The document discusses strategies for managing the economic crisis in Spain's healthcare system. It proposes (1) collaborating with industry to improve quality and introduce new technologies, (2) implementing risk-sharing agreements to distribute financial risk, and (3) rationalizing priorities and empowering decision-makers to consider value, efficacy, safety, and costs. The goal is to balance innovation, access, and financial sustainability through evidence-based healthcare technology assessment.

1. Estratègies de Gestió per fer front a la crisi econòmica: l’avaluació de fàrmacs II Trobada de Farmacèutics d’Hospital de Catalunya SCFH- Sociietat Catalana de Farmàcia Hospitalària Mont St Benet, 16 d’Abril de 2011 Oriol Solà-Morales, HTA Director

2. 12.117.772.605 € Interanual Gener 2011

5. Outline Algunes reflexions generals Algunes propostes

6. algunes reflexions generals

8. Financial ‘crunch’: expenditure in public prescriptions

9. Financial ‘crunch’: % Change in public prescriptions

10. Preus de Referència

11. Partides de despesa

12. Partides de despesa

13. Effect of reforms Austalia (Pharma benefit adv Board): +14% anual Canada (Ontario): +10% anual (15% 2001)

14. Registry & Financing of drugs Registry Price Financing AEMPS Ministry Cabinet DoH / Insurer CMS: Reasonable & Necessary CatSalut: appropriate adjustment of supply to the health needs of citizens NHS UK: comprehensive range of services CAIAQ: safety, effectiveness & efficiency FDA: Security & Efficacy EMA: quality, safety & efficacy

15. The impact of healthcare on health McKeown, Determinants of health, 1978

16. Benefits of new treatments Seruga, Annals Oncology 2010

17. Survival after Bone Marrow Graft autologous heterologous

18. Which is the current paradigm? cost Innovation ?

19. What the industry wants(HTAi Policy Forum, June 2010) Regulation only linked to scientific considerations, not economical All eligible patients have access, without restrictions Early dialogue with HTA/payers to align expectations and reduce development uncertainty Reduce the development costs Accept alternatives forms of evidence

20. What the industry wants(HTAi Policy Forum, June 2010) Regulation only linked to scientific considerations, not economical Eliminates equity and distributive justice All eligible patients have access, without restrictions No budget limits considerations Early dialogue with HTA/payers to align expectations and reduce development uncertainty Will that affect price seemingly? Reduce the development costs Introduces market imperfections Accept alternatives forms of evidence Reduces security? Are there any compensations? Risk Sharing?

21. algunes propostes

22. oferta Cost= Preu x Volum (C=P*Q)

23. Collaboration with the industry use time ‘competence’ / renovation Rearrangement / ‘Quality’ Evaluation Methodological evaluation / introduction Horizon Scanning

24. For who? Registry Price Reimbursement AEMPS Cabinet Insurer Prescription Only Non prescription / OTC Pharmacies ----- Physician Pharmacies Hospital Manager Hospital Promoter Insurer / Manager/ Physician MSyPS / AEMPS

25. Spain’s Healthcare System

26. Risk Sharing Qui el vol? Qui paga? Com es financia / qui el financia? Com es distribueix el risc? Estm preparats?

27. demanda Formació continuada Guíes farmacoterapèutiques Guies de Pràctica Clínica Copagament Racionar: Denial Delusion Defusion Deterrance Delay Arquitectura de decisions Avaluació de Tecnologies

28. Arquitecura de decisions

29. Nudge (Thaler i Sundstein) Incentivar: conèixer qui utilitza, qui escull, qui paga i qui obté els beneficis d’una intervenció; Entendre els mapes mentals: transformar les variables de decisió complexes en variables assimilables pel decisor; Accions per defecte: determinar quines són les accions que es realitzaran quan hi hagi falta d’acció–decisió; Esperar l’error: determinar què es farà quan l’usuari no segueixi l’opció considerada prioritària perquè reavaluï si la seva decisió és coherent amb l’escenari o ha estat fruit d’un error; Estructurar decisions complexes: en cas de decisions en què intervinguin concurrentment múltiples variables, intentar presentar les possibilitats de decisió estructurades per grups categòrics de dificultat creixent.

30. HTA, Technologies and Choice RationalisePrioritise Empower

31. RationalisePrioritise Empower HTA, Technologies and Choice

33. Appropriate Mix>Equity HTA, Technologies and Choice

34. Efficacy > Security > RoA > Cost >

35. CAIAQ Criteria

38. CAIAQ Approach

39. Forecast Assume 5/10.000 inhab Spain= 22.500 affected Estimated Budget impact: 505M€ (4%)

40. Creating Value This suggests that the producer or source of value must understand the relative knowledge of potential users and the context in which the evaluation of novelty and appropriateness will take place Lepak, Acad Manag Rev 2007

41. Creating Value Value is ….. is subjective and related to individual WTP WTP > production cost Related to novelty appropriateness Related to competitive advantage, dynamic capabilities organisational knowledge Buyers …. Must have specialised knowledge Cannot be separated from their context

42. Where? Context Implementation Funds Knowledge

43. Conclusions En el context actual cal revisar les mesuresqueafecten a la oferta i a la demanda facilitar (estructurar) la presa de decisions prendre les decisions