THE PILLARS OF COST-EFFECTIVENESSA PRACTICAL GUIDELINE FOR NEW

TECHNOLOGY COST-EFFECTIVE DECISION-MAKINGMario-Ricardo Calderón, Alejandro Salvatierra & Roel Roording

Novartis Pharma AG, Central America & Caribbean

Presented at ISPOR 20th Annual International Meeting, 16 – 20 May, 2015, Philadelphia, USA.

INTRODUCTION

ABSTRACT #55053

PRESENTATION CODE

PHP187

The critical importance and use of health technology assessment in health care decisions towards improved health is practically nonexistent in many Central American and Caribbean countries. A culture with a health economics mindset that enhances access to new technologies is needed; one that increases the knowledge and application of economic evaluation among health stakeholders to make cost-effective decisions that improve health.

Health care progress depends on the effective use of resources including knowledge of what drugs or interventions work, how much they cost and how they are administered or implemented. Patients, providers, policy makers and payers share universal goals in terms of drugs and technology use and acquisition --best quality, lowest cost and reasonable access. This has resulted in (1) greater focus on healthcare spending, cost-containment, prescribing behavior control and smaller perceived drug differentiation within the healthcare industry, and (2) increased need for differentiated products, compelling value propositions and better support and patient access strategies in the pharmaceutical industry. The rising costs of healthcare and limited resources have spurred the need for evaluating the economic viability of any drug or intervention. However, evaluation of health technologies and economic evaluations represent only one of the components of a comprehensive strategy to make technologies more accessible to patients.

OBJECTIVES

patients, healthcare providers, governments and society as a whole.

industries to make new technologies more cost-effective and available to patients in resource-limited settings.

METHODS AND DISCUSSION A needs assessment was conducted among key internal (pharmaceutical

and the Caribbean to gain insight about their behaviors, patterns and practices regarding new technology acquisition. Health stakeholders were interviewed at

Panama and the Dominican Republic during 2014. A literature review of lessons learned and best practices around the world complemented information collected from local stakeholders. No standardized way to make budget allocations or procurement decisions was

based on empiric estimates, previous year consumption, earmarked budgets,

drugs is critically important but, due to limited budgets and lack of cost-effectiveness evidence or knowhow, the key driver behind most decisions is price, the lowest price

possible. Stakeholders acknowledge that inexpensive drugs may turn out expensive at the end in terms of increased tangible (direct and indirect) and intangible costs and poor health outcomes. A simple, useable, read-do Checklist could guide stakeholders to select cost-effective health technologies, particularly new, innovative high cost drugs. The Checklist concept has been used effectively for over 75 years by the aeronautical

Boeing Corporation, October 1935). The World Health Organization translated this concept intuitively to the operating room to reduce the number of surgical deaths around the world in conjunction with the Harvard School of Public Health (WHO Surgical Safety Checklist, 2008). A basic organization tool –the simple Checklist—when properly conceived has proven effective in a wide range of

cases, protect personnel and respond appropriately (U.S. Centers for Disease

save lives and cope with extreme weather conditions and disasters (American Red Cross), etc. In pharmacoeconomics, as in aviation, medicine and public health, checklists can help ensure consistency and completeness in carrying out complex tasks. Hence, a practical Checklist with all knowledge domains needed to select new drugs and technologies could improve the decision makers´ communication and consistency of information and data, facilitate the decision-making process and determine the most cost-effective options for the health system.

RESULTS

CONCLUSIONS

REFERENCES

possible.

cost drugs and technologies more cost-effective.

technology selection and acquisition.

policy-makers and payers to (1) get the best drug and technology quality at the lowest cost with reasonable access, and (2) enhance healthcare partnerships and solutions towards improved individual and population health outcomes.

NP4 #C61505330213

CLINICAL EFFECTIVENESS

MEDICAL ACCESS EFFECTIVENESS

ECONOMIC EFFECTIVENESS

1. EFFICACY 4. VALUE-ADDED SERVICES 7. COST OF ILLNESS

2. SAFETY 5. MANAGED-ENTRY AGREEMENTS 8. COST-EFFECTIVENESS EVIDENCE

3. QUALITY 6. IMPACT INFORMATION 9. BUDGET IMPACT ANALYSIS

Symptoms Relief Training Programs Direct CostsSurvival Diagnostic Tools Indirect CostsQuality of Life Patient or Provider Services Intangible Costs

Frequency of Adverse Events Performace-Based Agreements Cost-Utility AnalysisSerious Adverse Events Financial-Based Agreements Cost-Benefit AnalysisRisk Management Plan Risk-Sharing Arrangements Cost-Effectiveness Analysis

Good Manufacturing Practices Epidemiological Burden Current Technology Mix Cost Bioavailability Evidence-Based Clinical Research New Technology Mix Cost Bioequivalency Real World Evidence Research Comorbidity Related Costs

Table 1 NEW TECHNOLOGY COST-EFFECTIVENESS CHECKLIST *(FIRST EDITION)