This document discusses the role of health technology assessment (HTA) and contracting mechanisms for new antibiotic drugs to address antimicrobial resistance (AMR). It notes that HTA typically focuses on clinical trial evidence but this presents challenges for antibiotics. The document recommends that HTA for antibiotics consider additional elements of public health value and that contracting move away from volume-based payments towards delinked models. International coordination on developing new approaches to AMR drug assessment and reimbursement is encouraged.
This is a presentation to the Australian Society for Antimicrobials (ASA) meeting in Melbourne, 27th February 2020. The presentation draws on research by OHE, funded by the Wellcome Trust, on innovative HTA methods and contracting for antibiotics. It proposes a subscription model delinking the use of new antibiotics from payments to developers for making the products available. It provides an update on UK (NICE and NHSE) plans to introduce a subscription model and suggests that Australia could also pilot such an approach.
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
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
Presentation - New Business Models for Antibiotics: Where Are We Now? 16 Marc...Office of Health Economics
Speaking at the Superbugs & Superdrugs conference in London on 16 March 2016, OHE’s Jorge Mestre-Ferrandiz delivered a presentation on financial and collaborative incentives to accelerate clinical success for antibiotics.
Jorge discussed the economic challenges around antibiotics, and whether there is a need for a new business model. He reviewed of the impact of previous incentives, explaining what has worked in the past, and discussed possible new business models.
Horizon 2020 Calls on Infectious Diseases and Improving Global HealthKTN
The webinar provided background information on various call topics and on support available for both UK and European organisations in how to apply for funding and search for partners. KTN hosted this event on behalf of Innovate UK and was delivered by Samana Brannigan, National Contact Point for Health, and Stephen Alexander, National Contact Point for Legal and Financial Issues.
The webinar gave an overview of H2020 Health Call topics, and support available for UK organisations in how to apply for funding, as well as information on Brexit and the continuation of UK participation in H2020. This enabled attendees to gain an insight into the benefits of participating, guidelines for preparing a project outline and the support and collaboration tools available.
In summary, the webinar covered:
- Open and Forthcoming Health Call Topics
- Support for UK Organisations
- UK participation in Horizon 2020
Find out more about the Health Special Interest Group at https://ktn-uk.co.uk/interests/health
This is a presentation to the Australian Society for Antimicrobials (ASA) meeting in Melbourne, 27th February 2020. The presentation draws on research by OHE, funded by the Wellcome Trust, on innovative HTA methods and contracting for antibiotics. It proposes a subscription model delinking the use of new antibiotics from payments to developers for making the products available. It provides an update on UK (NICE and NHSE) plans to introduce a subscription model and suggests that Australia could also pilot such an approach.
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
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
Presentation - New Business Models for Antibiotics: Where Are We Now? 16 Marc...Office of Health Economics
Speaking at the Superbugs & Superdrugs conference in London on 16 March 2016, OHE’s Jorge Mestre-Ferrandiz delivered a presentation on financial and collaborative incentives to accelerate clinical success for antibiotics.
Jorge discussed the economic challenges around antibiotics, and whether there is a need for a new business model. He reviewed of the impact of previous incentives, explaining what has worked in the past, and discussed possible new business models.
Horizon 2020 Calls on Infectious Diseases and Improving Global HealthKTN
The webinar provided background information on various call topics and on support available for both UK and European organisations in how to apply for funding and search for partners. KTN hosted this event on behalf of Innovate UK and was delivered by Samana Brannigan, National Contact Point for Health, and Stephen Alexander, National Contact Point for Legal and Financial Issues.
The webinar gave an overview of H2020 Health Call topics, and support available for UK organisations in how to apply for funding, as well as information on Brexit and the continuation of UK participation in H2020. This enabled attendees to gain an insight into the benefits of participating, guidelines for preparing a project outline and the support and collaboration tools available.
In summary, the webinar covered:
- Open and Forthcoming Health Call Topics
- Support for UK Organisations
- UK participation in Horizon 2020
Find out more about the Health Special Interest Group at https://ktn-uk.co.uk/interests/health
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
Pharmaceutical pricing in european countries - Valérie Paris - 22-01-15Carlos Betancur Gálvez
Valery Paris, analista senior de Política Sanitaria, División de Salud, de la Organización de Desarrollo y Cooperación Económica (OCDE), ha destacado en su ponencia la importancia de considerar en la asignación de los precios de los medicamentos “los beneficios más allá del sector de la salud”, en referencia al coste de oportunidad y a otras variables económicas de lo que supone la entrada de un medicamento en un determinado mercado. París también ha señalado la dificultad de establecer una política común de asignación de precios en los diferentes países europeos: “Los países no siempre llegan a un acuerdo, por ejemplo, en el grado de innovación de nuevos productos”.
Presentation by Paula Lorgelly - Beyond QALYs: A Quantum Leap Forward or a Le...Office of Health Economics
OHE’s Paula Lorgelly took part in the Future of Value: Insights from the Experts panel discussion, Indianapolis, on 1 March 2016.
Paula presented a paper which discusses issues with going 'beyond quality adjusted life years (QALYs)' when valuing health care interventions. There are three dimensions to consider when going beyond QALYs: develop a better measure of health (e.g. one that could be condition-specific); use broader measures of benefit; consider a societal perspective (e.g. include productivity loss and carers’ effects).
Paula’s presentation focused on utilising a broader measure of benefit, focusing on alternative such as the capability approach and subjective wellbeing measures.
The panel was sponsored by Eli Lilly.
Are Wider Societal Effects Considered in Healthcare Decision-making? An over...Office of Health Economics
Presentation at ISPOR Italy - 12.04.16 - Are Wider Societal Effects Considered in Healthcare Decision-making? An overview from other countries by Martina Garau, OHE
Following topics are covered in this slide deck:
Role and use of Pharmacoeconomics and health outcomes research | Impact of price regulation in India | Factors affecting drug pricing | Need, challenges and components of pharmacoeconomics | Aims, Objectives and principle of Pharmacoeconomic Evaluation | Different types of cost measurement | The Methods of Pharmacoeconomic Evaluation | Cost Analysis (CUA)
Slides from the presentation Patricia Danzon gave on affordability at the ISPOR Europe 2018 conference in Barcelona, Spain Slides from the presentation Patricia Danzon gave on affordability at the ISPOR Europe 2018 conference in Barcelona, Spain on November 12th.
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
Pharmaceutical pricing in european countries - Valérie Paris - 22-01-15Carlos Betancur Gálvez
Valery Paris, analista senior de Política Sanitaria, División de Salud, de la Organización de Desarrollo y Cooperación Económica (OCDE), ha destacado en su ponencia la importancia de considerar en la asignación de los precios de los medicamentos “los beneficios más allá del sector de la salud”, en referencia al coste de oportunidad y a otras variables económicas de lo que supone la entrada de un medicamento en un determinado mercado. París también ha señalado la dificultad de establecer una política común de asignación de precios en los diferentes países europeos: “Los países no siempre llegan a un acuerdo, por ejemplo, en el grado de innovación de nuevos productos”.
Presentation by Paula Lorgelly - Beyond QALYs: A Quantum Leap Forward or a Le...Office of Health Economics
OHE’s Paula Lorgelly took part in the Future of Value: Insights from the Experts panel discussion, Indianapolis, on 1 March 2016.
Paula presented a paper which discusses issues with going 'beyond quality adjusted life years (QALYs)' when valuing health care interventions. There are three dimensions to consider when going beyond QALYs: develop a better measure of health (e.g. one that could be condition-specific); use broader measures of benefit; consider a societal perspective (e.g. include productivity loss and carers’ effects).
Paula’s presentation focused on utilising a broader measure of benefit, focusing on alternative such as the capability approach and subjective wellbeing measures.
The panel was sponsored by Eli Lilly.
Are Wider Societal Effects Considered in Healthcare Decision-making? An over...Office of Health Economics
Presentation at ISPOR Italy - 12.04.16 - Are Wider Societal Effects Considered in Healthcare Decision-making? An overview from other countries by Martina Garau, OHE
Following topics are covered in this slide deck:
Role and use of Pharmacoeconomics and health outcomes research | Impact of price regulation in India | Factors affecting drug pricing | Need, challenges and components of pharmacoeconomics | Aims, Objectives and principle of Pharmacoeconomic Evaluation | Different types of cost measurement | The Methods of Pharmacoeconomic Evaluation | Cost Analysis (CUA)
Slides from the presentation Patricia Danzon gave on affordability at the ISPOR Europe 2018 conference in Barcelona, Spain Slides from the presentation Patricia Danzon gave on affordability at the ISPOR Europe 2018 conference in Barcelona, Spain on November 12th.
Adrian Towse's slides from a session will exploring how the benefits of antibiotics can best be captured in HTA, and how we should pay for them when their value may depend on restricting their use.
Author(s) and affiliation(s): Adrian Towse, Office of Health Economics
Conference/meeting: Health Technology Assessment International (HTAi) 2018
Location: Vancouver, Canada
Date: 03/06/2018
The Regulatory Policy Institute, based in Oxford, holds an annual conference on competition and regulation. At this year’s conference, OHE’s Jon Sussex described how the prescription medicines market in England is regulated for innovation.
The regulatory problem for the pharmaceutical market is different from that for utilities markets, transport, financial services and indeed markets for all other types of goods and services. The source of the regulatory problem for prescription medicines in the NHS is that the consumer (patient) neither decides which medicine is prescribed nor is responsible for paying for it. For other goods and services, the consumer decides and pays, as well as consumes. In the pharmaceutical market under the NHS, it is the payer who effectively decides the value of an innovation, not the patient.
The cost and risk in drug development are high. To determine how best to target its R&D efforts, the pharmaceutical industry needs clear signals about what innovation the health care payer, the NHS, values. The recent history of such signalling has been dominated in England by the actions of the National Institute for Health and Care Excellence (NICE), whose assessments also have considerable influence internationally. Moreover, although England represents only 2% of the world pharmaceutical market, its prices are use as a reference for pricing in other markets.
How NICE expresses the value of medicines can be viewed as a mean of regulating innovation. NICE always has based its decisions about value on the incremental cost to the tax-funded health and social care services of the additional quality-adjusted life years a new medicine offers to patients. During the last year, NICE has been consulting on ways to broaden its assessment of value, particularly on whether to take account of the burden of disease and wider societal impacts beyond QALYs. The decisions have not yet been made and the signal to potential pharmaceutical innovators remains fuzzy.
Understanding Regulatory and Payer Requirements Throughout CommercializationPAREXEL International
Learn about regulator and payer evidence requirements as well as other key market access considerations in drug development. Read this presentation from PAREXEL Consulting experts.
Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare.
The role of health technology assessment bodies in the value of cancer care i...Francois MAIGNEN
This presentation details the role of European HTA bodies in the value of new cancer therapies in Europe. The presentation also describes the NICE scientific advice activities and the activities of the HTA / regulatory parallel advice.
The presentation summarises recent changes implemented or being discussed in pricing and reimbursement/HTA systems in France, Germany and the UK. In Germany and France, the emphasis of the recent reforms is centred around the evidence requirements and, in particular, the use of comparator and head-to-head trials. In the UK, however, VBP is about the weighting given to the evidence and the social value of a drug. Overall, emphasis is increasing on 'proving' innovation and/or an additional health benefit as a precondition for a price higher than competitors.
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
The 2018 Open Session of the EuFMD Standing Technical Committee was held in Borgo Egnazia - Italy, 29-31 October 2018 . The session theme was on global vaccine security
The European Commission for the Control of Foot-and-Mouth Disease (EuFMD), one of FAO’s oldest Commissions, came into being on the 12th June 1954, with the pledge of the sixth founding member state to the principles of a coordinated and common action against Foot-and-mouth Disease.
Webinar 3: Alternative Approaches to Innovative Drug Pricing – 12:00pm on Wednesday, May 13, 2020. The third webinar will review Canada’s approach to managing drug prices with approaches used in other jurisdictions. A panel will discuss experiences with oncology therapies, rare disease drugs, and therapies for pandemics and other urgent situations as points of reference toward evolving alternatives to the proposed PMPRB guidelines.
Panel:
Martina Garau, Director, Office of Health Economics, UK;
Sandra Anderson, Senior VP, Innomar Strategies
PG Forest, Director, School of Public Policy, University of Calgary
Durhane Wong-Rieger, President & CEO, CORD
Moderator: Bill Dempster, 3Sixty Public Affairs
EUPATI guidances for interaction between Patient organisations and other stak...EUPATI
David Haerry
Increasing patient involvment
EUPATI guidances for interaction between Patient organisations and other stakeholders in medicines development
Overcoming the Challenges of Benefit Risk Assessment for Established ProductsSGS
Conducting/Implementing a benefit/ risk assessment can be very challenging for “old” established products. Scientific assessment on benefit/ risk is conducted based on the best evidence available. The main objective of this presentation is to discuss how this approach can be applied for different type of regulatory documents that are to be prepared for established products.
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
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
The issue of open-source models in the cost-effectiveness and disease-level (collaborative) models has been brewing for many years. There has been a marked growth in open science, and funding bodies and publishers increasingly require that research data be made available. As mentioned in our previous Issue Panel, “cost-effectiveness models synthesise a wide range of evidence to facilitate extrapolation over time and from intermediate to final decision endpoints. These models are often statistically sophisticated and require assumptions that are not directly testable. This can lead to decision-makers “discounting” the results of cost-effectiveness analyses, particularly if the developer is seen as partial.” Open-source models, then, would encourage greater transparency in pharmacoeconomic modeling and the reuse and updating of the best/most useful models; they are essential if cost-effectiveness analyses are to be widely accepted to reduce bias, increase transparency, improve model access, and allow for faster access to critical knowledge. The ISPOR-SMDM guidelines and the EUnetHTA joint action projects, are supportive of these views on collaboration, transparency, confidentiality, processes and consistency offered by the availability of open-source models to improve decision-making around health care and reimbursement. With openness and sharing, however, come issues of copyright and access and a need to define how model sharing can be achieved in a fair and equitable manner. There is, therefore, a need to develop an ongoing dialog on openness, especially where the research may be considered precompetitive and not worthy of IP investment. The pros and cons of open source models and the proposed mission of the Open Source Model SIG to curate an ongoing dialog regarding issues around creating, disseminating, sharing, evaluating, and updating open source cost-effectiveness and comparative effectiveness models will be debated amongst SIG members.
Author(s) and affiliation(s): Nancy Risebrough, Senior Principal, ICON plc, Toronto, Canada Jeroen P Jansen; Innovation & Value Initiative; Precision Medicine Group; and Stanford University Lotte Steuten, Vice President & Head of Consulting, Office of Health Economics, UK Renée JG Arnold, PharmD, RPh, ICON plc, New York, NY and Icahn School of Medicine at Mount Sinai, New York, NY, USA
Event: ISPOR 2019 Annual Meeting
Date: 20/05/2019
NGS-based diagnostic testing compared to single-marker genetic testing (SMGT), has the potential to improve testing efficiency and to identify more cancer patients who could benefit from targeted therapies, but the impact on outcomes and total costs of care is uncertain. Recent studies using simulation modeling informed with data from the Flatiron Health database, representing curated electronic health record-derived clinical information from 191 oncology practices, has shown only moderate cost effectiveness of NGS vs. SGMT for patients with advanced non-small cell lung cancer (aNSCLC). The data suggests, however, that efforts to increase the proportion of patients who receive targeted therapies would improve the cost-effectiveness of NGS. To effectively inform access and reimbursement policy decisions there is a need to examine the NGS value proposition from the perspective of all stakeholders.
Author(s) and affiliation(s): Lotte Steuten (Office of Health Economics, London, UK); Bernardo Goulart (Fred Hutchinson Cancer Research Center, Seattle, WA, US & Seattle Cancer Care Alliance, Seattle, WA, US); Neal J. Meropol (Flatiron Health, New York, NY, US & Case Western Reserve University, Cleveland, OH, US); Daryl Pritchard (Personalized Medicine Coalition, Washington, DC, US); and Scott D. Ramsey (Fred Hutchinson Cancer Research Center, Seattle, WA, US)
Event: ISPOR 2019
Location: New Orleans, LA, United States
Date: 20/05/2019
Graham was invited to the weekly seminar series by the Royal Brompton Hospital to deliver a presentation on health economics pertinent to Respiratory medicine. They care for a large number of patients with complex lung diseases at the institution and juggle the varied issues of resource (human, structural or financial). As one of many examples, high cost drugs for treating relatively unusual conditions comes up for debate all too frequently. The audience included consultant physicians, senior and junior trainees, nurses and other allied health professionals.
Date: 7 March 2019
Location: The Royal Brompton, London, UK
how to sell pi coins effectively (from 50 - 100k pi)DOT TECH
Anywhere in the world, including Africa, America, and Europe, you can sell Pi Network Coins online and receive cash through online payment options.
Pi has not yet been launched on any exchange because we are currently using the confined Mainnet. The planned launch date for Pi is June 28, 2026.
Reselling to investors who want to hold until the mainnet launch in 2026 is currently the sole way to sell.
Consequently, right now. All you need to do is select the right pi network provider.
Who is a pi merchant?
An individual who buys coins from miners on the pi network and resells them to investors hoping to hang onto them until the mainnet is launched is known as a pi merchant.
debuts.
I'll provide you the Telegram username
@Pi_vendor_247
Falcon stands out as a top-tier P2P Invoice Discounting platform in India, bridging esteemed blue-chip companies and eager investors. Our goal is to transform the investment landscape in India by establishing a comprehensive destination for borrowers and investors with diverse profiles and needs, all while minimizing risk. What sets Falcon apart is the elimination of intermediaries such as commercial banks and depository institutions, allowing investors to enjoy higher yields.
Resume
• Real GDP growth slowed down due to problems with access to electricity caused by the destruction of manoeuvrable electricity generation by Russian drones and missiles.
• Exports and imports continued growing due to better logistics through the Ukrainian sea corridor and road. Polish farmers and drivers stopped blocking borders at the end of April.
• In April, both the Tax and Customs Services over-executed the revenue plan. Moreover, the NBU transferred twice the planned profit to the budget.
• The European side approved the Ukraine Plan, which the government adopted to determine indicators for the Ukraine Facility. That approval will allow Ukraine to receive a EUR 1.9 bn loan from the EU in May. At the same time, the EU provided Ukraine with a EUR 1.5 bn loan in April, as the government fulfilled five indicators under the Ukraine Plan.
• The USA has finally approved an aid package for Ukraine, which includes USD 7.8 bn of budget support; however, the conditions and timing of the assistance are still unknown.
• As in March, annual consumer inflation amounted to 3.2% yoy in April.
• At the April monetary policy meeting, the NBU again reduced the key policy rate from 14.5% to 13.5% per annum.
• Over the past four weeks, the hryvnia exchange rate has stabilized in the UAH 39-40 per USD range.
Currently pi network is not tradable on binance or any other exchange because we are still in the enclosed mainnet.
Right now the only way to sell pi coins is by trading with a verified merchant.
What is a pi merchant?
A pi merchant is someone verified by pi network team and allowed to barter pi coins for goods and services.
Since pi network is not doing any pre-sale The only way exchanges like binance/huobi or crypto whales can get pi is by buying from miners. And a merchant stands in between the exchanges and the miners.
I will leave the telegram contact of my personal pi merchant. I and my friends has traded more than 6000pi coins successfully
Tele-gram
@Pi_vendor_247
Poonawalla Fincorp and IndusInd Bank Introduce New Co-Branded Credit Cardnickysharmasucks
The unveiling of the IndusInd Bank Poonawalla Fincorp eLITE RuPay Platinum Credit Card marks a notable milestone in the Indian financial landscape, showcasing a successful partnership between two leading institutions, Poonawalla Fincorp and IndusInd Bank. This co-branded credit card not only offers users a plethora of benefits but also reflects a commitment to innovation and adaptation. With a focus on providing value-driven and customer-centric solutions, this launch represents more than just a new product—it signifies a step towards redefining the banking experience for millions. Promising convenience, rewards, and a touch of luxury in everyday financial transactions, this collaboration aims to cater to the evolving needs of customers and set new standards in the industry.
USDA Loans in California: A Comprehensive Overview.pptxmarketing367770
USDA Loans in California: A Comprehensive Overview
If you're dreaming of owning a home in California's rural or suburban areas, a USDA loan might be the perfect solution. The U.S. Department of Agriculture (USDA) offers these loans to help low-to-moderate-income individuals and families achieve homeownership.
Key Features of USDA Loans:
Zero Down Payment: USDA loans require no down payment, making homeownership more accessible.
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Guaranteed Loan Program: The USDA guarantees a portion of the loan, reducing risk for lenders and expanding borrowing options.
Eligibility Criteria:
Location: The property must be located in a USDA-designated rural or suburban area. Many areas in California qualify.
Income Limits: Applicants must meet income guidelines, which vary by region and household size.
Primary Residence: The home must be used as the borrower's primary residence.
Application Process:
Find a USDA-Approved Lender: Not all lenders offer USDA loans, so it's essential to choose one approved by the USDA.
Pre-Qualification: Determine your eligibility and the amount you can borrow.
Property Search: Look for properties in eligible rural or suburban areas.
Loan Application: Submit your application, including financial and personal information.
Processing and Approval: The lender and USDA will review your application. If approved, you can proceed to closing.
USDA loans are an excellent option for those looking to buy a home in California's rural and suburban areas. With no down payment and flexible requirements, these loans make homeownership more attainable for many families. Explore your eligibility today and take the first step toward owning your dream home.
what is the future of Pi Network currency.DOT TECH
The future of the Pi cryptocurrency is uncertain, and its success will depend on several factors. Pi is a relatively new cryptocurrency that aims to be user-friendly and accessible to a wide audience. Here are a few key considerations for its future:
Message: @Pi_vendor_247 on telegram if u want to sell PI COINS.
1. Mainnet Launch: As of my last knowledge update in January 2022, Pi was still in the testnet phase. Its success will depend on a successful transition to a mainnet, where actual transactions can take place.
2. User Adoption: Pi's success will be closely tied to user adoption. The more users who join the network and actively participate, the stronger the ecosystem can become.
3. Utility and Use Cases: For a cryptocurrency to thrive, it must offer utility and practical use cases. The Pi team has talked about various applications, including peer-to-peer transactions, smart contracts, and more. The development and implementation of these features will be essential.
4. Regulatory Environment: The regulatory environment for cryptocurrencies is evolving globally. How Pi navigates and complies with regulations in various jurisdictions will significantly impact its future.
5. Technology Development: The Pi network must continue to develop and improve its technology, security, and scalability to compete with established cryptocurrencies.
6. Community Engagement: The Pi community plays a critical role in its future. Engaged users can help build trust and grow the network.
7. Monetization and Sustainability: The Pi team's monetization strategy, such as fees, partnerships, or other revenue sources, will affect its long-term sustainability.
It's essential to approach Pi or any new cryptocurrency with caution and conduct due diligence. Cryptocurrency investments involve risks, and potential rewards can be uncertain. The success and future of Pi will depend on the collective efforts of its team, community, and the broader cryptocurrency market dynamics. It's advisable to stay updated on Pi's development and follow any updates from the official Pi Network website or announcements from the team.
how to sell pi coins at high rate quickly.DOT TECH
Where can I sell my pi coins at a high rate.
Pi is not launched yet on any exchange. But one can easily sell his or her pi coins to investors who want to hold pi till mainnet launch.
This means crypto whales want to hold pi. And you can get a good rate for selling pi to them. I will leave the telegram contact of my personal pi vendor below.
A vendor is someone who buys from a miner and resell it to a holder or crypto whale.
Here is the telegram contact of my vendor:
@Pi_vendor_247
Turin Startup Ecosystem 2024 - Ricerca sulle Startup e il Sistema dell'Innov...Quotidiano Piemontese
Turin Startup Ecosystem 2024
Una ricerca de il Club degli Investitori, in collaborazione con ToTeM Torino Tech Map e con il supporto della ESCP Business School e di Growth Capital
what is the best method to sell pi coins in 2024DOT TECH
The best way to sell your pi coins safely is trading with an exchange..but since pi is not launched in any exchange, and second option is through a VERIFIED pi merchant.
Who is a pi merchant?
A pi merchant is someone who buys pi coins from miners and pioneers and resell them to Investors looking forward to hold massive amounts before mainnet launch in 2026.
I will leave the telegram contact of my personal pi merchant to trade pi coins with.
@Pi_vendor_247
how to sell pi coins on Bitmart crypto exchangeDOT TECH
Yes. Pi network coins can be exchanged but not on bitmart exchange. Because pi network is still in the enclosed mainnet. The only way pioneers are able to trade pi coins is by reselling the pi coins to pi verified merchants.
A verified merchant is someone who buys pi network coins and resell it to exchanges looking forward to hold till mainnet launch.
I will leave the telegram contact of my personal pi merchant to trade with.
@Pi_vendor_247
how can I sell pi coins after successfully completing KYCDOT TECH
Pi coins is not launched yet in any exchange 💱 this means it's not swappable, the current pi displaying on coin market cap is the iou version of pi. And you can learn all about that on my previous post.
RIGHT NOW THE ONLY WAY you can sell pi coins is through verified pi merchants. A pi merchant is someone who buys pi coins and resell them to exchanges and crypto whales. Looking forward to hold massive quantities of pi coins before the mainnet launch.
This is because pi network is not doing any pre-sale or ico offerings, the only way to get my coins is from buying from miners. So a merchant facilitates the transactions between the miners and these exchanges holding pi.
I and my friends has sold more than 6000 pi coins successfully with this method. I will be happy to share the contact of my personal pi merchant. The one i trade with, if you have your own merchant you can trade with them. For those who are new.
Message: @Pi_vendor_247 on telegram.
I wouldn't advise you selling all percentage of the pi coins. Leave at least a before so its a win win during open mainnet. Have a nice day pioneers ♥️
#kyc #mainnet #picoins #pi #sellpi #piwallet
#pinetwork
how can I sell pi coins after successfully completing KYC
OHE presents at G20 AMR-R&D meeting in Paris - Adrian Towse
1. ohe.org
HTA and payment mechanisms for
new drugs to tackle AMR
AMR R&D HUB
31 OCTOBER 2019 - PARIS
Adrian Towse
2. Agenda
1. Project objectives
2. The role of HTA and contracting
3. HTA and contracting for antibiotics
4. What constitutes value for antibiotics?
5. Measuring and modelling antibiotic value
6. Innovative payment models
7. Conclusions and recommendations
31 OCTOBER 2019
AMR R&D HUB - PARIS
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3. 1. Project objectives
● Review of recent proposals in the literature for changing HTA and contracting for antibiotics
● What constitutes value for antibiotics?
● Modelling antibiotic value
● Innovative payment models
● Comparison with current state of HTA and contracting for antibiotics in France, Germany, Italy,
Sweden, and the UK
● Recommendations on the future of antibiotics HTA and contracting, developed following a
programme of interviews and a Forum on ‘Value Assessment and Contracting for Antibiotics’
● This research was commissioned and funded by the Wellcome Trust
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4. 2. The role HTA and contracting
● Most national health systems undertake some form of value assessment of a new drug before providing or reimbursing it for patients
● Value assessment of new drugs is typically based around evidence from randomised controlled trials (RCTs)
● Given the value assessment, health systems decide if the price charged by manufacturers is justified, or what price they would be willing to pay,
for all or some of the label indications of the new drug
● Manufacturers are generally then paid an agreed price per pill
● Deals may be struck on the ‘list’ price, taking account of expectations or limits on prescribing, of volume and sometimes of outcomes
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5. 3. HTA and contracting for antibiotics
● Value assessment of new drugs is typically based around RCTs to show clinical superiority against a comparator treatment. This is a problem for
new antibiotics because:
● Estimates of effectiveness in patients to be treated are typically based on non-superiority trials
● Non-clinical data (such as PK/PD and in-vitro microbiological data) are typically not accepted by HTA agencies
● A considerable part of antibiotic value arises from externalities (benefits and costs to the non-treated individuals) which are not measured in RCTs
● The treatment strategies which will maximise value to patients and the wider public are not considered in RCTs
● Most pricing & reimbursement arrangements agree a price per pill. This is a problem for new antibiotics because:
● Stewardship arrangements limit use of the drug during the period of patent protection to optimise long term social value
● Low volumes will not provide a return on investment for developers
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6. 4. What constitutes value for antibiotics?
● A considerable part of antibiotic value arises from ‘externalities (e.g. transmission of infections, impact on rate of growth of AMR)
● Conventional HTA methods only include the effects associated with treating the immediate patient
● Examples of consideration in deliberative decision making, but no formal for AMR-related HTA assessment (e.g. France)
● Recent legislation in Germany has established that AMR can be considered as an additional value element of antibiotics, but not
clear how this will be applied in practice
● Previous work by OHE (Karlsberg Schaffer et al., 2017) made the case for going beyond the benefits of antibiotics typically
considered in HTA (i.e. health gains and cost offsets, and in some systems also unmet need, and productivity benefits) and
identified public health benefits that are relevant to the health system and wider society but are not considered in traditional
assessments
31 OCTOBER 2019
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7. 7
REACTIONS & RECOMMENDATIONS
● The typically ‘not included’ elements of
antibiotics appear to be important
● More research on avoiding double counting
and value measurement approaches
● To progress the inclusion of the value
elements, start from value dimensions that
have the greatest impact on overall value,
and for which it is possible to generate
evidence of value on
31 OCTOBER 2019
AMR R&D HUB - PARIS
Transmission value
Arises from preventing the spread of the infection
among the wider population by treating individual patients
Enablement value
Arises if from protecting the safety profile of surgical
procedures that rely on prophylactic or post-operation
antibiotic interventions
Diversity value
Arises where from attenuating the ‘selection pressure’ on
existing antibiotics and preserve the efficacy of these
exiting treatments against resistant pathogens
Insurance value
Arises from having access to an effective treatment
available in case of a catastrophic event, such as an
outbreak of multi-drug resistant pathogen
Novel action value
Arises from preventing cross-resistance among classes
of antibiotics, and fostering R&D of ‘follow-on’ products
with the same mechanism of action
Spectrum value
Emerges from antibiotics that cover a narrower spectrum
of pathogens, preventing the ‘collateral damage’ to the
microbiome and reducing the build-up of AMR
Unmet need Productivity benefits
Health gains Cost offsets
TYPICALLY
INCLUDEDTYPICALLYNOTINCLUDED
4. What constitutes value for antibiotics?
8. 5. Measuring and modelling antibiotic value
● Proposals to model the value of the public health benefits of antibiotics in HTA using QALYs and estimates of cost-
effectiveness in:
● Morton et al. (forthcoming) - recommendations to modify incremental cost-effectiveness ratios (ICERs) in order to
capture the public health effects of antibiotics
● Rothery et al. (2018) - approach for a comprehensive assessment, including consideration of relevant strategies for
antibiotic use and estimation of population benefits using dynamic models to simulate the dynamics of resistance
transmission and development
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9. 5. Measuring and modelling antibiotic value
REACTIONS & RECOMMENDATIONS
● Proposals rely on complex modelling exercises that require advanced expert capabilities for their implementation
● Adequate expert capacity may be available in the UK, but progress is needed to build it up in other countries
● Scarcity of data on AMR transmission and development
● Potential role of clinicians, epidemiologists and other experts judgement where data are missing or to simplify the estimation of resistance
trends and other key parameters
● Importance of using a perspective of analysis that captures appropriately the public health benefits of antibiotics
● Standard HTA methods rely on evidence from RCTs. These typically do not demonstrate clinical superiority of new antibiotics, and are site based
rather than pathogen based
● Appropriate antibiotic value should be modelled according to the clinically relevant strategies of use (typically pathogen based) and to
estimate of clinical value based on PK/PD data and expert opinion
● Some elements of antibiotic value (e.g. transmission value) are already applied to vaccines assessment
● The modelling expertise of certain member state agencies in charge of assessing vaccines (e.g. France, Germany and England) could be used to
assess the value of characteristics that are shared by vaccines and antibiotics
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10. 6. Innovative payment models
● The contracting of antibiotics is usually regulated through tariff-based payments (DRGs), which disincentivises the optimal use of new
antibiotics if their value is reflected in a high price
● Proposals for antibiotic contracting in terms of models that delink payments from volume sold, in order
to provide appropriate R&D reward while promoting stewardship:
● Daniel et al. (2017) propose a Priority Antimicrobial Value Entry (PAVE) award, consisting of a pre-set
market entry reward available upon launch, and a progressive shift towards value-based contracts
● Little discussion to date on novel contracting for antibiotics, it is unclear whether delinked payment models will be considered because they
represent a major departure from existing contracting approaches. Some progress in:
● the UK - NICE and NHS England have recently announced a pilot programme of a delinked payment-based system
● Sweden - pilot of lump sum payment model, but this initiative seems to address the availability of antibiotics in the Swedish market rather
than providing appropriate R&D incentives
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11. Governments should promote change of antibiotics assessment and contracting with internationally coordinated initiatives.
EUnetHTA for example, or successor bodies, could be tasked with a role in developing a joint assessment of a new antibiotic,
thus hopefully stimulating independent action.
Countries gaining experience with innovative HTA and contracting for antibiotics (UK) should
share the learnings with other countries to contribute to the common understanding of
the most effective policy interventions
7. Conclusions and recommendations
31 OCTOBER 2019
AMR R&D HUB - PARIS
11
Governments and funding institutions should continue to advocate change to HTA
and contracting for antibiotics around the world, particularly within Europe
12. In the short-term, new antibiotics should be excluded from DRG-bundled payments to disincentivise the use of cheaper
drugs.
‘Volume-delinked’ payments may instead represent a longer-term solution because these schemes encourage
better adherence to stewardship.
There is an overlap between the elements of value that are relevant for vaccines and antibiotics.
The advanced vaccines modelling approaches could be transferred to antibiotics to model the patterns of
transmission and herd immunity
Antibiotic value should be determined on consideration of actual strategies of usage,
even if these differ markedly from those tested in registration trials
The elements of value that are most relevant for particular types of antibiotics and usage
scenarios should be identified and expert elicitation should be used to inform
modelling
7. Conclusions and recommendations
31 OCTOBER 2019
AMR R&D HUB - PARIS
12
13. To keep up with the latest news and research, subscribe to our blog.
OHE’s publications may be downloaded free of charge from our website.
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Toenquire about additional information and analyses,
please contact:
Adrian Towse Professor, MA, MSc, PhD
Director Emeritus and Senior Research Fellow
atowse@ohe.org
15. The role of HTA and contracting for antibiotics
● The antibiotics available today are becoming obsolete at a fast pace, and industry development pipelines of antibiotics are weak
● The development of antibiotics faces a threefold challenge:
● Scientific - due to the low success rates in R&D stages
● Regulatory and Clinical - due to the challenges of generating evidence of clinical superiority in randomised controlled trial (RCT)
● Economic - due to the low expected returns on investments (ROI) from antibiotic sales
● A number of interventions have been proposed to antibiotics R&D:
● Push incentives - providing financial and scientific support the development of new antibiotics
● Pull incentives – providing rewards to manufacturers for bringing to market new antibiotics (e.g. market entry rewards, volume-delinked payment
models)
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16. 16
● Push incentives alone will not be sufficient to
stimulate investments in antibiotic innovation
(Ferraro, 2017; Towse et al., 2017), and the
necessary pull incentive to bring the desired
number of antibiotics to the market is large
(O’Neill, 2016; Towse et al., 2017)
● HTA should appropriately recognise the value of
antibiotics to ensure that the price paid (i.e. pull
incentive) is commensurate to their value to the
health system and society
● Payment models (i.e. pull incentive) should also
be aligned with stewardship to optimise the
expected health gains over the useful life of the
antibiotic
31 OCTOBER 2019
AMR R&D HUB - PARIS
Low discovery and
success rates in
R&D
Scarce evidence
of clinical
superiority in
RCTs
Low return on
investment
Scientific Regulatory & Clinical Economic
Price limited to that of
existing treatments
HTA methods do not
consider ABs public
health value
Stewardship restrict
volume usage to
preserve ABs
effectiveness
Push
incentives
Pull
incentives
HTA
recognising
ABs public
health value
CHELLENGESDRIVERS
POLICY
INTERVENTIONS
to inform