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Payer informayion requirements for relative effectiveness assessment vary across markets and create discrepencies in patient access to medicines
 

Payer informayion requirements for relative effectiveness assessment vary across markets and create discrepencies in patient access to medicines

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IHS Healthcare and Pharma research poster on payer information and patient access for relative effectiveness assessments. ISPOR 2012 poster

IHS Healthcare and Pharma research poster on payer information and patient access for relative effectiveness assessments. ISPOR 2012 poster

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    Payer informayion requirements for relative effectiveness assessment vary across markets and create discrepencies in patient access to medicines Payer informayion requirements for relative effectiveness assessment vary across markets and create discrepencies in patient access to medicines Document Transcript

    • Payer Information Requirements for RelativeEffectiveness Assessment Vary AcrossMarkets & Create Discrepencies in PatientAccess to MedicinesMarinoni G, Lockwood C, Honoré A, Rodrigues T, Izmirlieva M, Walker S, and Ando G (IHS, London, United Kingdom)Objective Case study 1: ticagrelor (prevention of thrombotic events)Across markets, rationalisation of healthcare expenditure is at the Australia (PBAC) •  ccepted for reimbursement upon a risk-sharing Atop of the political agenda. Increasingly, payers are evaluating agreement to address uncertaintypharmaceuticals in relation to existing treatments—in terms of Canada (CADTH) • Rejected for reimbursementefficacy, safety, and sometimes cost—to make P&R decisions. As United Kingdom (NICE) • Recommended for NHS usesuch, this study aimed to evaluate how relative effectiveness France (TC) • Accepted for reimbursement •  eemed a minor improvement over existing therapies Dassessment (REA) is used within the national P&R processes. Germany (G-BA) • Reimbursed •  eemed of significant added benefit in patients DMethods with non-ST-elevation myocardial infarction or unstable angina; of no proven added benefit in other patient populationsIHS assessed the impact of REA on patient access to medicines Case study 2: fingolimodin Australia, Brazil, Canada, France, Germany, Italy, the United (relapsing remitting multiple sclerosis)Kingdom, and the United States through primary and secondary Australia (PBAC) • Accepted for reimbursement upon price cutresearch. Over 30 key relative effectiveness assessors and P&R Canada (CADTH) • Restricted reimbursementdecision makers were interviewed to understand the methodology United Kingdom (NICE) •  ecommended for NHS use upon proposal Rfor REA in their respective country, as well as their data of a patient access schemerequirements and preferences by care segment and therapeutic France (TC) • Accepted for reimbursement • Deemed a minor improvement over existing therapiesarea. Germany (G-BA) • Reimbursed •  eemed of no proven added benefit except in DResults patients with rapidly evolving RRMS where a slight added benefit was foundSome countries assess new pharmaceuticals in relation to their Case study 3: fampridineappropriate comparators to make public funding decisions, some (improvement of walking ability in adults with multiple sclerosis)to inform pricing decisions/negotiations, and others leverage REA United Kingdom • Not recommended for NHS Scotland use1 (SMC; NETAG) • NETAG found no evidence for cost-effectivenessin both their pricing and reimbursement decision-making France (TC) •  onditional reimbursement (reassessment within Cprocesses. In terms of how therapeutic value is factored into the 12 months, 15% reimbursement level)P&R decision-making process, countries can be segmented into • Deemed of no improvement over existing therapiesbroad categories based on whether or not costs are considered in Germany (G-BA) • Reimbursed • Deemed of no proven added benefitaddition to clinical performance. Italy (AIFA) • Rejected for reimbursement REA position in REA assessment 1 : Automatic rejection, as manufacturer did not submit a reimbursement dossier P&R process methodology RRMS: relapsing-remitting multiple sclerosis | NETAG: North East Treatment Advisory Group Source: IHS research, 2012 Australia Informs pricing Economic evaluation and reimbursement In terms of information needs, payers wish to be in a position to Brazil Informs pricing Mix of methodologies1 evaluate how new medicines compare with the standard of care in and reimbursement their specific healthcare setting and in their patient population Canada Informs pricing Mix of methodologies when making their P&R decisions. In addition, they prefer hard and reimbursement clinical endpoints on which to base their decisions. Surrogate France Informs pricing Added therapeutic endpoints are not looked upon favourably, and when used, they and reimbursement value evaluation must be validated. Germany Informs pricing Added therapeutic value evaluation Italy Informs pricing and reimbursement Mix of methodologies Conclusions United Kingdom Informs reimbursement Economic evaluation In relation to REA, patient access to medicines is more stringent in United States Informs reimbursement Mix of methodologies countries that undertake economic evaluation. In the future, REA will increasingly be used by payers to rationalise finite healthcare1: Consists of the use of both an economic evaluation and anevaluation of added therapeutic value resources and budgets. This will limit patient access to medicinesSource: IHS research, 2012 that are not deemed to bring sufficient benefit in relation to existing treatment alternatives. Reimbursement delisting andThe evaluation of the therapeutic value of a medicine can result in restricted reimbursement decisions are also likely to becomeP&R decision discrepancies across markets. These coverage more common.disparities notably reflect societal and methodological differencesin the way the available evidence is interpreted across markets. FOR MORE INFORMATION ABOUT IHS GLOBAL INSIGHT HEALTHCARE & PHARMACEUTICAL SERVICES www.ihs.com/healthcare and www.ihs.com/healthcareblog Please email: gustav.ando@ihs.com for any questions related to this poster