The value of work in Health Technology Assessments (HTAs)

Marieke KroliBMG/iMTA, Erasmus University Rotterdam

Introduction: Marieke Krol

• Researcher at Erasmus University– HTA related research, PhD thesis on productivity

costs in economic evaluations• Active in teaching– Coordinater of the HTA course in two Master

programs (Health Economics, health Economics, Policy and Law

– Coordinator of the HTA specialisation

Why Health Technology Assessment?

• A new therapy enters the market– Should that therapy be reimbursed?

• HTA provides insight in costs and effects of (new) interventions compared with existing interventions

• What are the additional costs?• What are the additional benefits?• Are the benefits worth the extra expenses?

Cost-effectiveness ratio of B versus A

• What are the additional costs?• What are the additional benefits?

ICER = Incremental cost-effectiveness ratio

(costs New - costs Old)(effects New – effects Old)

• Common outcome: costs per QALY• Are the benefits worth the extra expenses?

– What is a QALY worth?

Perspective

• Health care perspective– Include costs paid from the health care budget

• Societal perspective– Include all relevant costs (and effects)– E.g. out of pocket payments and productivity costs

Productivity costs

“Costs associated with production loss and replacement costs due to illness, disability and death of productive persons, both paid and unpaid.” (Brouwer et al. Health Econ 1997: 6(5))

I.e. People suffering from ill health are commonly less productive, which involves costs.

Productivity costs in HTA

• Productivity costs are excluded in 90% of published HTA studies

• Costs (or savings) often exceed medical costs• Ignoring these costs does not make these

costs les relevant• Work of patients with MSD is significantly

affected!

Expected outcomes of this workshop

• What we hope you will gain from this workshop– An improved understanding of the importance of ‘productivity

in HTA’ – An increased insight to the views of relevant stakeholders (e.g.

patients, doctors, policy makers, researchers)– Increased knowledge of international differences in HTA and the

role of productivity in HTA• What it hopefully brings us

– Input for further FfW HTA discussions based on your experience, ideas and discussions

– An increased insight in potential barriers of including productivity in HTA among different stakeholders

Imagine the following

• There is a new expensive drug (drug X) on the market for the treatment of moderate to severe rheumatoid arthritis.

• The drug is slightly more effective than the drugs currently reimbursed in your country

• The drug is considerably more expensive• The decision makers in your country need to

decide on reimbursement of drug X.

Questions

• Should work play a role in the decision to reimburse drug X?– What do you think as a stakeholder?

• What do you know about the role of HTA is in your country?– Is productivity included in HTA in your country?

• What are the barriers to inclusion of work in HTA in your national setting?

• Who are the stakeholders in your country?• Where and how to start the debate in your country?