Medicare's use of cost-effectiveness analysis for prevention (but not for treatment)

Chambers, James D.; Cangelosi, Michael J.; Neumann, Peter J.

doi:10.1016/j.healthpol.2014.11.012

Cited by 19 publications

(16 citation statements)

References 28 publications

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“…While policy makers use cost-effectiveness analyses to assist in understanding what interventions might provide the best value for money [3], cost-effectiveness analyses – and their related sensitivity analyses – also provide important additional information such as clinical, epidemiologic, and/or economic benchmarks for interventions to achieve cost-effectiveness. If an intervention is not cost-effective under current conditions, analyses can project under what conditions it might become so.…”

Section: Introductionmentioning

confidence: 99%

Modeling and Cost-Effectiveness in HIV Prevention

Jacobsen

Walensky

2016

Curr HIV/AIDS Rep

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With HIV funding plateauing and the number of people living with HIV increasing due to the roll-out of life-saving antiretroviral therapy, policy makers are faced with increasingly tighter budgets to manage the ongoing HIV epidemic. Cost-effectiveness and modeling analyses can help determine which HIV interventions may be of best value. Incidence remains remarkably high in certain populations and countries, making prevention key to controlling the spread of HIV. This paper briefly reviews concepts in modeling and cost-effectiveness methodology, then examines results of recently published cost-effectiveness analyses on the following HIV prevention strategies: condoms and circumcision, behavioral or community-based interventions, prevention of mother to child transmission, HIV testing, pre-exposure prophylaxis, and treatment as prevention. We find that the majority of published studies demonstrate cost-effectiveness; however, not all interventions are affordable. We urge continued research on combination strategies and methodologies that take into account willingness to pay and budgetary impact.

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Section: Introductionmentioning

confidence: 99%

Modeling and Cost-Effectiveness in HIV Prevention

Jacobsen

Walensky

2016

Curr HIV/AIDS Rep

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“…Confusion may occur if a new innovation provides high value when measured with one outcome or perspective but no value when measured using a different outcome or perspective. 46 The committee was particularly eager to see more research on incentives to improve value and to leverage past research 47 while navigating the governmental limitations on human resources, contracting, and information technology. The committee also agreed that we must enlist the help of patients in driving policy agenda and clinical care towards defining and improving value.…”

Section: Discussionmentioning

confidence: 99%

Opportunities to Enhance Value-Related Research in the U.S. Department of Veterans Affairs

et al. 2016

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“…This is illustrated by the emergence in recent years of several tools (as described below and summarised in Table 1) to enable payers, clinicians and patients to make better informed decisions [12,13], as well as by the introduction of CUAs to support clinical guideline development [14], drug formulary management by certain health plans [15], and for the assessment of preventive measures by Medicare [16]. Moreover, the independent non-profit Institute for Clinical and Economic Review (ICER) is producing evidence reports using the CUA methodology as a free resource available to any stakeholder interested in evidence-based and cost-effectiveness-driven healthcare decision-making [17].…”

Section: Introduction and Objectivesmentioning

confidence: 99%

The potential price and access implications of the cost-utility and budget impact methodologies applied by NICE in England and ICER in the US for a novel gene therapy in Parkinson’s disease

Jørgensen

Servos

Kefalas

2018

Journal of Market Access & Health Policy

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Background: NICE in England, and ICER in the US both use cost-utility analyses (CUA) and budget impact analyses (BIA) to assess value for money and affordability, however the thresholds used differ greatly.Objective: To perform a cross-country comparison of the results of the CUA and BIA and detail the implications for reimbursed price and volumes, for a novel gene therapy for Parkinson’s disease (PD).Methods: A Markov model was built to perform country-specific CUAs and BIAsFindings: The US ceiling price identified through CUA is ~ 1.8 times higher than in England (aligning to our previous US/UK price comparison analysis of high-cost drugs). However, the net budget impact corresponding to these price levels would limit number of patients treated in order not to exceed the BIA threshold. Performance-based annuity payments can increase patient access at launch without exceeding the thresholds while reducing payers’ data uncertainty.Conclusion: Our cost-utility analysis in PD shows a difference in price potential between the US and England that aligns with what is observed in practice for other high-cost drugs. Furthermore, the budget impact threshold operational in England imposes a greater downwards pressure on price and/or volumes than the one applied by ICER in the US.

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Medicare's use of cost-effectiveness analysis for prevention (but not for treatment)

Cited by 19 publications

References 28 publications

Modeling and Cost-Effectiveness in HIV Prevention

Modeling and Cost-Effectiveness in HIV Prevention

Opportunities to Enhance Value-Related Research in the U.S. Department of Veterans Affairs

The potential price and access implications of the cost-utility and budget impact methodologies applied by NICE in England and ICER in the US for a novel gene therapy in Parkinson’s disease

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