Amani Thomas Mori and Bjarne Robberstad’s paper on pharmacoeconomics in Tanzania is a great contribution.
In part, it addresses a generally held hypothesis that pharmacoeconomic studies are impossible in Tanzania and comparable countries because no data is available with which to conduct such analyses. Mori et al clearly demonstrate that researchers have overcome [...]
Amani Thomas Mori and Bjarne Robberstad’s paper on pharmacoeconomics in Tanzania is a great contribution.
In part, it addresses a generally held hypothesis that pharmacoeconomic studies are impossible in Tanzania and comparable countries because no data is available with which to conduct such analyses. Mori et al clearly demonstrate that researchers have overcome data barriers and successfully deploy pharmacoeconomic methods to guide resource allocation decisions. The lack of data is not entirely the rate limiter but rather the systematic collection and electronic recording of such data – a finding we shared with colleagues in our 2011 Health Policy paper.
Paper-based records are generally available at the level of health care purchasers and health facilities and when captured in an electronic database, various efficiency-related questions can be answered with pharmacoeconomic methods.
More resources are needed to facilitate this process.
PharmacoEconomics: 1 April 2010 – Volume 28 – Issue 4 – pp 295-306
Background: Research sponsored by the pharmaceutical industry is often assumed to be more likely to report favourable cost-effectiveness results.
Objective: To determine whether there was a relationship between the source of funding and the reporting of positive results.
Methods: We conducted a [...]
PharmacoEconomics: 1 April 2010 – Volume 28 – Issue 4 – pp 295-306
Background: Research sponsored by the pharmaceutical industry is often assumed to be more likely to report favourable cost-effectiveness results.
Objective: To determine whether there was a relationship between the source of funding and the reporting of positive results.
Methods: We conducted a systematic review of the literature to identify economic evaluations of bisphosphonates for the treatment of osteoporosis. We extracted the source of funding, region of study, the journal name and impact factor, and all reported incremental cost-effectiveness ratios (ICERs). We identified which ICERs were under the thresholds of $US20 000, $US50 000 and $US100 000 per QALY. A quality score between 0 and 7 was also given to each of the studies. We used generalized estimating equations for the analysis.
Results: The systematic review yielded 532 potential abstracts; 17 of these met our final eligibility criteria. Ten studies (59%) were funded by non-industry sources. A total of 571 ICERs were analysed. There was no significant difference between the number of industry- and non-industry-funded studies reporting ICERs below the thresholds of $US20 000 and $US50 000. However, industry-sponsored studies were more likely to report ICERs below $US100 000 (odds ratio = 4.69, 95% CI 1.77, 12.43). Studies of higher methodological quality (scoring >4.5 of 7) were less likely to report ICERs below $US20 000 and $US50 000 than studies of lower methodological quality (scores <4). Methodological quality was not significantly different between studies reporting ICERs under $US100 000.
Conclusions: In this relatively small sample of studies of bisphosphonates, the funding source (industry vs non-industry) did not seem to significantly affect the reporting of ICERs below the $US20 000 and $US50 000 thresholds. We hypothesize that methodological quality might be a more significant factor than the source of funding in differentiating which studies are likely to report favourable ICERs, with the higher-quality studies significantly less likely to report ICERs below $US20 000 and $US50 000 per QALY. Further research should explore this finding.
Valerie Paris provides some insight into the thinking at the OECD concerning pharmaceutical policy. While Paris promotes the need to standardize HTA across markets, what is overlooked are unique incentives and disincentives at the country-level that may work against a process of standardization. This may range from structural aspects of a health care system, reimbursement [...]
Valerie Paris provides some insight into the thinking at the OECD concerning pharmaceutical policy. While Paris promotes the need to standardize HTA across markets, what is overlooked are unique incentives and disincentives at the country-level that may work against a process of standardization. This may range from structural aspects of a health care system, reimbursement mechanisms, ownership of health care facilities, and many other aspects that will reflect in data collected for HTAs. Paris claims there is little known about risk-sharing agreements, but she overlooks a wave of literature that dissects such agreements including the two papers I published in 2008 on this subject, paper 1 and paper 2.
Joao
**************
Leela Barham talks to Valérie Paris of the OECD’s Health Division about how policymakers and pharma firms can achieve better value for money. At a time of considerable financial challenge, options for policy makers to achieve better value for money across the entire health system are much needed. In late 2009, the OECD published options for policy makers, including ensuring efficiency in pharmaceutical expenditure. Despite differences across national health systems, cultures, and the myriad policies affecting pricing and reimbursement, Valérie Paris, from the Health Division of the OECD, says that there are some options that should be explored. Her pharmaceutical policy checklist includes:
* Obtaining value for money while promoting future innovation by considering relative cost-effectiveness in pricing and purchasing decisions, while ensuring that rewards to innovation are consistent with the value of benefits offered;
* Seeking opportunities for establishing price-volume agreements or confidential rebates when value-based unit prices cannot be established (due to risk of parallel trade, for example);
* Exploring the potential for risk-sharing arrangements to reduce the financial risk presented by new medicines when information on costs and effects is insufficient;
* Encouraging generic substitution and price competition in the off-patent market;
* Creating incentives for physicians, pharmacists and patients to promote the appropriate prescribing, dispensing and use of medicines, recognizing that expenditure includes volume/mix as well as price components;
* Considering whether there are opportunities for efficiencies in the distribution chain;
* Ensuring that overall healthcare spending efficiency is not compromised by efforts to improve efficiency of pharmaceutical expenditure.
This article by Huw Tippett reminds me so much of discussions during the 90′s when pharmaceutical companies were under considerable pressure from governments to lower prices. Much of this gave rise to alternative business models and this is partly the reason for the risk-sharing models /pay for performance discuss today. Tippett’s article discusses an inflection [...]
This article by Huw Tippett reminds me so much of discussions during the 90′s when pharmaceutical companies were under considerable pressure from governments to lower prices. Much of this gave rise to alternative business models and this is partly the reason for the risk-sharing models /pay for performance discuss today. Tippett’s article discusses an inflection point as though it were an event. The inflection point he refers to is a transformative process and is less about a single point but rather a series of incremental changes over time. One of those changes is the need to move away from out-dated business models that rely heavily on marketing and selling to one that focuses on extracting the economic value of innovation and aligning these to societal demands.
Joao
**********
Huw Tippett, head of global sales for Novartis, explains his firm’s new focus on creating customer value and unlocking value from key accounts. Not long ago, the pharmaceutical industry was cruising through wildly profitable times. Sales forces were growing, market access was easy, and loss of exclusivity was an afterthought. How things have changed. Today, sales forces seem bloated, rep productivity is falling, market access is more difficult, cost containment pressures are greater, shifts in stakeholder power are substantial, and competition from generics is formidable. Taken together, these changes constitute an inflection point for the industry, says Huw Tippett, head of global sales for Novartis.
Pharmacoeconomics 2010: 28(3) 175- 184
Bridges, John F.P.; Onukwugha, Eberechukwu; Mullins, C. Daniel
Abstract
The application of cost-effectiveness analysis in healthcare has become commonplace in the US, but the validity of this approach is in jeopardy unless the proverbial $US50 000 per QALY benchmark for determining value for money is updated for the 21st [...]
Pharmacoeconomics 2010: 28(3) 175- 184
Bridges, John F.P.; Onukwugha, Eberechukwu; Mullins, C. Daniel
Abstract
The application of cost-effectiveness analysis in healthcare has become commonplace in the US, but the validity of this approach is in jeopardy unless the proverbial $US50 000 per QALY benchmark for determining value for money is updated for the 21st century. While the initial aim of this article was to review the arguments for abandoning the $US50 000 threshold, it quickly turned to questioning whether we should maintain a fixed threshold at all. Our consideration of the relevance of thresholds was framed by two important historical considerations. First, cost-effectiveness analysis was developed for a resource allocation exercise where a threshold would be determined endogenously by maximizing a fixed budget across all possible interventions and not for piecemeal evaluation where a threshold needs to be set exogenously. Second, the foundations of the $US50 000 threshold are highly dubious, so it would be unacceptable merely to adjust for inflation or current clinical practice.
Upon consideration of both sides of the argument, we conclude that the arguments for abandoning the concept for maintaining a fixed threshold outweigh those for keeping one. Furthermore, we document a variety of reasons why a threshold needs to vary in the US, including variations across payer, over time, in the true budget impact of interventions and in the measurement of the effectiveness of interventions. We conclude that while a threshold may be needed to interpret the results of a cost-effectiveness analysis, that threshold must vary across payers, populations and even procedures.
Carapinha, J. (2008) Setting the Stage for Risk-Sharing Agreements: International Experiences and Outcomes-based Reimbursement. South African Family Practice, 2008;50(4):62-65.
Abstract
Carapinha, J. (2008) Setting the Stage for Risk-Sharing Agreements: International Experiences and Outcomes-based Reimbursement. South African Family Practice, 2008;50(4):62-65.
Abstract
Background: Biological medicines are clinically effective but very expensive in South Africa. The business decisions of biological manufacturers and payers (medical schemes) impact the access patient’s have to biological medicines. This paper presents risk-sharing agreements as a means of managing the risk of introducing biological medicines into the healthcare market.
Methods: The paper critically reviews literature of some prominent international experiences with risk-sharing agreements and the nuances associated with such agreements. The paper also critiques the outcomes-based reimbursement of biological medicine and the structural necessities for its successful implementation.
Results: A risk-sharing agreement is a useful tool to manage the risk of introducing clinically effective and very expensive medicines into the healthcare market. It is also a tool that bridges the conflicting priorities of the manufacturer of biological medicine and the payer.
Conclusion: The application of risk-sharing agreements within an international context informs the local discussion. This paper is the first in a two-part series that serves to review the international experience with risk-sharing agreements and critique the outcomes-based reimbursement of biological medicines. The backdrop is set for a discussion of the application of risk-sharing agreements in South Africa, which is the purpose of the second paper in this series.
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