A comparative study of the role of disease severity in drug reimbursement decision making in four European countries

Franken, M; Stolk, Elly; Scharringhausen, Tessa; Boer, Anthonius de; Koopmanschap, Marc

doi:10.1016/j.healthpol.2014.10.007

Cited by 33 publications

(25 citation statements)

References 31 publications

(48 reference statements)

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“…Efficiency considerations often fall by the wayside and are trumped by evidence of clinical benefit, political and/or other considerations (Martin et al, ; Eddama and Coast, ; Boon et al, ; Armstrong et al, ). There is no agreement on what these decision criteria should be, how important they should be relatively to one another, nor is there a common framework for how they should be used in combination (Chabot and Rocci, ; Boon et al, ; Franken et al, ; McDonald et al, ; Franken et al, ; Cleemput et al, ; Drummond, ; Franken et al, ). There is also a lack of guidance to the interpretation of evidence, including PE (Wranik, ; Franken et al, ).…”

Section: Challeges Of a Regionalized Review Processmentioning

confidence: 99%

The evolution of the cancer formulary review in Canada: Can centralization improve the use of economic evaluation?

Wranik

Gambold

Hanson

et al. 2016

Int J Health Plann Mgmt

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SummaryPublic reimbursement of drugs is a costly proposition for health care systems. Decisions to add drugs to the public formulary are often guided by review processes and committees. The evolution of the formulary review process in Canada's publicly funded health system is characterized by increased centralization and systematization. In the past, the review of evidence and recommendation was conducted at the regional level, but was replaced with the pan‐Canadian Oncology Drug Review in 2011. We assess the extent to which centralization and systematization of the review process have responded to past challenges, focusing on the use of economic evaluation in the process. Past challenges with economic evaluation experienced by regionalized review committees were identified from literature and qualitative data collected in the province of Nova Scotia. We categorize these using a typology with a macro‐, meso, and micro‐level hierarchy, which provides a useful framework for understanding at which level change is required, and who has the authority to influence change. Using grounded theory methods, we identify approaches used by Nova Scotia past committee members to compensate for perceived shortcomings of the process. These include an undue reliance on other committee members, on the multidisciplinarity of the committee, and on past decisions. Using a policy analysis approach, we argue that centralization and systematization of the review process only partially address the shortcomings of the previous regionalized process. Lessons from Canada can inform policy discussions across all health systems, where similar challenges with the formulary review process have been identified. © 2016 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.

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Section: Challeges Of a Regionalized Review Processmentioning

confidence: 99%

The evolution of the cancer formulary review in Canada: Can centralization improve the use of economic evaluation?

Wranik

Gambold

Hanson

et al. 2016

Int J Health Plann Mgmt

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“…Interpretation is further complicated by evidence of heterogeneity in attitudes within the population surveyed, raising questions of how to represent an overall societal view [56]. Examples of the use of severity in HTA include Sweden and The Netherlands (variable threshold), as well as France (as a dimension of clinical benefit assessment) [62]. End-of-life criteria are used in HTA by NICE and the Scottish Medicines Consortium, allowing more flexibility in the cost per QALY under specific criteria [5, 7].…”

Section: Discussionmentioning

confidence: 99%

Does the Public Prefer Health Gain for Cancer Patients? A Systematic Review of Public Views on Cancer and its Characteristics

et al. 2017

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BackgroundPolicies such as the Cancer Drugs Fund in England assumed a societal preference to fund cancer care relative to other conditions, even if that resulted in lower health gain for the population overall.ObjectiveThe aim of this study was to investigate the evidence for such a preference among the UK public.MethodsThe MEDLINE, PubMed and Econlit electronic databases were searched for studies relating to preferences for prioritising cancer treatment, as well as studies relating to preferences for the characteristics of cancer (severity of disease, end-of-life). The searches were run in November 2015 and updated in March 2017. Empirical preference studies, studies of public views, and studies in English were included.ResultsWe identified 24 studies relating to cancer preferences. Two directly addressed health trade-offs in the UK—one showed a preference for health gain in cancer, while the other found no such preference but provided results consistent with population health maximisation. Other studies mostly showed support for cancer but did not require a direct health trade-off. Severity and end-of-life searches identified 12 and 6 papers, respectively, which were additional to existing reviews. There is consistent evidence that people give priority to severe illness, while results for end-of-life are mixed.ConclusionWe did not find consistent support for a preference for health gains to cancer patients in the context of health maximisation. The evidence base is small and the results are highly sensitive to study design. There remains a contradiction between these findings and the popular view of cancer, and further work is required to determine the features of cancer which contribute to that view.Electronic supplementary materialThe online version of this article (doi:10.1007/s40273-017-0511-7) contains supplementary material, which is available to authorized users.

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“…(5,6) The literature has generally examined this issue from the perspective of the last available listing recommendation, and has suggested that international differences are accounted by social determinants, including preferences for treatment, disease severity and rarity (7,8) and local clinical practice;(4) as well as methodological factors, including HTA design and sufficiency of pharmacoeconomic evidence, (7,9) and use of comparative data. (4) As has been previously argued, however, HTA is a complex process that cannot be fully understood if the perspective concentrates exclusively on final listing decisions.…”

Section: Introductionmentioning

confidence: 99%

A comparative study of drug listing recommendations and the decision-making process in Australia, the Netherlands, Sweden, and the UK

2016

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Drug listing recommendations from health technology assessment (HTA) agencies often fail to coincide with one another. We conducted a comparative analysis of listing recommendations in Australia (PBAC), the Netherlands (CVZ), Sweden (TLV) and the UK (NICE) over time, examined interagency agreement, and explored how process-related factors-including time delay between HTA evaluations, therapeutic indication and orphan drug status, measure of health economic value, and comparator-impacted decision-making in drug coverage. Agreement was poor to moderate across HTA agency listing recommendations, yet it increased as the delay between HTA agency appraisals decreased, when orphan drugs were assessed, and when low-value medicines (immunosuppressants, antineoplastics) were removed from the sample. International differences in drug listing recommendations seem to occur in part due to inconsistencies in how the supporting evidence informs assessment, but also to differences in how domestic priorities shape the value-based decision-making process.

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A comparative study of the role of disease severity in drug reimbursement decision making in four European countries

Cited by 33 publications

References 31 publications

The evolution of the cancer formulary review in Canada: Can centralization improve the use of economic evaluation?

The evolution of the cancer formulary review in Canada: Can centralization improve the use of economic evaluation?

Does the Public Prefer Health Gain for Cancer Patients? A Systematic Review of Public Views on Cancer and its Characteristics

A comparative study of drug listing recommendations and the decision-making process in Australia, the Netherlands, Sweden, and the UK

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