Similarities and Differences Between Five European Drug Reimbursement Systems

Abstract

As shared strengths, all systems have clear objectives reflected in reimbursement criteria and all are prepared to pay for drugs with sufficient added value. However, all systems could improve the transparency of the decision-making process; especially appraisal lacks transparency. Systems could increase the use of (systematic) revisions and could make better use of HTA (among others cost-effectiveness) to obtain value for money and ensure system sustainability.

Incorporação de novos medicamentos pela Comissão Nacional de Incorporação de Tecnologias do SUS, 2012 a junho de 2016

“…Despite the importance of hepatitis C as a public health problem in Brazil, these several aspects are certainly a matter of great concern given the potential health impacts and scarce resources for health care in the country. Additional clinical benefits compared totechnologies that were already available, having low impact on the finances and budget and the clinical needs not being fulfilled, were all the main justifications used for incorporations of the new medicines on SUS in 2015. International studies that examined processes related to the reimbursement of drugs have been attracting attention for the important therapeutic value and additional benefits as relevant criteria for decision-making 29 . On the other hand, estimates of the influence of small budgetary impacts was possibly amplified by the large number of recommendations for incorporation conducted as simplified processes, which are applied for requests that involve criteria including low costs and low budgetary impact for SUS' forecast, among others.…”

Governance of conditional reimbursement practices in the Netherlands

“…A comparison between the Netherlands and France is warranted since both countries share common features, such as high GDP per capita and a perceived progressive approach towards orphan drug reimbursement within a common umbrella EU regulatory framework, albeit with distinct governance mechanisms (see e.g. [12]). There are also small differences in the number of reimbursed orphan drugs ( Table 1).…”

Involving Patients in Reducing Decision Uncertainties Around Orphan and Ultra-Orphan Drugs: A Rare Opportunity?

“…In Australia, patient organizations may request review of a specific drug [50][51][52]. Opportunities for patient organizations to prepare 'patient submissions' for consideration alongside the evaluation or assessment report on the clinical and economic evidence reviewed by a decision-making committee have been established in six of the 22 countries (Australia, Canada, Finland, Germany, The Netherlands, and the UK) [51,53,57,[61][62][63][64][65][66]. However, the scope of the submissions varies.…”