OBJECTIVES: To assess the appropriateness of pharmacoeconomics methodologies used in Pricing and Reimbursement (P&R) Applications of innovative therapies in Slovakia. METHODS: Analyzing recent submissions from local Marketing Authorization Holder representatives (MAH) on presented pharmacoeconomics methodologies from an official Slovak Ministry of Health (MoH) P&R Portal, which is publicly available, and comparing presented methodologies with currently valid legal framework on assessment and appraisal of innovative therapies in Slovakia.
RESULTS:We have analyzed 162 recently (2016-2017) submitted P&R Applications of innovative therapies by MAH. Cost Utility Analysis (CUA), which is compulsary required for innovative therapies by the Law (Act of Drug, #363/ 2011), was presented in less then 1/3 of all applications (30,25%). The most common methodology used (48,77%) was Cost Minimisation Analysis (CMA), followed by either single CUA or CEA (8,64%). Less then 7% of all applications have used more then ona analysis, out of which CEA+CMA was the most frequent (4,94%). Suprisingly enought, there have been assessed aplications without any analysis presented as well (6,17%). Furthermore, we have analyzed final assessment and appraisal decisions, published during by Expert and Reimbursement Committees. Reasonings for negative assessment was recorded. None of all stakeholders involved (MoH, Health Insurance Companies or Healthcare Surveillance Authority) have been able to challenge the efficiency of health technology assessment and appraisal in terms of simple validation of pharmacoeconomics methodologies used, based on the currently valid legal requirements. CONCLUSIONS: Existing Drug Policy in Slovakia, inspite of being one of the most transparent across OECD countries, have no formal and/or informal simple validation tools in place to assess at least retroactivly the MAH P&R submissions and to avoid or limit the impact of significantly missleading inputs on pharmacoeconomics methodology used after the successful P&R assessment and appraisal. Such a malpractice in P&R methodology leads to continuous inefficiency in public healthcare spendings.
mobility cup (DMC) to allow their reimbursement under a commercial name. The aim of this study was to highlight regulatory changes brought by the new regulation as suggested by the assessment of DMCs by the CNEDiMTS. Methods: A retrospective analysis of the clinical data described in the opinions issued by the CNEDiMTS was carried out from the beginning of the individual evaluation of DMCs in 2014 until the first quarter of 2019. These data were compared with the clinical requirements of the EU MDR. Results: The CNEDiMTS supported the reimbursement of 42/71 DMCs (59%), 38 of them were based on specific clinical studies, all of which were observational. Of this 38 DMCs, 53% reported published and retrospective studies, 79% were cohorts, 71% multicentre, 74% non-comparative and the median follow-up time for patients was 40 months (mean: 45 6 30 months). Four files of DMCs didn't include specific clinical studies. Instead, two included a technical equivalence rationale comparing them to other DMCs. The CNEDiMTS has requested the implementation of a post-registration follow-up study for all DMCs eligible for reimbursement to confirm their in preventing dislocations and long-term survival. Conclusions: The CNEDiMTS formulated requirements on the specific clinical data expected. This assessment suggests that the EU MDR might require clinical studies for IMDs, with a significant restriction for equivalence. Real life monitoring studies could be designed to meet both the requirements of CE marking under the EU MDR and those of post-registration monitoring studies required for reimbursement.
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