE and IQWiG. BMC Health Serv Res 2020; 20:343. [PMID: 32321496 PMCID: PMC7178559 DOI: 10.1186/s12913-020-5050-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 02/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The question of how to set the cost-effectiveness threshold for new, innovative medicines is a matter of ongoing controversy. One prominent proposal suggests that the cost-effectiveness threshold adopted by the U.K. National Institute for Health and Care Excellence (NICE) should represent the opportunity cost for the U.K. National Health Service resulting from the adoption of new medicines. The purpose of this article is to compare this proposal for the U.K. with the approach chosen by the Institute for Quality and Efficiency in Health Care (IQWiG) in Germany, which relies on indication-specific cost-effectiveness thresholds. MAIN TEXT The 'ideal' NICE and IQWiG surprisingly share the fundamental principle of inferring the willingness to pay from existing care. For this and other reasons, indication-specific thresholds based on IQWiG's methodology do not lead to more inefficiency at the health system's level than a generic threshold based on the 'ideal' NICE (keeping other conditions the same). Also, applying either decision rule to one country will yield a similar long-term growth in population spending. Assuming that everything else is equal, both decision rules are predicted to decrease long-term expenditure growth. Convergence of the two decision rules would require, among others, ruling out waste in the 'ideal' NICE's approach and, for IQWiG's approach, using the same relative weights for life expectancy and health-related quality of life as the quality-adjusted-life-year model. CONCLUSION This article shows that both decision rules have notable commonalities in terms of inferring the willingness to pay from existing care and the projected impact on long-term growth in population spending.
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Affiliation(s)
- Afschin Gandjour
- Frankfurt School of Finance and Management, Adickesallee 32-34, 60322, Frankfurt am Main, Germany.
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Abstract
BACKGROUND AND OBJECTIVE Legislation introduced in 2011 in Germany has instituted an early benefit assessment of newly licensed pharmaceuticals with a subsequent price negotiation. For orphan drugs (ODs) a special legal framework applies, which accounts for the fact that ODs do not have to prove an added benefit over an appropriate comparative therapy previously determined by the decision maker. As, in addition, the content of negotiations between pharmaceutical companies and the payer is confidential, the aim of this study was to identify factors influencing the negotiated prices of ODs. METHODS Twelve hypotheses on factors influencing the negotiated OD price were derived based on the existing literature and framework agreement between payers and pharmaceutical unions according to German social legislation. Univariate analyses were applied to detect statistically significant correlations between annual therapeutic costs of ODs and the hypothesized factors. Bivariate analyses were used to determine confounding factors. In addition, a multiple ordinary least squares (OLS) regression with backward selection was conducted. Finally, sensitivity analyses assessed the robustness of the results. RESULTS Thirty-five ODs were included in the analysis. The univariate analyses and subsequent sensitivity analyses validated five of the 12 hypotheses formulated. Univariate analyses suggest a statistically significant association between the OD price and the (i) therapeutic area; (ii) approval for pediatric care; (iii) treatment population size; (iv) cost of comparative therapies; and (v) European prices. The OLS regression identified European prices as the variable with the strongest association with the negotiated prices. CONCLUSION We show that German OD pricing is a multivariate phenomenon. However, due to interdependencies, these results must be treated with caution.
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Affiliation(s)
- Franziska Worm
- Health Economics, University Duisburg-Essen, Essen, Germany
| | - Charalabos-Markos Dintsios
- Institute for Health Services Research and Health Economics, Medical Faculty, Heinrich-Heine-University Düsseldorf, Building: 12.49, Moorenstr. 5, 40225, Düsseldorf, Germany.
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Gandjour A. A proportional rule for setting reimbursement prices of new drugs and its mathematical consistency. BMC Health Serv Res 2020; 20:240. [PMID: 32293433 PMCID: PMC7092469 DOI: 10.1186/s12913-020-5055-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Value-based pricing (VBP) of new drugs has been suggested both as a way to control health expenditures and to maximize health benefits based on the available resources. The purpose of this work is to present a simple mathematical proof showing that prices of new drugs are set in a mathematically consistent way when the sum of intervention and downstream costs is proportional to the size of health benefits. Such proportional relationship underlies the efficiency-frontier method used by the German Institute for Quality and Efficiency in Health Care (IQWiG). METHODS A proof by contradiction is presented that is based upon the following three premises: 1) total costs (intervention plus downstream costs) of existing non-dominated drugs and interventions are acceptable to decision-making bodies; 2) new drugs with health benefits in-between those of the most and second most effective existing interventions are not automatically excluded from reimbursement and are acceptable if prices are sufficiently low; and 3) value is measured on a cardinal scale. RESULT The proof shows that a proportional rule sets reimbursement prices of new drugs in a mathematically consistent way. CONCLUSION Based on the proof and the underlying assumptions a proportional relationship between costs and health benefits ensures mathematical consistency in VBP of drugs.
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Affiliation(s)
- Afschin Gandjour
- Frankfurt School of Finance & Management, Adickesallee 32-34, 60322, Frankfurt am Main, Germany.
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Dintsios CM, Beinhauer I. The impact of additive or substitutive clinical study design on the negotiated reimbursement for oncology pharmaceuticals after early benefit assessment in Germany. Health Econ Rev 2020; 10:7. [PMID: 32172494 PMCID: PMC7071579 DOI: 10.1186/s13561-020-00263-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 02/28/2020] [Indexed: 05/03/2023]
Abstract
BACKGROUND We analysed the impact of clinical study design for oncological pharmaceuticals on the subsequent price negotiations after early benefit assessment between pharmaceutical companies and the German National Association of Statutory Health Insurance Funds. The analysis was conducted for all oncology pharmaceuticals that underwent the early benefit assessment in Germany since its introduction in 2011 up to September 2016. METHODS It was differentiated between additive (new therapy in addition to baseline therapy) and substitutive study designs (baseline therapy to be replaced). The study design was derived from the dossiers of the pharmaceutical companies submitted to the Federal Joint Committee. Subgroup specific costs in case of granted added benefit were calculated as annual therapy costs and compared with the costs of the appropriate comparators to quantify price premiums. Further price influencing factors were analysed in univariate and multivariate regression analysis considering the budget impact for the statutory health insurance as well. RESULTS The mean and the median of the additive premiums for substitutive designs (€50,477.68 and €49,841.24) were higher than for additive designs, if the comparator was different to best supportive care (€48,750.00 and €42,820.44). The mean multiplicative premium for the substitutive designs was 15.07 versus 2.29 for the additive designs. EU-Prices and target population size had a significant effect on the reimbursement. The adjusted R-square in the log Premium OLS-regressions reached 0.708 when including all explanatory variables and considering interaction between target population and annual costs of the comparator. CONCLUSIONS Study design as an additional important influencing factor of the negotiations next to those stated in the framework agreement was identified and verified. Therefore, study design should be considered by pharmaceutical companies and by decision makers and payers within strategic price planning as a potential predictor. For some specific categories the number of cases was small. Further analyses should be performed when more oncology pharmaceuticals have passed the early benefit assessment.
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Affiliation(s)
- C. M. Dintsios
- Medical Faculty, Institute for Health Services Research and Health Economics, Heinrich Heine University, Building: 12.49, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - I. Beinhauer
- Health Economics, Cologne, Trainee at Bayer Vital GmbH, Leverkusen, Germany
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Shi Y, Wan X, Tan C, Li J, Peng L. Model-Based Cost-Effectiveness Analysis of Panitumumab Plus FOLFIRI for the Second-Line Treatment of Patients with Wild-Type Ras Metastatic Colorectal Cancer. Adv Ther 2020; 37:847-59. [PMID: 31902066 DOI: 10.1007/s12325-019-01214-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The NCT00339183 trial demonstrated that adding panitumumab to fluorouracil, leucovorin and irinotecan (FOLFIRI) as a second-line therapy of wild-type RAS metastatic colorectal cancer (mCRC) increases the median progression-free survival (PFS). Nevertheless, panitumumab is not yet approved in China, and the costs and outcomes of the therapy are still unclear. We estimated the cost-effectiveness of this intervention from the perspective of Chinese health care systems by constructing two pricing scenarios for panitumumab. Scenario 1: Pricing is based on the price of a similar product (cetuximab) in China. Scenario 2: We estimated the value-based price. METHODS A partitioned survival model was created based on the results of the NCT00339183 trial, which evaluated panitumumab plus FOLFIRI versus FOLFIRI. The model simulated the disease progression. We calculated medical costs from the perspectives of the Chinese health care systems. The primary outcome measures were costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). RESULTS In scenario 1, compared with FOLFIRI alone, FOLFIRI with panitumumab arm had an ICER of ¥1,539,988/QALY. The most influential factors were the mean overall survival (OS), utility before progression and cost of panitumumab. The probability of panitumumab plus FOLFIRI being cost-effective in China was 0% when the willingness-to-pay (WTP) threshold was ¥193,932/QALY. In scenario 2, when the cost of panitumumab was assumed to be ¥4032.61 or ¥5218.96 per cycle, the ICERs approximated the WTP thresholds of ¥193,932/QALY or ¥420,633/QALY, respectively. In this value-based pricing scenario, panitumumab plus FOLFIRI is estimated to be cost-effective. CONCLUSION We construct two pricing scenarios in China. In scenario 1, panitumumab plus FOLFIRI as a second-line therapy of mCRC provided an incremental benefit, but simultaneously increased costs (at the current price) even further. In scenario 2, when the value-based price was adopted, panitumumab plus FOLFIRI was estimated to be cost-effective. Our study establishes a pricing framework for new anticancer drugs to reflect the economics of drugs. TRIAL REGISTRATION NUMBER NCT00339183.
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Gandjour A. Underuse of innovative medicines in Germany: A justification for government intervention? Health Policy 2018; 122:1283-1286. [PMID: 30389185 DOI: 10.1016/j.healthpol.2018.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 08/10/2018] [Accepted: 08/22/2018] [Indexed: 11/29/2022]
Abstract
The German market for innovative medicines is characterized by simultaneous underuse and overuse. In order to address these deficits and improve decision making by physicians, the German parliament recently passed a law which mandates implementing reimbursement decisions on innovative medicines in the prescription software for physicians. This article discusses the political process leading to the law as well as its rationale in view of economic theory. Based on the considerably larger extent of underuse than overuse of innovative medicines in Germany this article predicts that the law will lead to an increase in sales by the pharmaceutical industry. It argues that legislation to increase prescription rates through information technology is questionable in a market where competitive forces should prevail. The correct approach, in line with economic theory, is either to improve information availability for patients or change existing regulation in the case of government failure. The latter may include revoking penalties for physician prescriptions and imposing prescription exclusions.
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Affiliation(s)
- Afschin Gandjour
- Frankfurt School of Finance & Management, Adickesallee 32-34, 60322 Frankfurt am Main, Germany.
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Mahlich J, Sindern J, Suppliet M. Cross-national drug price comparisons with economic weights in external reference pricing in Germany. Expert Rev Pharmacoecon Outcomes Res 2018; 19:37-43. [PMID: 30273062 DOI: 10.1080/14737167.2019.1527221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Since 2012, the pharmaceutical reimbursement legislation in Germany has been applying external reference pricing that uses country-specific economic weights for foreign prices. However, the law does not specify technical details. Therefore, we develop a proposal on how national income weights can be taken into consideration. AREAS COVERED We develop weighting schemes that draw on gross domestic product per capita and adjust for purchasing power parities and exchange rates. In a second step, we populate the weighting schemes with economic data as well as with the price data for a pharmaceutical product (abiraterone acetate). Weighting the price of abiraterone acetate by gross domestic product per capita indicates potential price differentials of up to 43 percentage points across European prices in the German basket. EXPERT COMMENTARY The weighting of foreign pharmaceutical prices by economic indicators, i.e. gross domestic product per capita, can capture economic differences across countries. It would also allow for differential Ramsey pricing which might foster innovation.
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Affiliation(s)
- Jörg Mahlich
- a Health Economics and Outcomes Research , Janssen-Cilag , Neuss , Germany.,b University of Düsseldorf, Institute for Competition Economics , Düsseldorf , Germany
| | - Jörn Sindern
- a Health Economics and Outcomes Research , Janssen-Cilag , Neuss , Germany
| | - Moritz Suppliet
- c TILEC and Department of Economics , Tilburg University , Tilburg , The Netherlands
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Sandmann FG, Mostardt S, Lhachimi SK, Gerber-Grote A. The efficiency-frontier approach for health economic evaluation versus cost-effectiveness thresholds and internal reference pricing: combining the best of both worlds? Expert Rev Pharmacoecon Outcomes Res 2018; 18:475-486. [DOI: 10.1080/14737167.2018.1497976] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Frank G. Sandmann
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Mostardt
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - Stefan K. Lhachimi
- Research Group Evidence-Based Public Health, Leibniz-Institute for Epidemiology and Prevention Research (BIPS), Bremen, Germany
- Institute for Public Health and Nursing, Health Sciences Bremen, University Bremen, Bremen, Germany
| | - Andreas Gerber-Grote
- School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
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Lauenroth VD, Stargardt T. Pharmaceutical Pricing in Germany: How Is Value Determined within the Scope of AMNOG? Value Health 2017; 20:927-935. [PMID: 28712622 DOI: 10.1016/j.jval.2017.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 04/04/2017] [Accepted: 04/08/2017] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To analyze how value is determined within the scope of the German Pharmaceutical Restructuring Act, which came into effect in 2011. METHODS Using data from all pharmaceuticals that had undergone assessment, appraisal, and price negotiations in Germany before June 30, 2016, we applied generalized linear model regression to analyze the impact of added benefit on the difference between negotiated prices and the prices of comparators. Data were extracted from the Federal Joint Committee's appraisals and price databases. We specified added benefit in various ways. In all models, we controlled for additional criteria such as size of patient population, European price levels, and whether the comparators were generic. RESULTS Our regression results confirmed the descriptive results, with price premiums reflecting the extent of added benefit as appraised by the Federal Joint Committee. On the substance level, an added benefit was associated with an increase in price premium of 227.2% (P < 0.001) compared with no added benefit. Moreover, we saw increases in price premium of 377.5% (P < 0.001), 90.0% (P < 0.001), and 336.8% (P < 0.001) for added benefits that were "considerable," "minor," and "not quantifiable," respectively. Beneficial effects on mortality were associated with the greatest price premium (624.3%; P < 0.001), followed by such effects on morbidity (174.7%; P < 0.001) and adverse events (93.1%; P = 0.019). CONCLUSIONS Price premiums, or "value," are driven by health gain, the share of patients benefiting from a pharmaceutical, European price levels, and whether comparators are generic. No statement can be made, however, about the appropriateness of the level of price premiums.
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Affiliation(s)
| | - Tom Stargardt
- Hamburg Center for Health Economics, Hamburg, Germany
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Ludwig S, Dintsios CM. Arbitration Board Setting Reimbursement Amounts for Pharmaceutical Innovations in Germany When Price Negations between Payers and Manufacturers Fail: An Empirical Analysis of 5 Years' Experience. Value Health 2016; 19:1016-1025. [PMID: 27987628 DOI: 10.1016/j.jval.2016.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 05/16/2016] [Accepted: 05/28/2016] [Indexed: 05/28/2023]
Abstract
BACKGROUND In Germany, an arbitration board is setting reimbursement amounts for drug innovations when price negations between payers and manufacturers fail. OBJECTIVE To empirically analyze all arbitrations since the reform of Germany's Act to Reorganize the Pharmaceuticals' Market in the Statutory Health Insurance System came into effect. METHODS All available relevant documents up to January 2016 were screened and the identified contentious issues between the negotiation parties extracted. Reimbursement requests of both the negotiating parties and the arbitrations were transformed into a comparable format on the basis of defined daily doses and then contrasted among each other. RESULTS In the given period, 16 arbitrations took place. The arbitration board is implementing the same criteria used in the negotiations between manufacturers and payers. Almost all arbitrations dealt with generic appropriate comparative therapies. Reimbursement amounts set by arbitration were on average 38.4% less than the mean of negotiation parties' requests (69.2% less than the manufacturers' requests). The corresponding prescription volumes were arranged rather centrally. All but one arbitration refer to a 1-year contract period. The arbitration board rarely decided on further technical contentious points. Hence, no heuristics referring to them were derivable. CONCLUSIONS There is some evidence for a quasi-algorithmic approach of the arbitration board, even though it is legally determined that it has to decide while taking the peculiar conditions of each case into due consideration, including the characteristics of the respective therapeutic area. The balance of interests proved to be within a very narrow space albeit it concerns in principle discretionary decisions. Thus, the purpose of arbitration seems not to be achieved sufficiently.
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Affiliation(s)
- Saskia Ludwig
- Cologne Institute for Health Economics and Clinical Epidemiology, University of Cologne, Germany
| | - Charalabos-Markos Dintsios
- Institute of Health Services Research and Health Economics, Medical Faculty Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
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Fischer KE, Heisser T, Stargardt T. Health benefit assessment of pharmaceuticals: An international comparison of decisions from Germany, England, Scotland and Australia. Health Policy 2016; 120:1115-1122. [DOI: 10.1016/j.healthpol.2016.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/19/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
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Affiliation(s)
- Afschin Gandjour
- Frankfurt School of Finance and Management, Sonnemannstr. 9-11, 60314, Frankfurt am Main, Germany.
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Abstract
The U.S. must assess its pricing and reimbursement system for prescription drugs. The current system is attracting intense scrutiny for various reasons. Drug pricing and reimbursement mechanisms used in other countries are described to assess what an optimal system should entail.
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Affiliation(s)
- Daniel A Goldstein
- Davidoff Cancer Center, Rabin Medical Center, Petach Tikvah, Israel Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Michal Sarfaty
- Davidoff Cancer Center, Rabin Medical Center, Petach Tikvah, Israel Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Brandes A, Sinner MF, Kääb S, Rogowski WH. Early decision-analytic modeling - a case study on vascular closure devices. BMC Health Serv Res 2015; 15:486. [PMID: 26507131 PMCID: PMC4624700 DOI: 10.1186/s12913-015-1118-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 09/24/2015] [Indexed: 01/11/2023] Open
Abstract
Background As economic considerations become more important in healthcare reimbursement, decisions about the further development of medical innovations need to take into account not only medical need and potential clinical effectiveness, but also cost-effectiveness. Already early in the innovation process economic evaluations can support decisions on development in specific indications or patient groups by anticipating future reimbursement and implementation decisions. One potential concept for early assessment is value-based pricing. Methods The objective is to assess the feasibility of value-based pricing and product design for a hypothetical vascular closure device in the pre-clinical stage which aims at decreasing bleeding events. A deterministic decision-analytic model was developed to estimate the cost-effectiveness of established vascular closure devices from the perspective of the Statutory Health Insurance system. To identify early benchmarks for pricing and product design, three strategies of determining the product’s value are explored: 1) savings from complications avoided by the new device; 2) valuation of the avoided complications based on an assumed willingness-to-pay-threshold (the efficiency frontier approach); 3) value associated with modifying the care pathways within which the device would be applied. Results Use of established vascular closure devices is dominated by manual compression. The hypothetical vascular closure device reduces overall complication rates at higher costs than manual compression. Maximum cost savings of only about €4 per catheterization could be realized by applying the hypothetical device. Extrapolation of an efficiency frontier is only possible for one subgroup where vascular closure devices are not a dominated strategy. Modifying care in terms of same-day discharge of patients treated with vascular closure devices could result in cost savings of €400-600 per catheterization. Conclusions It was partially feasible to calculate value-based prices for the novel closure device which can be used to inform product design. However, modifying the care pathway may generate much more value from the payers’ perspective than modifying the device per se. Manufacturers should thus explore the feasibility of combining reimbursement of their product with arrangements that make same-day discharge attractive also for hospitals. Due to the early nature of the product, the results are afflicted with substantial uncertainty.
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Affiliation(s)
- Alina Brandes
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany.
| | - Moritz F Sinner
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilian University, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Stefan Kääb
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilian University, Marchioninistrasse 15, 81377, Munich, Germany. .,Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK, German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Biedersteiner Strasse 29, 80802, Munich, Germany.
| | - Wolf H Rogowski
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany. .,Ludwig-Maximilian University, Munich, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Clinical Center, Ziemssenstrasse 1, 80336, Munich, Germany.
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Gissel C, Götz G, Mahlich J, Repp H. Cost-effectiveness of Interferon-free therapy for Hepatitis C in Germany--an application of the efficiency frontier approach. BMC Infect Dis 2015; 15:297. [PMID: 26223310 PMCID: PMC4520276 DOI: 10.1186/s12879-015-1048-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 07/21/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The approval of direct-acting antivirals for Interferon-free treatment revolutionized the therapy of chronic Hepatitis C infection. As of August 2014, two treatment regimens for genotype 1 infection received conditional approval in the European Union: Sofosbuvir and Ribavirin for 24 weeks and Sofosbuvir and Simeprevir with or without Ribavirin for 12 weeks. We aim to analyze the cost-effectiveness of both regimens in Germany. METHODS We set up a Markov model with a lifetime horizon to simulate immediate treatment success and long-term disease progression for treatment-naive patients. The model analyzes both short-term and long-term costs and benefits from the perspective of the German Statutory Health Insurance. We apply the efficiency frontier method, which was suggested by German Institute for Quality and Efficiency in Health Care for cost-effectiveness analysis in Germany. RESULTS The efficiency frontier is defined by dual therapy and first generation direct-acting antiviral Boceprevir, yielding a maximum of € 1,447.69 per additional percentage point of sustained virologic response gained. Even without rebates, Sofosbuvir/Simeprevir is very close with € 1,560.13 per additional percentage point. It is both more effective and less expensive than Sofosbuvir/Ribavirin. CONCLUSIONS In addition to higher sustained virologic response rates, new direct-acting antivirals save long-term costs by preventing complications such as liver cirrhosis, hepatocellular carcinoma and ultimately liver transplants, thereby offsetting part of higher drug costs. Our findings are in line with the guidance published by German Society for Gastroenterology, Digestive and Metabolic Diseases, which recommends Sofosbuvir/Simeprevir for Interferon ineligible or intolerant patients.
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Affiliation(s)
- Christian Gissel
- Department of Economics and Business, Justus Liebig University Giessen, Giessen, Germany.
- General Medicine, Department of Medicine, Justus Liebig University Giessen, Klinikstrasse 32, 35392, Giessen, Germany.
| | - Georg Götz
- Department of Economics and Business, Justus Liebig University Giessen, Giessen, Germany.
| | - Jörg Mahlich
- Janssen Pharmaceutical K.K., 5-2, Nishi-kanda 3-chome, Chiyoda-ku, Tokyo, 101-0065, Japan.
- Düsseldorf Institute for Competition Economics (DICE), University of Düsseldorf, Düsseldorf, Germany.
| | - Holger Repp
- General Medicine, Department of Medicine, Justus Liebig University Giessen, Klinikstrasse 32, 35392, Giessen, Germany.
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Orben T, Rasch A, Dintsios CM. Re: "Early benefit assessment of new drugs in Germany--results from 2011 to 2012" [Health Policy 116 (2-3) (2014) 147-153]. Health Policy 2014; 118:271. [PMID: 25456020 DOI: 10.1016/j.healthpol.2014.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Tina Orben
- German Association of Research-based Pharmaceutical Companies (vfa), Berlin, Germany.
| | - Andrej Rasch
- German Association of Research-based Pharmaceutical Companies (vfa), Berlin, Germany
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Eger S, Mahlich JC. Pharmaceutical regulation in Europe and its impact on corporate R&D. Health Econ Rev 2014; 4:23. [PMID: 26208924 PMCID: PMC4502069 DOI: 10.1186/s13561-014-0023-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 09/11/2014] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Many European countries regulate the markets for prescription drugs in order to cope with rising health expenditures. On the other hand, regulation distorts incentives to invest in pharmaceutical R&D. This study aims at empirically assessing the impact of regulation on pharmaceutical R&D expenditures. METHODS We analyze a sample of 20 leading pharmaceutical companies between 2000 and 2008. The share of sales in Europe serves as a proxy for the degree of pharmaceutical regulation. We control for other firm specific determinants of R&D such as cash flow, company size, leverage ratio, growth rate, and Tobin's q. RESULTS Our results suggest a nonlinear relationship between European sales ratio and R&D intensity. Beyond a threshold of 33% of sales generated in Europe, a higher presence in Europe is associated with lower R&D investments. CONCLUSION The results can be interpreted as further evidence of the deteriorating effect of regulation on firm's incentives to invest in R&D.
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Affiliation(s)
- Stephan Eger
- />Medical University of Vienna, Spitalgasse 23, Vienna, 1090 Austria
| | - Jörg C Mahlich
- />University of Vienna, Department of Economics, Oskar-Morgenstern-Platz 1, Vienna, 1090 Austria
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Abstract
Background. Since 2011, when the German Pharmaceutical Market Restructuring Act (AMNOG) came into effect, newly licensed pharmaceuticals must demonstrate an added benefit over a comparator treatment to be reimbursed at a value greater than the reference price. Evidence submitted by manufacturers is assessed by the Institute for Quality and Efficiency in Health Care (IQWiG) and subsequently appraised by the German Federal Joint Committee (FJC) as part of so-called early benefit assessments (EBA). This study aims to explain the decisions made, clarify the roles of the parties (manufacturers, IQWiG, FJC) involved, and guide manufacturers in developing future submissions by analyzing 42 EBAs concluded since January 2011. Methods. We developed a variable list representing the essential components of the EBA: the rating decisions of manufacturers, IQWiG, and the FJC regarding each pharmaceutical’s added benefit; the characteristics of the pharmaceutical; the characteristics of the EBA process; the types of evidence submitted; the methods used to generate evidence; and the pharmaceutical’s maximum possible budget impact. We used Cohen’s kappa to analyze agreement between the rating decisions of the different parties. The chi-square test and bivariate regression were used to identify associations between components of the EBA process and the rating decisions of the FJC. Results. We observed a low level of agreement between manufacturers and the FJC (kappa = 0.21; 95% CI 0.107–0.31) and a substantial level of agreement between IQWiG and the FJC (kappa = 0.64; 95% CI 0.451–0.827) in their rating decisions. The characteristics of the EBA process—for example, duration of the process ( P = 0.357), participation in the official hearing ( P = 0.227), and the pharmaceutical’s budget impact ( P = 0.725)—did not have a significant effect on the rating decisions of the FJC. There was, however, an association between the type of evidence submitted and the FJC’s rating decision when the manufacturer’s dossier reported outcomes related to morbidity ( P = 0.009) or adverse events ( P < 0.001) but not mortality ( P = 0.718) or quality of life ( P = 0.783). Conclusions. While the FJC tends to disagree with the rating of benefit by manufacturers, it softens IQWiG’s decisions, potentially to make the final outcome more acceptable. Concerns voiced that the FJC might be exceeding its statutory authority by taking cost or procedural considerations into account appear to be unfounded. Choosing appropriate evidence to submit for each endpoint remains a challenge, as submission of health outcomes evidently influences decisions.
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Affiliation(s)
- Katharina E. Fischer
- University of Hamburg, Hamburg Center for Health Economics, Hamburg, Germany (KEF, TS)
| | - Tom Stargardt
- University of Hamburg, Hamburg Center for Health Economics, Hamburg, Germany (KEF, TS)
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Husereau D, Henshall C, Jivraj J. Adaptive approaches to licensing, health technology assessment, and introduction of drugs and devices. Int J Technol Assess Health Care 2014; 30:241-9. [PMID: 24921416 DOI: 10.1017/S0266462314000191] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Adaptive approaches to the introduction of drugs and medical devices involve the use of an evolving evidence base rather than conventional single-point-in-time evaluations as a proposed means to promote patient access to innovation, reduce clinical uncertainty, ensure effectiveness, and improve the health technology development process. METHODS This report summarizes a Health Technology Assessment International (HTAi) Policy Forum discussion, drawing on presentations from invited experts, discussions among attendees about real-world case examples, and background paper. RESULTS For adaptive approaches to be understood, accepted, and implemented, the Forum identified several key issues that must be addressed. These include the need to define the goals of and to set priorities for adaptive approaches; to examine evidence collection approaches; to clarify the roles and responsibilities of stakeholders; to understand the implications of adaptive approaches on current legal and ethical standards; to determine costs of such approaches and how they will be met; and to identify differences in applying adaptive approaches to drugs versus medical devices. The Forum also explored the different implications of adaptive approaches for various stakeholders, including patients, regulators, HTA/coverage bodies, health systems, clinicians, and industry. CONCLUSIONS A key outcome of the meeting was a clearer understanding of the opportunities and challenges adaptive approaches present. Furthermore, the Forum brought to light the critical importance of recognizing and including a full range of stakeholders as contributors to a shared decision-making model implicit in adaptive pathways in future discussions on, and implementation of, adaptive approaches.
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Gerber-Grote A, Sandmann FG, Zhou M, ten Thoren C, Schwalm A, Weigel C, Balg C, Mensch A, Mostardt S, Seidl A, Lhachimi SK. Decision making in Germany: Is health economic evaluation as a supporting tool a sleeping beauty? Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen 2014; 108:390-6. [DOI: 10.1016/j.zefq.2014.06.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/25/2014] [Accepted: 06/25/2014] [Indexed: 11/26/2022]
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Sacristán JA, Dilla T, Antoñanzas F. Priorización de intervenciones sanitarias en función de su efectividad: un paso intermedio en el camino hacia una medicina más eficiente. Med Clin (Barc) 2012; 139:458-60. [DOI: 10.1016/j.medcli.2012.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 06/28/2012] [Indexed: 10/27/2022]
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Fischer KE. A systematic review of coverage decision-making on health technologies-evidence from the real world. Health Policy 2012; 107:218-30. [PMID: 22867939 DOI: 10.1016/j.healthpol.2012.07.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 05/30/2012] [Accepted: 07/09/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Quantitative analysis of real-world coverage decision-making offers insights into the revealed preferences of appraisal committees. Aim of this review was to structure empirical evidence of coverage decisions made in practice based on the components 'methods and evidence', 'criteria and standards', 'decision outcome' and 'processes'. METHODS Several electronic databases, key journals and decision committees' websites were searched for publications between 1993 and June 2011. Inclusion criteria were the analysis of past decisions and application of quantitative methods. Each study was categorized by the scope of decision-making and the components covered by the variables used in quantitative analysis. RESULTS Thirty-two studies were identified. Many focused on pharmaceuticals, the UK NICE or the Australian PBAC. The components were covered comprehensively, but heterogeneously. Seventy-two variables were identified of which the following were more prevalent: specifications of the decision outcome; the indications considered for appraisal, identification of incremental cost-effectiveness ratios, appropriateness of evaluation methods, type of economic or clinical evidence used for assessment, and the decision date. CONCLUSIONS Research was dominated by analysis of decision outcomes and appraisal criteria. Although common approaches were identified, the complexity of coverage decision-making - reflected by the heterogeneity of identified variables - will continue to challenge empirical research.
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Affiliation(s)
- Katharina Elisabeth Fischer
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; University of Hamburg, Hamburg Center for Health Economics, Esplanade 36, 20354 Hamburg, Germany.
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McGuire A. The European value-pricing game. Expert Rev Pharmacoecon Outcomes Res 2012; 12:5-6. [DOI: 10.1586/erp.11.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Journal Watch. Pharmaceut Med 2011; 25:269-277. [DOI: 10.1007/bf03256869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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