Efficacy, Safety, and Economics of Innovative Medicines: The Role of Multi-Criteria Decision Analysis and Managed Entry Agreements in Practice and Policy

Fens, Tanja; Puijenbroek, Eugène van; Postma, Maarten J.

doi:10.3389/fmedt.2021.629750

Cited by 4 publications

(6 citation statements)

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“…Health technology assessments use a broad spectrum of elements to inform decision makers 14 . This decision process can cover issues of acquisition, finance, or adequate use of technologies, as well as disinvestment in ineffective or old alternatives 31,32 .…”

Section: Discussionmentioning

confidence: 99%

“…Health technology assessments use a broad spectrum of elements to inform decision makers. 14 This decision process can cover issues of acquisition, finance, or adequate use of technologies, as well as disinvestment in ineffective or old alternatives. 31,32 To support health decisions, it is important that managers have access to technology information, such as advantages (benefits), disadvantages (risks), uncertainties, and costs.…”

Section: Treatment Phasementioning

confidence: 99%

“…To analyze this model of epidural intervention, cost‐effectiveness analysis was adopted, which is a method of associating costs with clinical outcomes. The objective of the cost‐effectiveness analysis is to evaluate the impact of different alternatives, aiming to identify them with better treatment effects, generally in exchange for lower cost 12–14 . In recent decades, cost‐effectiveness has become a central element of health technology assessment 14 …”

Section: Introductionmentioning

confidence: 99%

“…The objective of the cost‐effectiveness analysis is to evaluate the impact of different alternatives, aiming to identify them with better treatment effects, generally in exchange for lower cost 12–14 . In recent decades, cost‐effectiveness has become a central element of health technology assessment 14 …”

Section: Introductionmentioning

confidence: 99%

“…The objective of the cost-effectiveness analysis is to evaluate the impact of different alternatives, aiming to identify them with better treatment effects, generally in exchange for lower cost. [12][13][14] In recent decades, cost-effectiveness has become a central element of health technology assessment. 14 In this context, the objective of this study was to carry out a cost-effectiveness pharmacoeconomic analysis to evaluate the impact of morphine/ropivacaine epidural implantation treatment in patients with gastrointestinal cancer, with pain that is difficult to clinically control, compared to conventional treatment via the oral route, from the perspective of the Brazilian public health care provider, referred to as the Unified Health System (Sistema Único de Saúde-SUS in Portuguese).…”

Section: Introductionmentioning

confidence: 99%

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Cost‐effectiveness analysis of epidural morphine/ropivacaine treatment in patients with cancer pain

Vieira,

de Barros,

Price

et al. 2023

Pain Practice

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BackgroundCancer pain is one of the main causes of human suffering, which can generate disabilities and compromise quality of life, giving rise to several psychosocial and economic consequences.AimsThis quantitative study sought to perform a cost‐effectiveness pharmacoeconomic analysis to assess the impact of implanting epidural morphine associated with ropivacaine treatment in gastrointestinal cancer patients with pain that is difficult clinical control, compared with conventional oral treatment.Materials and MethodsThe study population consisted of 24 patients with gastrointestinal neoplasia who underwent treatment for cancer pain that was difficult to clinically control. 12 patients each were recruited into the control and intervention groups, respectively. While patients in the control group were administered drug treatment orally, patients in the intervention group underwent a surgical procedure for subcutaneous implantation of a catheter that allowed epidural administration of morphine and ropivacaine. For pain assessment, the Visual Analogue Scale was applied. Data analysis had a descriptive character of costs, taking into account the costs for the year 2021. The study perspective was the Brazilian public healthcare provider, referred to as the Unified Health System (Sistema Único de—SUS in Portuguese). Costs were computed over the time horizon corresponding to the duration of treatment, from the first medical consultation (when the treatment was defined) to the end (end of treatment, disease progression, or death). Treatment duration was divided into three phases (first 60 days, support with palliative care, and end‐of‐life care). To assess the robustness of the economic analysis, sensitivity analyses were performed, considering the effectiveness of pain reduction on the Visual Analogue Scale, and a comparison of results using the median prices of pharmaceutical components used in the study.ResultsThe mean age of patients was 59.3 years. The results from the cost‐effectiveness analysis showed the epidural morphine/ropivacaine treatment to be more effective with regard to pain reduction on the pain scale, particularly for end‐of‐life care, when compared to the conventional oral treatment, however, at a significantly higher cost.DiscussionFrom the accomplishment of this research, it was observed that the application of the pain assessment scale is a way to better interpret and understand the patient's pain, facilitating care planning and decision‐making by health professionals, as well as monitoring the effectiveness of the proposed new treatment.ConclusionTo present a better cost‐effectiveness ratio, a reduction in the cost of the new epidural technology or an increase in the value of the existing oral intervention would be required. However, the latter is not feasible and unlikely to occur. A value judgement to decide whether the incremental benefit associated with the use of the new intervention is worth the extra cost will have to be made by the healthcare provider. Interventions that can relieve cancer pain symptoms should be investigated continuously, in search of evidence to support clinical practice and promote better quality of life for patients.

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Section: Discussionmentioning

confidence: 99%