OHE Lunchtime Seminar with Associate Professor Paula Lorgelly, Deputy Director, Office of Health Economics
From the Antipodes to the Motherland: reflections on HTA decision makers as budget takers and budget makers
In this presentation, OHE's Shah explains what a QALY is, how NICE has used QALYs in its decisions, whether and when other factors might take priority -- e.g. in end-of-life situations, and the importance of systematically gathering and analysing public preferences about such exceptions.
Please share this slideshow with anyone who may be interested!
Watch all our webinars: https://www.youtube.com/playlist?list=PL4dDQscmFYu_ezxuxnAE61hx4JlqAKXpR
In this webinar:
● A discussion on the Canadian public and private drug access environment
● A moderated panel on the broader access and innovation context, featuring an update on international access to innovative therapies, patient support programs, and innovative pathways for access to treatments
View the video:
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In this presentation, OHE's Shah explains what a QALY is, how NICE has used QALYs in its decisions, whether and when other factors might take priority -- e.g. in end-of-life situations, and the importance of systematically gathering and analysing public preferences about such exceptions.
Please share this slideshow with anyone who may be interested!
Watch all our webinars: https://www.youtube.com/playlist?list=PL4dDQscmFYu_ezxuxnAE61hx4JlqAKXpR
In this webinar:
● A discussion on the Canadian public and private drug access environment
● A moderated panel on the broader access and innovation context, featuring an update on international access to innovative therapies, patient support programs, and innovative pathways for access to treatments
View the video:
Follow our social media accounts:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Pinterest - https://www.pinterest.com/survivornetwork
YouTube - https://www.youtube.com/user/Survivornetca
Reimbursement and pricing strategies for drugs for ultra rare diseases: What can Canada learn from experiences across the pond?
Tania Stafinski, University of Alberta
Rare Disease Day Conference 2020 March 9-10
Please share this video with anyone who may be interested!
Watch all our webinars: https://www.youtube.com/playlist?list=PL4dDQscmFYu_ezxuxnAE61hx4JlqAKXpR
In this webinar:
● A discussion on disparities in provincial reimbursement for cancer medications, and what patients can do about it
● Explanation of the different ways that cancer treatments are managed and funded across Canada, and outline the impact this has on patients depending on where they live in the country
View the video: https://youtu.be/NN3AcGYMXac
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Twitter - https://twitter.com/survivornetca
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Global HTA and pricing mechanisms
What can we learn about national medicines pricing and procurement?
Led by Janssen UK
Day One, Pop-up University 3, 16.00
Key factors driving access and uptake of hepatitis C treatments in Europe. Re...Office of Health Economics
This presentation summarises the results of experts interviews aiming to identify the key factors which have influenced the access and the uptake of direct acting antivirals (DAAs) in selected European countries. This qualitative piece of analysis was conducted as part of a larger project studying the development and the diffusion of innovation in the market of treatments for hepatitis C. The interviews shed light on the reimbursement strategies and other factors, relating to the ability of individual health care systems to supply the treatments, which may have influenced, positively of negatively, access and speed of uptake of DAAs in Europe.
Author(s) and affiliation(s): Margherita Neri, Office of Health Economics; Mikel Berdud, Office of Health Economics; Martina Garau, Office of Health Economics; Phill O’Neill, Office of Health Economics; Chris Sampson, Office of Health Economics; Adrian Towse, Office of Health Economics.
Conference/meeting: EuHEA Conference 2018
Location: Maastricht, Netherlands
Date: 11/07/2018
In this presentation, Bill Dempster and Johanne Chambers of 3Sixty Public Affairs walk through the different steps in bringing a new medicine through the regulatory review process, health technology assessment and funding, highlighting where patients can make a difference, and how their role is rapidly expanding.
Learn how to leverage effective strategies for global drug development, including expedited regulatory pathways, personalized medicines and genomics. View the full presentation from PAREXEL Consulting experts.
Reimbursement and pricing strategies for drugs for ultra rare diseases: What can Canada learn from experiences across the pond?
Tania Stafinski, University of Alberta
Rare Disease Day Conference 2020 March 9-10
Please share this video with anyone who may be interested!
Watch all our webinars: https://www.youtube.com/playlist?list=PL4dDQscmFYu_ezxuxnAE61hx4JlqAKXpR
In this webinar:
● A discussion on disparities in provincial reimbursement for cancer medications, and what patients can do about it
● Explanation of the different ways that cancer treatments are managed and funded across Canada, and outline the impact this has on patients depending on where they live in the country
View the video: https://youtu.be/NN3AcGYMXac
Follow our social media accounts:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Pinterest - https://www.pinterest.com/survivornetwork
YouTube - https://www.youtube.com/user/Survivornetca
Global HTA and pricing mechanisms
What can we learn about national medicines pricing and procurement?
Led by Janssen UK
Day One, Pop-up University 3, 16.00
Key factors driving access and uptake of hepatitis C treatments in Europe. Re...Office of Health Economics
This presentation summarises the results of experts interviews aiming to identify the key factors which have influenced the access and the uptake of direct acting antivirals (DAAs) in selected European countries. This qualitative piece of analysis was conducted as part of a larger project studying the development and the diffusion of innovation in the market of treatments for hepatitis C. The interviews shed light on the reimbursement strategies and other factors, relating to the ability of individual health care systems to supply the treatments, which may have influenced, positively of negatively, access and speed of uptake of DAAs in Europe.
Author(s) and affiliation(s): Margherita Neri, Office of Health Economics; Mikel Berdud, Office of Health Economics; Martina Garau, Office of Health Economics; Phill O’Neill, Office of Health Economics; Chris Sampson, Office of Health Economics; Adrian Towse, Office of Health Economics.
Conference/meeting: EuHEA Conference 2018
Location: Maastricht, Netherlands
Date: 11/07/2018
In this presentation, Bill Dempster and Johanne Chambers of 3Sixty Public Affairs walk through the different steps in bringing a new medicine through the regulatory review process, health technology assessment and funding, highlighting where patients can make a difference, and how their role is rapidly expanding.
Learn how to leverage effective strategies for global drug development, including expedited regulatory pathways, personalized medicines and genomics. View the full presentation from PAREXEL Consulting experts.
Easter means more than just chocolate bunnies. Easter break is usually a time when people start thinking about their summer travel plans. With the weather starting to warm up, the sunshine usually persuades consumers to venture out to take short breaks during the four day long weekend.
With a bit more leisure time to search for that perfect break, our data indicates that 39 percent of consumers book their holidays 22-30 days in advance, while 32 percent of users book their holidays 15-21 days before Easter.
Given this, it’s definitely not too early as travel marketers to begin promoting the “Easter Travel” trend. With Easter falling this Sunday, Media iQ decided to look at audience attributes and browsing patterns of consumers who searched for travel related content during Easter.
Our insights can help marketers plan their marketing campaigns more efficiently, budget intelligently for the coming Easter break, and understand when travellers are planning their travel, and where they plan to visit, thereby increasing conversions and bookings.
Social media came to the fore with the rise in the popularity of social networks. Borne out of the idea to allow users to not only talk to each other but also to relate to each other, they have gained growing influence on purchase decisions. Once misinterpreted as a modern day “chat room” that has no implications on your business, brands are now harvesting social media to gauge perception and actual campaign performance. In today’s world of the growing customer voice, you need to understand, engage and connect to customers on their turf – and their turf means places like social networks.
Web 2.0 expert Yuval Zukerman will provide a comprehensive lesson on social media. During this presentation he’ll delve into the types, categories, and characteristics of social media, giving a wealth of examples. Who’s using this next generation online get-together? Yuval will share that too, along with research demographics, and user and usage statistics. You’ll get an inside look at what features users are clamoring for, as well as what issues, such as privacy and safety, are playing a role in the future of social networks. Once Yuval has transformed you into a social networking guru, he’ll also provide tips on how you can utilize this new Web 2.0 connectivity phenomenon as a marketing means, with real world examples on who’s doing it and how.
Teaching Mathematics through Integrated Brain Gym in Pair Checks of Cooperati...iosrjce
IOSR Journal of Humanities and Social Science is a double blind peer reviewed International Journal edited by International Organization of Scientific Research (IOSR).The Journal provides a common forum where all aspects of humanities and social sciences are presented. IOSR-JHSS publishes original papers, review papers, conceptual framework, analytical and simulation models, case studies, empirical research, technical notes etc.
Introduction to Regulatory Affairs - Pauwels Consulting AcademyPauwels Consulting
On Tuesday, June 14, our colleagues Fiorenzo Savoretti, Senior Regulatory and Quality Consultant at Pfizer and Nick Deschacht, Senior RA Consultant at GSK, gave an interesting “Introduction to Regulatory Affairs”.
Fiorenzo and Nick talked about RA and their projects, each from their unique angle. They delivered their presentations for ## attendees at our Brussels office at the Lambroekstraat 5a in Diegem.
Please share this webinar with anyone who may be interested!
Watch all our webinars: https://www.youtube.com/playlist?list=PL4dDQscmFYu_ezxuxnAE61hx4JlqAKXpR
In this webinar:
● Primer for attendees attending the November 15-16 Drug Pricing Policy Summit
● Broad conceptual blueprint of federal and provincial/territorial public health policy structures across Canada
● Description of legal frameworks, government responsibility centres and their mandates for treatment access, with reference to specific opportunities for patient engagement
View the video: https://youtu.be/X9AB70om-Dw
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Please share this video with anyone who may be interested!
Watch all our webinars: https://www.youtube.com/playlist?list=PL4dDQscmFYu_ezxuxnAE61hx4JlqAKXpR
In this webinar:
● Takeaways from a roundtable held on June 1st about patient-centred pharmacare in Canada
● Reports from patient groups and other subject matter experts
● A cohesive vision and set of values for national pharmacare in Canada
View the video: https://youtu.be/HMy_gsTDkfI
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Gerry Jeffcott, of 360 Public Affairs, gave a presentation for the CCSN on the drug approval process in Canada on March 27, 2014. He outlines the divide between public and private networks, cost management, as well as the review and approval process for pharmaceuticals in Canada.
Join Bill Dempster & guests Louise Binder & Martine Elias as they discuss the updates to the federal pharmaceutical price reform proposal, how patient leaders are responding and what steps they are taking to ensure that patients are being heard by decision makers.
Summer 2020 PMPRB Webinar Series: Webinar 2 (July 16, 2020)
Hearing From Those Who Really Matter. This Webinar will take place after the PMPRB’s promised rescheduled “public forums” and “research webinars.”
Roundtable
Lindy Forte, Principal Consultant, Patient Access Solutions
Dr. Shawn Whatley, family physician, Munk Senior Fellow, Macdonald Laurier Institute and past president of the OMA
Barbara Jaszewski, Advisor Cloud and past global vice president of pricing and market access
Catherine Boivin, SMA Patient
Durhane Wong-Rieger, President & CEO, CORD
Moderator: Bill Dempster, CEO, 3Sixty Public Affairs
OHE Lecturing for Professional Training at International Centre of Parliament...Office of Health Economics
On 7th November 2018, Bernarda Zamora delivered a pro bono lecture to professionals from diverse countries enrolled at the Professional Certificate in Strategic Planning organised by the International Centre of Parliamentary Studies.
Author(s) and affiliation(s): Bernarda Zamora, Office of Health Economics
Conference/meeting: Professional Certificate in Strategic Planning organised by the International Centre of Parliamentary Studies
Location: Conference Centre, London
Date: Conference Centre, London
Pauline Norris (University of Otago, New Zealand): Insight in the New Zealand health care system, with a focus on medicines – current status and developments. Kelan tutkimuksen "Lääke-euro talouden puristuksessa" -seminaari 3.6.2015, Helsinki.
This webinar was an interactive live webcast from the Canadian Organization for Rare Disorders’ Rare Disease Day event in Ottawa.
The session was moderated by 3Sixty Public Affairs’ Bill Dempster, who was joined by several Canadian experts in pharmaceutical access, including a former director of the Ontario Public Drug Programs.
This discussion reviewed the current state of public reimbursement for orphan medicines and examined how the emerging discussions about a new national pharmacare program will affect patient access to these medicines.
The session was followed by an interactive question and answer session.
Presenters:
• Bill Dempster, co-founder of 3Sixty Public Affairs Inc., is an in-demand health and pharmaceutical policy expert who works with a range of clients to navigate complex political, policy, regulatory and reimbursement challenges in the Canadian life sciences field
Please share this slideshow with anyone who may be interested!
In this webinar:
● What has prompted the recent re-emergence of public calls for national pharmacare?
● What are Canadian health ministers doing to address this issue?
● What are some potential models for national pharmacare that are under discussion?
Contact the presenters:
● Bill Dempster - wdempster@3sixtypublicaffairs.com
● Gerry Jeffcott - gjeffcott@3sixtypublicaffairs.com
View the video: https://youtu.be/Eh3593x4aoI
Please share this video with anyone who may be interested!
Watch all our webinars: https://www.youtube.com/playlist?list=PL4dDQscmFYu_ezxuxnAE61hx4JlqAKXpR
In this webinar:
● Background to the role of private drug insurance plans in Canada
● Impact on access of recent developments in private insurance plan programs
● Future directions of private insurance in Canada
View the video: https://youtu.be/rik50CrMffY
Follow our social media accounts:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Pinterest - https://www.pinterest.com/survivornetwork
YouTube - https://www.youtube.com/user/Survivornetca
How High Will They Go? Managing Rising Drug Prices in a Changing Healthcare E...CompleteRx
In 2016, spending on prescription drugs is expected to reach $500 billion. So, how high will they really go? That is a common question asked with drug prices as recent headlines have exploited drug pricing schemes and how the pharmaceutical industry is handling rising prices. This webinar discusses how hospitals and health systems can prepare for and manage rising drug costs, ensure patient care and positively impact the bottom line.
On 31 October 2019, Adrian Towse and Chris Henshall from the Office of Health Economics (OHE) presented at the G20 meeting on antimicrobial drugs R&D in Paris organised by the Wellcome Trust. The topic of their presentation was HTA and payment mechanisms for new drugs to tackle antimicrobial resistance.
This presentation looks at ways in which governments can set prices, including “cost plus”, value, and the external referencing of prices elsewhere. It looks at the role that competition can play in keeping down prices. In that context it briefly discusses pricing proposals being considered in Malaysia. It makes the case for using HTA to inform pricing decisions.
Adrian Towse
% GDP spending in UK, G5 countries and OECD upper middle income countries. W...Office of Health Economics
This presentation looks at rates of GDP spend on health care, distinguishing between categories of country (i.e. levels of GDP pre capita). It looks at the relationship between rates of spending and moves to universal health coverage, and explores alternative ways of increasing expenditure and making decisions about which services to provide with the money available.
The role of real world data and evidence in building a sustainable & efficien...Office of Health Economics
This presentation defines RWD and RWE in the context of digital health, and looks at potential uses for RWD and RWE. It briefly sets out the current landscape in Malaysia and looks at the challenges in using RWE. In particular, the issues of access, governance and ensuring good quality are considered.
The aim of this educational symposium was to discuss why we should seek value across the health care system and how we can apply existing research methods to measure the value of services. While considerable political attention in developed countries continues to be focused on drug spending, there is also growing awareness of the significant contribution of non-drug components of health care (e.g., hospital services and inefficient care delivery) to overall spending growth and patient affordability. At the same time, there is growing interest in making greater use of value assessment and value-based payment to control spending and better align it with care quality. In order to promote greater value, and to do so in ways that respond to the needs of payers and patients, it is essential to assess value across both drug- and non-drug interventions and health care services. This panel will offer expert viewpoints to identify and discuss gaps in value information, rationale and approaches to track and reduce system-wide low value care, and research methods for how to measure health care services.
Role Substitution, Skill Mix, and Provider Efficiency and Effectiveness : Les...Office of Health Economics
Graham participated in an organised session on Monday July 15th 2019. In the session he presented his paper with his co-author Ioannis Laliotis from the London School of Economics. The paper revisits the relationship between workforce and maternity outcomes in the English NHS in an attempt to contribute knowledge to an important policy question for which there has been a paucity of research.
This research explores the feasibility of introducing an Outcome-Based Payment approach for new cancer drugs in England. A literature review explored the current funding landscape in England, the available evidence on existing OBP schemes internationally, and
which outcomes cancer patients value most. Two focus groups and an online survey with patients and carers, as well as interviews with NHS and government stakeholders, healthcare
professionals, and pharmaceutical industry representatives, provided additional evidence on the feasibility and suitability of OBP schemes
Understanding what aspects of health and quality of life are important to peopleOffice of Health Economics
Poster presentation from the EuroQol Plenary Meeting 2019, Brussels, Belgium. By Koonal Shah, Brendan Mulhern, Patricia Cubi-Molla, Bas Janssen, and David Mott.
Koonal presented as part of an organised session on ‘moving beyond conventional economic approaches in palliative and end of life care’. He summarised the empirical evidence on the extent of pubic support for an end of life premium, before discussing some novel approaches that have been used in recent studies. His presentation was discussed by Helen Mason of Glasgow Caledonian University.
Author(s) and affiliation(s): Koonal Shah, Office of Health Economics
Event: iHEA Congress
Date: 17/07/2019
Location: Basel, Switzerland
Assessing the Life-Cycle Value Added of Second Generation Antipsychotics in S...Office of Health Economics
This research presented in a poster at HTAi 2019, Cologne (Germany) by a team of OHE and IHE researchers, estimates the value added by second generation antipsychotics over their life-cycle in the UK and Sweden. It concludes that considering the entire life-cycle, the value added by SGAs to the system is higher than the expected value estimated at launch. P&R decisions should consider how to measure, capture and take into account the value added by medicines over the long-run.
Author(s) and affiliation(s): Mikel Berdud (Office of Health Economics, London), Niklas Wallin-Bernhardsson (Institute for Health Economics, Stockholm), Bernarda Zamora (Office of Health Economics, London), Peter Lindgren (Institute for Health Economics, Stockholm), Adrian Towse (Office of Health Economics, London)
Event: HTAi 2019 Annual Meeting
Date: 18/06/2019
Location: Cologne, Germany
There is growing recognition that HTA and contracting systems for antimicrobials need to be adapted to help fight the threat of antimicrobial resistance (AMR), but there is little agreement on how. This poster reports findings from a literature review, expert interviews and face-to-face discussions at a Forum on the current HTA and payment systems for antibiotics across Europe and a number of recommendations for adapting these systems to respond to the challenges of AMR.
Author(s) and affiliation(s): Margherita Neri (OHE) Grace Hampson (OHE) Christopher Henshall (OHE visiting fellow, independent consultant) Adrian Towse (OHE)
Event: HTAi annual conference 2019
Date: 18/06/2019
Location: Cologne, Germany
Assessing the Life-cycle Value Added of Second-Generation Antipsychotics in S...Office of Health Economics
This study aims to guide access decisions and drive the discussion on access and price, through recognition of the dynamic nature of value added by pharmaceutical innovation over the long-run. The analysis of the life-cycle value of risperidone estimates the value generated in the UK and Sweden. Results show that health systems were able to appropriate most of the life-cycle value generated, and this is larger than estimated at launch.
Author(s) and affiliation(s): Mikel Berdud(1), Niklas Wallin-Bernhardsson(2), Bernarda Zamora(1), Peter Lindgren(2), and Adrian Towse(1) (1) Office of Health Economics (2) The Swedish Institute for. Health Economics
Event: XXXIX JORNADAS DE ECONOMÍA DE LA SALUD
Date: 12/06/2019
Location: Albacete, Spain
Prescribed Specialised Services (PSS) Commissioning for Quality and Innovation (CQUIN) schemes were launched in 2013 in England with the aim of improving the quality of specialised care and achieving value for money. During this presentation, Marina Rodes Sanchez described the key features of the schemes and discussed its strengths and weaknesses based on international pay-for-performance literature.
Author(s) and affiliation(s): Yan Feng, Queen Mary University of London; Søren Rud Kristensen, Imperial College London; Paula Lorgelly, King’s College London; Rachel Meacock, University of Manchester; Marina Rodes Sanchez, Office of Health Economics; Luigi Siciliani, University of York; Matt Sutton, University of Manchester
Event: XXXIX Spanish Health Economics Association Conference
Date: 12/06/2019
Location: Albacete, Spain
In this session, Meng Li sets out estimates of real option value for drugs arguing that option value matters and can be calculated. Adrian Towse sets out likely payer concerns about incorporating real option value into decision making. Meng Li responds to these concerns. Jens Grueger sets out how industry considers investment opportunities, arguing that if patients (and society) have preferences these need to be reflected in P&R decisions.
Author(s) and affiliation(s): Meng Li, Postdoctoral Research Fellow, Leonard D Schaeffer Center, University of Southern California, Los Angeles, CA, USA. Adrian Towse, Emeritus Director, Office of Health Economics, London, UK Jens Grueger, formerly Head of Global Access, Senior Vice President at F. Hoffmann-La Roche
Event: ISPOR 2019
Location: New Orleans, USA
Date: 21/05/2019
MCDA OR WEIGHTED CEA BASED ON THE QALY? WHICH IS THE FUTURE FOR HTA DECISION ...Office of Health Economics
In this ISPOR session Chuck Phelps and Adrian Towse debated the case for and against using MCDA to support HTA decision making, as compared to weighting or augmenting a QALY based ICER approach. Chuck Phelps argued for use of MCDA, Adrian Towse for weighting the QALY. Nancy Devlin set the scene and moderated.
Author(s) and affiliation(s): Nancy Devlin, Director, Centre for Health Policy, University of Melbourne, Australia Adrian Towse, Emeritus Director, Office of Health Economics, London, UK Chuck Phelps, University of Rochester, Rochester, NY USA
Event: ISPOR 2019
Location: New Orleans, USA
Date: 21/05/2019
This presentation by Morris Kleiner (University of Minnesota), was made during the discussion “Competition and Regulation in Professions and Occupations” held at the Working Party No. 2 on Competition and Regulation on 10 June 2024. More papers and presentations on the topic can be found out at oe.cd/crps.
This presentation was uploaded with the author’s consent.
Sharpen existing tools or get a new toolbox? Contemporary cluster initiatives...Orkestra
UIIN Conference, Madrid, 27-29 May 2024
James Wilson, Orkestra and Deusto Business School
Emily Wise, Lund University
Madeline Smith, The Glasgow School of Art
Have you ever wondered how search works while visiting an e-commerce site, internal website, or searching through other types of online resources? Look no further than this informative session on the ways that taxonomies help end-users navigate the internet! Hear from taxonomists and other information professionals who have first-hand experience creating and working with taxonomies that aid in navigation, search, and discovery across a range of disciplines.
0x01 - Newton's Third Law: Static vs. Dynamic AbusersOWASP Beja
f you offer a service on the web, odds are that someone will abuse it. Be it an API, a SaaS, a PaaS, or even a static website, someone somewhere will try to figure out a way to use it to their own needs. In this talk we'll compare measures that are effective against static attackers and how to battle a dynamic attacker who adapts to your counter-measures.
About the Speaker
===============
Diogo Sousa, Engineering Manager @ Canonical
An opinionated individual with an interest in cryptography and its intersection with secure software development.
This presentation, created by Syed Faiz ul Hassan, explores the profound influence of media on public perception and behavior. It delves into the evolution of media from oral traditions to modern digital and social media platforms. Key topics include the role of media in information propagation, socialization, crisis awareness, globalization, and education. The presentation also examines media influence through agenda setting, propaganda, and manipulative techniques used by advertisers and marketers. Furthermore, it highlights the impact of surveillance enabled by media technologies on personal behavior and preferences. Through this comprehensive overview, the presentation aims to shed light on how media shapes collective consciousness and public opinion.
Acorn Recovery: Restore IT infra within minutesIP ServerOne
Introducing Acorn Recovery as a Service, a simple, fast, and secure managed disaster recovery (DRaaS) by IP ServerOne. A DR solution that helps restore your IT infra within minutes.
Supercharge your AI - SSP Industry Breakout Session 2024-v2_1.pdf
Lunchtime Seminar with Paula Lorgelly - 14 December 2015
1. Assoc Prof Paula Lorgelly
14th December 2015
From the Antipodes to the
Motherland: reflections on HTA
decision makers as budget takers
and budget makers
2. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
By way of introduction
3. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Presentation Plan
• HTA decision making globally and locally
• Review/describe how the United Kingdom,
Australia and New Zealand make funding
decisions/recommendations
• Listing and funding
• Case studies
• include cancer drugs
• Ways forward for NICE?
• Economic theory of decision making
4. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Health Technology Appraisal
Globally and Locally
5. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
HTA Globally – one size does
not fit all
• Various committees
• NICE in England and Wales
• SMC in Scotland
• CADTH CDR in Canada
• IQWiG in Germany
• Pharmaceutical Benefits Advisory Committee (PBAC) in
Australia
• Pharmaceutical Management Agency (PHARMAC) in New
Zealand
• Alternative criteria
6. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
http://www.ispor.org/PEguidelines/index.asp
7. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Factors that influence HTA
decisions
• A range of factors affect adoption decisions
• Recent synthesis found that there is little
consensus across agencies Bossers et al, 2015
• Additionally differences in studies focusing on
the same agencies
• However, for NICE cost effectiveness appears to
be important Devlin & Parkin, 2003; Dakin et al, 2006; Dakin et
al, 2014; Cerri et al, 2014
8. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
HTA Locally – UK issues
• NICE cost effectiveness threshold
• End of Life inflation
• Cancer Drugs Fund
• Austerity and affordability
9. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
The Motherland and the Antipodes
10. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
United Kingdom
• Population = 64.1m
• GDP per capita = $39,800 (PPP)
• Real growth rate = 3%
• Health expenditure % GDP = 9.1%
• Pharmaceutical expenditure =
£16,393m (Oct 2015)
• Pharma exp per capita = $367
($US PPP 2008) OECD, 2014
11. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
NICE
• Established in 1999 to undertake technology
appraisals and produce clinical guidelines
• Now has a wider remit
• Appraisal committee considers the evidence
• Clinical – Patient benefits
• Economic – Value for money
12. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Decision Criteria and
Recommendations
• Explicit cost effectiveness threshold, £20k-£30k
per QALY
• End of life threshold of £50k (weight of 1.6)
• Decisions
• Recommended
• Optimised (restricted)
• Only in research (approve with research)
• Reject
13. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Implementation into NHS
• Mandatory that approved technologies are made
available within 90 days
• Clinical Commissioning Groups are to find this
money
• NICE does not advise on how to find this money,
although does produce costing templates to understand
the budget implications locally
• In some instances NHS England may provide special
funding
14. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Criticisms
• A postcode lottery remains with regard to what
disinvestment decisions are made locally to fund
NICE decisions
• NICE has no funding mandate, threshold bears
no relation to the budget impact
15. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Australia
• Population = 22.8m
• GDP per capita = $46,600 (PPP)
• Real growth rate = 2.7%
• Health expenditure % GDP = 9.4%
• Pharmaceutical expenditure =
$10,050m (AUD)
• Pharma exp per capita = $509
($US PPP 2008) OECD, 2014
16. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
PBAC
• PBAC established by act of parliament in 1953
• Since 1993 mandatory that submissions include
economic evidence
• The PBAC is an independent expert body
appointed by the Australian Government
• Economic Subcommittee (ESC)
• Drug Utilisation Subcommittee (DUSC)
• No new medicine can be listed unless the
committee makes a positive recommendation
17. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Submission requirements
• Clinical evidence
• Safety
• Economic evidence
• cost minimisation analysis
• cost effectiveness analysis
• Consider budget impact (5 year forecast)
18. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Decision Criteria
• No explicit cost effectiveness threshold
• Often assumed to be $50,000 per QALY
• Some consider PBAC to work within a value
based pricing framework
19. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Recommendations
• PBAC makes recommendations to the Minister
for Health for Pharmaceutical Benefits Scheme
(PBS) listing
• Positive, reject, defer
• Sponsor negotiates pricing arrangements with
Department of Health
• When that listing is expected to cost more than
$20 million in any one of the four years of the
forward estimates period the Cabinet must give
approval
20. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Funding decisions
• Very few instances where Minister/DoH has not
funded as per PBACs recommendation
• Sildenafil for erectile dysfunction (2002)
• Number of deferrals in 2011
• Hep C drugs (discussed later)
• Most notable was trastuzumab for metastatic
breast cancer, which in 2001 was not
recommended by PBAC
• Resulted in the Herceptin Program
• Although this year it came into the PBS
21. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Pharmaceutical expenditure
22. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Criticisms
• Timely access to drugs
• High cost drugs and expenditure growth
• Cost of generics
23. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
New Zealand
• Population = 4.4m
• GDP per capita = $35,300 (PPP)
• Real growth rate = 3.3%
• Health expenditure % GDP = 9.7%
• Pharma expenditure = $795m (NZD)
• Pharma exp per capita = $261
($US PPP 2008) OECD, 2014
24. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
PHARMAC
• Established in 1993
• PHARMAC's statutory objective is: ’to secure for
eligible people in need of pharmaceuticals, the
best health outcomes that are reasonably
achievable from pharmaceutical treatment and
from within the funding provided.’ Section 47(a)
of the NZPHD Act
• Expanded remit to evaluate hospital
pharmaceuticals and medical devices
25. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Decision criteria (current)
1. The health needs of all eligible people within New Zealand;
2. The particular health needs of Māori & Pacific peoples;
3. The availability and suitability of existing medicines, therapeutic medical devices
and related products and related things;
4. The clinical benefits and risks of pharmaceuticals;
5. The cost-effectiveness of meeting health needs by funding
pharmaceuticals rather than using other publicly funded health & disability
support services;
6. The budgetary impact (in terms of the pharmaceutical budget and the
Government’s overall health budget) of any changes to the Schedule;
7. The direct cost to health service users;
8. The Government’s priorities for health funding, as set out in any objectives notified
by the Crown to PHARMAC, or in PHARMAC’s Funding Agreement, or elsewhere;
and
9. Such other criteria as PHARMAC thinks fit. PHARMAC will carry out appropriate
consultation when it intends to take any such “other criteria” into account.
26. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Factors for Consideration, 2016
27. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Cost effectiveness
• Incremental utility cost ratio (IUCRs), i.e. the incremental
QALY gains per unit net cost, is the metric used
• Expressed as QALYs per $1 million of the total budget
invested
• QALYs gained per $1M spend emphasises health gain, by
presenting the result as maximising health gains as
opposed to minimising cost
• Less inference on cost-effectiveness thresholds, instead
focuses decisions on opportunity cost (the gains within a
set budget)
28. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Cost effectiveness threshold?
• There is no threshold below which a pharmaceutical is
considered cost-effective
• Proposals are only considered in relation to other funding
proposals at the time
• Cost-effectiveness is only one decision criterion used by
PHARMAC
• Spending on pharmaceuticals is required to be kept within
a fixed budget
• What is and is not considered cost-effective will vary with
the amount of funding available
Metcalfe and Grocott, 2010
29. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Recommendation to list
• Pharmacology and Therapeutics Advisory
Committee (PTAC) advises PHARMAC, offer
recommendation
• Positive: high, medium and low priority
• If PHARMAC accept then begin commercial
negotiations
• Funding within a fixed capped budget, so need
to fund new products from savings
30. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
PHARMAC’s budget
31. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Praise and Criticisms
• “Pharmac is possibly the most publicly respected
body in this country. Protesters took to the streets at
the mere suggestion its ability to drive hard bargains
with pharmaceutical manufacturers might be
compromised in the recently concluded Trans-Pacific
Partnership trade negotiations. ‘Big Pharma's’
occasional lobbying attempts to change Pharmac's
remit only reinforces our confidence in the
professionals who decide how our taxes can be spent
for medicines of most value.” NZ Herald, 5th Dec
• Lack of choice
• Waiting list of drugs
32. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Summary comparison
NICE PBAC PHARMAC
Serving a population of 64m 23m 4.4m
Pharmaceutical
spending per person is
$367 $509 $261
Considers economic
evidence
Yes Yes Yes
Has an explicit cost
effectiveness threshold
Yes Maybe No
Has an explicit budget
threshold
No No Yes
Implementation Mandatory but
not funded
Funded If there is money
in the fixed
budget
33. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Case studies and comparisons
34. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Case studies - Sofosbuvir
• Sovaldi (Gilead)
• Blockbuster drug
• Extraordinary high cost
• Costs US$84k for a 12 week
course
• One of a number of direct-
acting antivirals (DAA)
• Notably cost effective at most acceptable
thresholds
35. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
What happened in the UK?
• NICE approved Sofosbuvir in Feb 2015
• Estimated cost of implementing the guidance would be £106m
• Accepted that NHS England should be allowed longer than
the standard 3 months to implement (31st July 2015)
• Recently NICE approved three further treatments
• Prior to this NHS England took proactive approach creating
an Emergency Access Programme
• There are now Operational Delivery Networks to help NHS
England commission hepatitis treatment
• Commercial in confidence pricing arrangements
36. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
What happened in Australia?
• Sofosbuvir first reviewed March 2014, then again in March
2015 (with a price discount)
• Range of other DAAs reviewed at the July 2015 meeting
• The PBAC advised the Minister:
• that there is the high clinical need for all oral interferon-free
treatments of CHC to be made available on the PBS
• that these treatments would be cost-effective at $15,000/QALY
range and that there was no basis on which to recommend that
any one treatment be more expensive than another
• there is a large opportunity cost to health care system. Given
this large opportunity cost, the cost of a course of treatment
should be set irrespective of the duration, and that other
pricing policies be considered
37. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
What happened in Australia?
• Rumour that Sovaldi will cost $AUD65k
• Estimated that there are 233,000 patients =
$15b (twice the pharmaceutical budget)
• Approved as Section 100 drug
• Rationing by stealth
38. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
What happened in New Zealand?
• Considered Sofosbuvir in August 2014
• PHARMAC ranked it (and Ledipasvir+Sofosbuvir;
Harvoni) high priority for certain groups of
patients
• Decompensated cirrhosis
• Pre/post liver transplant
• Essential mixed cryoglobulinaemia
• But not get listed nor funded
39. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
What happened in New Zealand?
• Request for Information in Aug 2015 to help
inform a decision
• Gauging supply, and understanding new agents in the
pipeline, getting a better understanding of health
utilisation and prevalence
• Next communication is due Nov/Dec 2015
40. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Case studies - Pembrolizumab
• Keytruda (MSD)
• Immunotherapy for advanced stage melanoma
• First in a new class of cancer
immunotherapeutics
• Described by oncologists as revolutionary
• Follows the success of ipilimumab (Yeroy)
targeted therapy
41. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
What happened in the UK?
• Melanoma is the fifth most common cancer in
the UK
• Yervoy reviewed in 2012 and 2014, received
positive recommendation with Patient Access
Scheme (PAS)
• NICE published positive recommendation for
Keytruda in October 2015
• First drug to be approved through the Medicines
and Healthcare Products Regulatory Agency’s
Early Access to Medicine Scheme (EAMS)
42. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
What happened in Australia?
• Highest rate of melanoma in the world
• PBAC considered Keytruda at the March 2015
meeting
• Yervoy was approved in November 2012, after rejecting
at July 2011 and March 2012 meetings
• Committee said that Keytruda appeared to offer
a clinical advantage over Yervoy, but the
economic modelling did not allow a price
advantage to be estimated with confidence
• Proposed a managed entry scheme, may result
in revising the price
43. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
What happened in New
Zealand?
• Second highest rate of melanoma (after Australia)
• PHARMAC considered the evidence to still be developing
• Pricing being sort was excessively high, adversely
affecting the cost effectiveness ($300,000 for a full
course)
• In December 2015 PHARMAC recommended, but with low
priority
• In 2014 PHARMAC declined Yeroy
• Calls for the government to intervene, which is what
happened in 2008 with Herceptin
• Health minister recently conceded that it was wrong to overrule
PHARMAC
44. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Case studies – Trastuzumab
Emtansine
• Kadcyla (Roche)
• New line of targeted therapy for HER2 positive
breast cancer
• Part of Roche’s monopoly on targeted therapies for
breast cancer, includes Trastruzumab (Herceptin) and
Pertuzumab (Perjeta)
45. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
What happened in the UK?
• NICE first reviewed Kadcyla in April 2014
• Not cost effective even given flexibility in
threshold with EoL allowance
• Funded on CDF in 2014
• Roche recently agreed a discount with NHS
England to retain it on the CDF
• November 2015 NICE rejected it again, still not
cost effective
• Notably a lesser discount was offered to NICE
• “Questionable long-term future in the NHS”
46. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
What happened in Australia?
• Reminder that Herceptin for advanced cancer
was not funded via the PBS
• Evaluation of both Kadcyla and Perjeta were
problematic as the comparator was not deemed
cost effective
• Reviewed first in July 2013 and then with pertuzumab in
March 2014
• Herceptin for advanced cancer patients needed
to be brought into the PBS
• Note it has been periodically reviewed since 2001
47. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
What happened in Australia?
• Evaluated all three in November 2014
• Herceptin and Perjeta were approved (with risk sharing
arrangements), Kadcyla was deferred
• In an out-of-session meeting pricing proposal for Kadcyla
was proposed and accepted by PBAC
48. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
What happened in New Zealand?
• MedSafe approved but no evidence that
PHARMAC is reviewing it
• Perjeta reviewed in February 2014, given low
priority
• Possibly an instance where the manufacturer
doesn’t wish to enter the market
49. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Cancer Drugs Fund
• Established with a fixed budget
• Lack of incentive to price cost effectively
resulted in NICE rejecting many cancer drugs
and these being funded on the CDF
• Budget was not constrained, now there is a need
for a rationing mechanism
• New consultation document regarding the CDF
• No equivalent in Australia nor New Zealand
• Although many oncologists in Australia have called for a
fund to expedite access while the PBS is overhauled
50. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Economics of Agency Decision
Making
51. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Agency Problem
• Principal-agent problem
• Principal recruits an agent to act on their behalf
• Due to asymmetry of information
• Agent acts imperfectly
• Lack of understanding of principal’s preferences and a
lack of (misaligned) incentives
• Generally in health economics see it in the
patient-doctor relationship (purchaser-provider
split)
52. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Agency problem in HTA
• Principal is the health service (NHS), agent is
the HTA agency (NICE)
• What criteria is of importance to the NHS?
• Funds allocation beyond technologies, includes hospitals
and other health providers
• Is this the same criteria NICE are using?
53. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Double agent problem
• Alternatively the population (general
public and/or patients) is the
principal and health service is their
agent, for whom NICE is their agent
• Again asymmetric information
• Given local implementation issues, the principal
could be at the level of the local catchment
• Highlights the implementation issues
54. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Misspecification of the objective
function
• NICE is seeking to maximise QALYs
• NHS is seeking to maximise health
• The public is seeking to maximise what?
• Health/wellbeing/wealth?
• What does the principal wish to maximise?
• Depends on who the principal is
55. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Misspecification of the
constraint
• Need to understand opportunity cost of
decisions
• What is the budget the agency is working
within?
• Is it possible to set an informed threshold?
• Threshold setter
• One that can be adapted/relaxed when faced
with adopting technologies which will have non-
marginal effects on the budget
• Threshold searcher
56. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
A way forward for NICE and the
NHS?
• PHARMAC’s fixed budget appears to offer more
affordable pharmaceutical prices, but with
limited drugs
• PHARMAC’s request for a greater budget was recently
denied
• PBAC appears to function with no budgetary
constraints, but this results in delays and
concerns regarding future budget impact
• What could be the NICEst approach?
57. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
NICEst approach Sampson, 2015
• It could be a threshold setter
• What is the social value of a QALY?
• It could be a threshold searcher
• Need to consider the current budget and affordability
issues
• This would require it to make disinvestment decisions (at
what threshold?)
• It could abandon the threshold (or at least give
less weight to it) and go down the PBMA or
MCDA approach
58. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
What could NHS England do?
• Alternatively, NHS England could search for the
threshold and then set the threshold for its
agent
• Or perhaps not have an agent at all?
• However need for credible separation of the
appraisal and implementation task
59. From the Antipodes to the Motherland:
reflections on HTA decision makers and budgets
Questions?
Comments?
Thank you!