Revision of Ireland’s Cost-Effectiveness Threshold: New State-Industry Drug Pricing Deal Should Adequately Reflect Opportunity Costs

O’Mahony, James F.

doi:10.1007/s41669-021-00289-0

Cited by 3 publications

(3 citation statements)

References 33 publications

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“…The NCPE’s HTA concluded that the ICER for dupilumab in adult patients with moderate-to-severe, refractory AD exceeded €66,000 per QALY. This is well above the threshold of €45,000/QALY that has been used within the decision making processes in Ireland [ 8 , 25 ]. The predicted gross budget impact estimate was €38.3 million over 5 years, with the licence extension granted to the adolescent population expected to increase the budget impact substantially.…”

Section: Discussionmentioning

confidence: 98%

Health technology management: the experience of a managed access approach to the reimbursement of dupilumab in Ireland

2023

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Background Dupilumab was the first biological medicine to receive marketing authorisation, in Ireland, for the treatment of atopic dermatitis (AD). In 2019, Ireland’s National Centre for Pharmacoeconomics recommended that dupilumab not be reimbursed at the submitted price; it was not cost effective. Following confidential price negotiations, the Health Service Executive (HSE) reimbursed dupilumab subject to a HSE-Managed Access Protocol (MAP). Patients with refractory, moderate-to-severe AD were deemed eligible to receive treatment under the MAP; the cohort for which dupilumab is expected to be most effective and most cost effective (versus standard of care). Approval, for treatment, is granted on an individual patient basis by the HSE-Medicines Management Programme. Aims Applications for approval of treatment with dupilumab were analysed to determine the percentage of patients deemed eligible. Key characteristics of this population were investigated. Methods Data from individual patient applications were analysed. Key characteristics of the approved population were investigated using IBM SPSS Statistics® version 27. Data were derived from the HSE-Primary Care Reimbursement Service pharmacy claims database. The number of patients who received dupilumab over the study period was determined. Results In total, 96% of submitted applications were deemed eligible. Of these, 65% were male and 87% were adults. In the main, the approved patient population had severe refractory AD; the mean Eczema Area Severity Index score was 28.72. Conclusion The majority of applications submitted were approved. This work highlights how a MAP can facilitate access to treatment in patients who are deemed eligible whilst containing overall expenditure.

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Section: Discussionmentioning

confidence: 98%

Health technology management: the experience of a managed access approach to the reimbursement of dupilumab in Ireland

2023

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“…The cost-effectiveness of the vaccine was assessed in terms of discounted life years lost, QALYs, and incremental cost-effectiveness ratios (ICERs) against a cost-effectiveness threshold of EUR 45,000/QALY [ 36 , 37 ]. QALYs were discounted at an annual rate of 3%.…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness of the Use of Adjuvanted Quadrivalent Seasonal Influenza Vaccine in Older Adults in Ireland

2023

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Background: Enhanced vaccines (e.g., containing adjuvants) have shown increased immunogenicity and effectiveness in older adults, who often respond sub-optimally to conventional influenza vaccines. In this study, we evaluated the cost-effectiveness of an inactivated, seasonal, MF59-adjuvanted quadrivalent influenza vaccine (aQIV) for use in adults ≥ 65 years in Ireland. Methods: A published dynamic influenza model incorporating social contact, population immunity, and epidemiological data was used to assess the cost-effectiveness of aQIV in adults ≥ 65 years of age compared with a non-adjuvanted QIV. Sensitivity analysis was performed for influenza incidence, relative vaccine effectiveness, excess mortality, and the impact on bed occupancy from co-circulating influenza and COVID-19. Results: The use of aQIV resulted in discounted incremental cost-effectiveness ratios (ICERs) of EUR 2420/quality-adjusted life years (QALYs) and EUR 12,970/QALY from societal and payer perspectives, respectively, both of which are below the cost-effectiveness threshold of EUR 45,000/QALY. Sensitivity analysis showed that aQIV was effective in most scenarios, except when relative vaccine effectiveness compared to QIV was below 3%, and resulted in a modest reduction in excess bed occupancy. Conclusion: The use of aQIV for adults ≥ 65 years old in Ireland was shown to be highly cost-effective from both payer and societal perspectives.

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“…Currently, those with PHI can bypass aspects of the public hospital system by accessing private care within both public and private hospitals. If the introduction of universal health care in Ireland includes the removal of private practice from public hospitals (thereby reducing the ability of those with PHI to access private services), those with PHI may prefer a continuation of the status quo rather than supporting reforms that will likely require an increase in taxation (O'Mahony, 2021) and potentially impact on their ability to access health care in a timely manner. Recently, objections were raised by members of the public (and medical professionals) about the removal of private maternity care from public hospitals with some arguing that this would reduce choice for patients given the lack of private maternity hospitals (Malone, 2023).…”

Section: Reform Proposals But Limited Implementation: Why?mentioning

confidence: 99%

Improving access to healthcare in Ireland: an implementation failure

Connolly

2023

HEPL

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There are significant barriers to accessing health and social care services in Ireland including high user charges, long waits and limited availability of some services. While a number of reform proposals have committed to improving access to health care, implementation of these proposals has been limited. The aim of this paper is to identify and discuss policy implementation failures concerned with improving access to health and social care services in Ireland. Four potential reasons for the repeated failure to implement stated reform proposals are identified including a failure to identify and address the practicalities of implementation, competing health care demands, the political cycle and stakeholder resistance. While there has been a shift in Irish health care policy documents in the last 10 years with increasing emphasis on ensuring access to health care based on need rather than ability to pay, a repeated failure to implement the proposed reforms raises questions as to whether there is a real commitment to improving access to health care.

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Revision of Ireland’s Cost-Effectiveness Threshold: New State-Industry Drug Pricing Deal Should Adequately Reflect Opportunity Costs

Cited by 3 publications

References 33 publications

Health technology management: the experience of a managed access approach to the reimbursement of dupilumab in Ireland

Health technology management: the experience of a managed access approach to the reimbursement of dupilumab in Ireland

Cost-Effectiveness of the Use of Adjuvanted Quadrivalent Seasonal Influenza Vaccine in Older Adults in Ireland

Improving access to healthcare in Ireland: an implementation failure

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