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de Pouvourville G, Cunningham D, Fricke FU, Lindgren P, Mantovani L, Murphy LA, Solà-Morales O, Mestre-Ferrandiz J, Akehurst R. Across-Country Variations of Real-World Data and Evidence for Drugs: A 5-European-Country Study. Value Health 2023; 26:3-10. [PMID: 36709042 DOI: 10.1016/j.jval.2023.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 08/08/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVES This study aimed to describe the role of real-world data (RWD) and real-world evidence (RWE) in health technology assessment (HTA) in 5 European countries and to identify the hurdles to the acceptance of RWE and suggest directions toward its more effective use. METHODS Authors from France, Germany, Italy, and Sweden used a common template to extract evidence. For England, the Cancer Drugs Fund was described and analyzed as a particular model for the use of RWD to provide evidence for coverage decisions and managed entry agreements. RESULTS In all countries except Germany, HTA bodies acknowledged the relevance of RWD/RWE to address postlaunch uncertainties. In Germany, evidence from randomized controlled trials remains the gold standard, and evidence based on RWD is generally rejected. Multiple sources of RWD exist, but the quality, the immediate relevance of existing sources, and their interoperability limit their adaptation to the specifics of a given drug. This leads to skepticism about the validity of the evidence. Timing is also a key issue: the production of evidence may not be synchronized with the HTA and pricing bodies' agendas. The Cancer Drugs Fund case emphasizes that a strong partnership among all stakeholders and a pragmatic use of existing data, alongside clinical evidence provided by companies, are key success factors. CONCLUSIONS A continuous investment in national health information systems is a key issue for providing valid RWE. Processes and aids to guide the acceptability and usage of RWE derived from pairing between sources and questions are essential.
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Kohli MA, Maschio M, Cartier S, Mould-Quevedo J, Fricke FU. The Cost-Effectiveness of Vaccination of Older Adults with an MF59-Adjuvanted Quadrivalent Influenza Vaccine Compared to Other Available Quadrivalent Vaccines in Germany. Vaccines (Basel) 2022; 10:vaccines10091386. [PMID: 36146464 PMCID: PMC9503029 DOI: 10.3390/vaccines10091386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/24/2022] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 11/24/2022] Open
Abstract
Enhanced quadrivalent influenza vaccines that include an adjuvant (aQIV) or a high dose of antigen (QIV-HD), which stimulate a stronger immune response in older adults than the standard vaccine (QIVe), are now approved. The objective of this research is to compare available vaccines and determine the cost-effectiveness of immunizing persons aged 65 years and above with aQIV compared to QIVe and QIV-HD in Germany. A compartmental transmission model calibrated to outpatient visits for influenza in Germany was used to predict the number of medically attended infections using the three vaccines. The rates of hospitalizations, deaths, and other economic consequences were estimated with a decision tree using German data where available. Based on meta-analysis, the rVE of −2.5% to 8.9% for aQIV versus QIV-HD, the vaccines are similar clinically, but aQIV is cost saving compared to QIV-HD (unit cost of EUR 40.55). All results were most sensitive to changes in vaccine effectiveness. aQIV may be cost-effective compared to QIVe depending on the willingness to pay for additional benefits in Germany. As aQIV and QIV-HD are similar in terms of effectiveness, aQIV is cost saving compared to QIV-HD at current unit prices.
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Affiliation(s)
- Michele A. Kohli
- Quadrant Health Economics Inc., 92 Cottonwood Crescent, Cambridge, ON N1T 2J1, Canada
| | - Michael Maschio
- Quadrant Health Economics Inc., 92 Cottonwood Crescent, Cambridge, ON N1T 2J1, Canada
| | - Shannon Cartier
- Quadrant Health Economics Inc., 92 Cottonwood Crescent, Cambridge, ON N1T 2J1, Canada
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Tunis S, Hanna E, Neumann PJ, Toumi M, Dabbous O, Drummond M, Fricke FU, Sullivan SD, Malone DC, Persson U, Chambers JD. Variation in market access decisions for cell and gene therapies across the United States, Canada, and Europe. Health Policy 2021; 125:1550-1556. [PMID: 34763929 DOI: 10.1016/j.healthpol.2021.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 02/25/2021] [Revised: 08/13/2021] [Accepted: 10/03/2021] [Indexed: 11/29/2022]
Abstract
Transformative cell and gene therapies have now launched worldwide, and many potentially curative cell and gene therapies are in development, offering the prospect of significant health gains for patients. Access to these therapies depend on decisions made by health technology assessment (HTA) and payer organizations. We sought to describe the emerging cell and gene therapies market access landscape by analyzing 17 US commercial payer medical policies, and HTA reports from five European countries and Canada. We found that some US health plans applied coverage restrictions more often than others (four plans applied restrictions in all decisions, while four plans applied restrictions in <30% of decisions). The European and Canadian HTA bodies recommend access to fewer therapies than US health plans, reflecting a more stringent approach in the context of limited evidence and high scientific uncertainty that is commonly associated with these treatments. Our findings suggest that patient access to approved cell and gene therapies is restricted in all regions studied, though the nature of these restrictions differs between US health plans and the European/Canada HTA recommendations. Payers, HTA groups, pharmaceutical companies, and other stakeholders should collaborate to more clearly define the "uncertainties" and develop market access policies that balance benefits of early access with ongoing data collection to close evidence gaps over time.
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Affiliation(s)
| | | | | | | | - Omar Dabbous
- Novartis Gene Therapies, Inc. Bannockburn, IL, USA.
| | | | | | | | | | - Ulf Persson
- IHE - The Swedish Institute for Health Economics, Lund, Sweden
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Petykó ZI, Kaló Z, Espin J, Podrazilová K, Tesař T, Maniadakis N, Fricke FU, Inotai A. Development of a core evaluation framework of value-added medicines: report 1 on methodology and findings. Cost Eff Resour Alloc 2021; 19:57. [PMID: 34465350 PMCID: PMC8406013 DOI: 10.1186/s12962-021-00311-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/23/2021] [Accepted: 08/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background Medicines that are based on known molecules and are further developed to address healthcare needs and deliver relevant improvement for patients, healthcare professionals and/or payers are called value-added medicines (VAMs). The evaluation process of VAMs is heterogeneous across countries, and it has been primarily designed for originator pharmaceuticals with confirmatory evidence collected alongside pivotal clinical trials. There is a mismatch between evidence requirements by public decision-makers and evidence generated by manufacturers of VAMs. Our objective was to develop a core evaluation framework for VAMs. Methods Potential benefits offered by VAMs were collected through a systematic literature review and allocated to separate domains in an iterative process. The draft list of domains and their applicability were validated during two consecutive virtual workshops by health policy experts representing countries with different economic statuses, geographical and decision-making contexts. Results Based on 158 extracted studies, the final consensus on the evaluation framework resulted in 11 value domains in 5 main clusters, including unmet medical needs, health gain (measured by health care professionals), patient-reported outcomes, burden on households, and burden on the health care system. Conclusions The proposed framework could reduce the heterogeneity in value assessment processes across countries and create incentives for manufacturers to invest in incremental innovation. However, some domains may not be equally relevant or accepted in all countries, therefore the core framework needs thorough adaptation in specific jurisdictions. Supplementary Information The online version contains supplementary material available at 10.1186/s12962-021-00311-6.
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Affiliation(s)
- Zsuzsanna Ida Petykó
- Center for Health Technology Assessment, Semmelweis University, Üllői rd. 25, Budapest, 1085, Hungary.,Syreon Research Institute, Mexikói str. 65/A, Budapest, 1142, Hungary
| | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University, Üllői rd. 25, Budapest, 1085, Hungary.,Syreon Research Institute, Mexikói str. 65/A, Budapest, 1142, Hungary
| | - Jaime Espin
- Andalusian School of Public Health, Granada, Spain
| | | | - Tomáš Tesař
- Department of Organisation and Management of Pharmacy, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovakia
| | - Nikos Maniadakis
- Department of Public Health Policies, Sector of Health Systems and Policy, School of Public Health, University of West Attica, Athens, Greece
| | | | - András Inotai
- Center for Health Technology Assessment, Semmelweis University, Üllői rd. 25, Budapest, 1085, Hungary. .,Syreon Research Institute, Mexikói str. 65/A, Budapest, 1142, Hungary.
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Kaló Z, Petykó ZI, Fricke FU, Maniadakis N, Tesař T, Podrazilová K, Espin J, Inotai A. Development of a core evaluation framework of value-added medicines: report 2 on pharmaceutical policy perspectives. Cost Eff Resour Alloc 2021; 19:42. [PMID: 34266465 PMCID: PMC8280561 DOI: 10.1186/s12962-021-00296-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/30/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A core evaluation framework that captures the health care and societal benefits of value added medicines (VAMs, also often called repurposed medicines) was proposed in Report 1, aiming to reduce the heterogeneity in value assessment processes across countries and to create incentives for manufacturers to invest into incremental innovation. However, this can be impactful only if the framework can be adapted to heterogeneous health care financing systems in different jurisdictions, and the cost of evidence generation necessitated by the framework takes into account the anticipated benefits for the health care system and rewards for the developers. AREAS COVERED The framework could potentially improve the pricing and reimbursement decisions of VAMs by adapting it to different country specific decision-contexts such as deliberative processes, augmented cost-effectiveness frameworks or formal multi-criteria decision analysis (MCDA); alternatively, some of its domains may be added to current general evaluation frameworks of medicines. The proposed evaluation framework may provide a starting point for practices based on which VAMs can be exempted from generic pricing mechanisms or can be integrated into the reimbursement and procurement system, allowing for price differentiation according to their added value. Besides evidence from RCTs, pricing and reimbursement decision processes of VAMs should allow for ex-ante non-RCT evidence for certain domains. Alternatively, relying on ex-post evidence agreements-such as outcome guarantee or coverage with evidence development-can also reduce decision uncertainty. CONCLUSIONS The core evaluation framework for VAMs could trigger changes in the existing pricing, reimbursement and procurement practices by improving the appraisal of the added value created by incremental innovation.
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Affiliation(s)
- Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University, Üllői rd. 25, 1085, Budapest, Hungary
- Pharmaceutical Policy Research, Syreon Research Institute, Mexikói str. 65/A, 1142, Budapest, Hungary
| | - Zsuzsanna Ida Petykó
- Center for Health Technology Assessment, Semmelweis University, Üllői rd. 25, 1085, Budapest, Hungary
- Pharmaceutical Policy Research, Syreon Research Institute, Mexikói str. 65/A, 1142, Budapest, Hungary
| | | | - Nikos Maniadakis
- Department of Public Health Policies, Sector of Health Systems and Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Tomáš Tesař
- Department of Organisation and Management of Pharmacy, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovakia
| | | | - Jaime Espin
- Andalusian School of Public Health, Granada, Spain
| | - András Inotai
- Center for Health Technology Assessment, Semmelweis University, Üllői rd. 25, 1085, Budapest, Hungary.
- Pharmaceutical Policy Research, Syreon Research Institute, Mexikói str. 65/A, 1142, Budapest, Hungary.
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Aballéa S, Thokagevistk K, Velikanova R, Simoens S, Annemans L, Antonanzas F, Auquier P, François C, Fricke FU, Malone D, Millier A, Persson U, Petrou S, Dabbous O, Postma M, Toumi M. Health economic evaluation of gene replacement therapies: methodological issues and recommendations. J Mark Access Health Policy 2020; 8:1822666. [PMID: 33144927 PMCID: PMC7580851 DOI: 10.1080/20016689.2020.1822666] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 05/08/2023]
Abstract
Objective: To provide recommendations for addressing previously identified key challenges in health economic evaluations of Gene Replacement Therapies (GRTs), including: 1) the assessment of clinical effectiveness; 2) the valuation of health outcomes; 3) the time horizon and extrapolation of effects beyond trial duration; 4) the estimation of costs; 5) the selection of appropriate discount rates; 6) the incorporation of broader elements of value; and 7) affordability. Methods: A literature review on economic evaluations of GRT was performed. Interviews were conducted with 8 European and US health economic experts with experience in evaluations of GRT. Targeted literature reviews were conducted to investigate further potential solutions to specific challenges. Recommendations: Experts agreed on factors to be considered to ensure the acceptability of historical cohorts by HTA bodies. Existing prospective registries or, if not available, retrospective registries, may be used to analyse different disease trajectories and inform extrapolations. The importance of expert opinion due to limited data was acknowledged. Expert opinion should be obtained using structured elicitation techniques. Broader elements of value, beyond health gains directly related to treatment, can be considered through the application of a factor to inflate the quality-adjusted life years (QALYs) or a higher cost-effectiveness threshold. Additionally, the use of cost-benefit analysis and saved young life equivalents (SAVE) were proposed as alternatives to QALYs for the valuations of outcomes of GRT as they can incorporate broader elements of value and avoid problems of eliciting utilities for paediatric diseases. Conclusions: While some of the limitations of economic evaluations of GRT are inherent to limited clinical data and lack of experience with these treatments, others may be addressed by methodological research to be conducted by health economists.
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Affiliation(s)
| | | | - Rimma Velikanova
- Groningen Research Institute of Pharmacy, PharmacoTherapy, Epidemiology & Economics, University of Groningen, Groningen, Netherlands
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Lieven Annemans
- Department of Public Health, Ghent University, Ghent, Belgium
| | | | - Pascal Auquier
- CEReSS - Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Clément François
- Creativ-Ceutical, HEOR, Paris, France
- Public Health Department - Research Unit, Aix-Marseille University, Marseille, France
| | | | - Daniel Malone
- Pharmacotherapy Faculty, College of Pharmacy, University of Utah, Salt Lake City, USA
| | | | - Ulf Persson
- The Swedish Institute for Health Economics (IHE), Lund, Sweden
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Omar Dabbous
- Global Health Economics and Outcomes Research and Real World EvidenceAveXis Inc, Novartis Gene Therapies, Bannockburn, IL, USA
| | - Maarten Postma
- Groningen Research Institute of Pharmacy, PharmacoTherapy, Epidemiology & Economics, University of Groningen, Groningen, Netherlands
| | - Mondher Toumi
- Creativ-Ceutical, HEOR, Paris, France
- Public Health Department - Research Unit, Aix-Marseille University, Marseille, France
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Drummond MF, Neumann PJ, Sullivan SD, Fricke FU, Tunis S, Dabbous O, Toumi M. Analytic Considerations in Applying a General Economic Evaluation Reference Case to Gene Therapy. Value Health 2019; 22:661-668. [PMID: 31198183 DOI: 10.1016/j.jval.2019.03.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [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: 01/17/2019] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 05/05/2023]
Abstract
The concept of a reference case, first proposed by the US Panel on Cost-Effectiveness in Health and Medicine, has been used to specify the required methodological features of economic evaluations of healthcare interventions. In the case of gene therapy, there is a difference of opinion on whether a specific methodological reference case is required. The aim of this article was to provide a more detailed analysis of the characteristics of gene therapy and the extent to which these characteristics warrant modifications to the methods suggested in general reference cases for economic evaluation. We argue that a completely new reference case is not required, but propose a tailored checklist that can be used by analysts and decision makers to determine which aspects of economic evaluation should be considered further, given the unique nature of gene therapy.
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Affiliation(s)
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA, USA
| | - Sean D Sullivan
- CHOICE Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Frank-Ulrich Fricke
- Fakultät Betriebswirtschaft, Technische Hochschule Nürnberg Georg Simon Ohm, Nürnberg, Germany
| | - Sean Tunis
- Center for Medical Technology Policy, Baltimore, MD, USA
| | | | - Mondher Toumi
- Public Health Department, Aix-Marseille University, Marseille, France
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Csanádi M, Kaló Z, Prins CP, Grélinger E, Menczelné Kiss A, Fricke FU, Fuksa L, Tesar T, Manova M, Lorenzovici L, Vokó Z, Garrison LP. The implications of external price referencing on pharmaceutical list prices in Europe. Health Policy and Technology 2018. [DOI: 10.1016/j.hlpt.2018.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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10
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Fricke FU. Cost-effectiveness analysis (CEA) health economic point of view. Am Heart J 2006; 151:e1; author reply e3. [PMID: 16368280 DOI: 10.1016/j.ahj.2005.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Abstract
BACKGROUND AND PURPOSE It is generally known and accepted that percutaneous coronary intervention (PCI) has undergone a patient-relevant innovation with the introduction of drug-eluting stents (DES): prospective, randomized, controlled studies with a primary clinical endpoint have shown that DES, especially those releasing sirolimus from a polymer (SES) or those releasing paclitaxel from a polymer (PES), significantly and relevantly reduce the restenosis rate and hence the number of needed reinterventions in the target vessel (target vessel revascularization [TVR]) as compared to bare metal stents (BMS). For this improvement of quality of life, cost-effectiveness analyses comparing DES and BMS in the US and German health care systems have been reported. For the comparison of DES and coronary artery bypass graft surgery (CABG), no economic data regarding the German health care system have been published. The goal of the present study is to provide such an economic analysis investigating the question whether DES can reduce costs as compared to CABG within the German health care system. METHODS Based on the clinical data for PCI with a PES for long and complex lesions (TAXUS VI) and for CABG (ARTS I), the comparison was calculated for the time interval of 1 year. The analysis of the PCI group was derived from a TVR of 11% including a CABG rate of 1%; the CABG group analysis was based on a TVR of 3.8% including a PCI rate of 3.1% and a re-CABG rate of 0.7%. At a stent factor of 2.75, the costs per stent were calculated to be 250 Euro for the BMS and 1,500 Euro for the PES. The total costs for 12 months included the follow-up costs for reinterventions. The results were tested for stability according to a sensitivity analysis. RESULTS Patients' demographics were well comparable between the PCI and the CABG groups. The primary costs, including the reinterventions, were 7,841 Euro for PCI and 12,415 Euro for CABG. The sensitivity analysis revealed that only at more than eight stents per patient and a need for reintervention of ca. 10% did the cost of PCI with PES reach the level of the cost for CABG. CONCLUSION Within the German health care system, in patients with a social insurance, PCI of long and complex lesions with PES significantly reduces costs as compared to CABG to the amount of 4,574 Euro per patient. The cost-effectiveness analyses of currently ongoing prospective, randomized trials (SYNTAX und FREEDOM) will provide more insight into the economic comparison of PCI with DES and CABG.
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Fricke FU. [The physician in times of economic forces]. Med Klin (Munich) 1996; 91:809-11. [PMID: 9082170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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