Economic Evaluation of Pharmaceuticals

Abstract

In recent years there has been a large increase in the number of economic evaluations of pharmaceuticals. Many of these studies have been commissioned by individual pharmaceutical companies, in support of new or existing products. In 2 countries, Australia and Canada (in the province of Ontario), draft guidelines issued by the government have outlined the requirements for economic evaluations to be submitted in support of requests for reimbursement (government subsidy) of particular products. One consequence of the guidelines is that they clarify what is required, and in specifying the procedure for submission of dossiers, identify a clear audience for the economic evaluation. In contrast, the situation in Europe is diverse. A wide range of healthcare systems exist, including national health services and more liberal systems, involving a wide range of insurers and providers. European countries also differ widely in their approach to the pricing and reimbursement of pharmaceuticals. Because of this diversity, the nature, conduct and impact of economic evaluation in Europe is not clear. It is therefore difficult for pharmaceutical companies to develop appropriate strategies for economic evaluation and for analysts to decide on appropriate study methodology. This article reviews the nature of any official guidance or requirements for economic evaluation, the potential for use of economic evaluation, the range of studies carried out and the identifiable impacts. There is currently no official guidance in any country, although some countries are considering issuing guidelines. In some countries there is official encouragement to pharmaceutical companies to undertake studies, and where economic data have been presented they have been considered by the relevant committees. The potential uses of economic evaluation vary widely from country to country. These can be classified in terms of a potential role in undertaking national price negotiations, deciding on reimbursement status or copayment level, deciding on inclusion in local formularies or in treatment guidelines, or in improving prescribing decisions. Approximately 80 economic evaluations of pharmaceutical products have been conducted to date in Europe, covering a wide range of clinical areas. There are relatively few examples of identifiable effects of such studies. In part this is because it is often difficult to assess the part played by various items of data. Nevertheless, the overriding conclusion is that economic evaluation of medicines is likely to be more relevant in Europe in the future. The problem for the pharmaceutical industry is in determining when and how.

Clinical Endpoints and Economic Parameters for Market Access and Value Creation

“…Another important factor is that, when clinical and economic endpoints are collected simultaneously in clinical trials, it allows comparison with the cost of alternative drug/device/technology treatment(s), placebo or in some cases standard non-drug management. [4] …”

Pharmacoeconomics for migraine and headache researchers: basic concepts, methods and terminology

“…The whole process may be thought open to bias [27] from choice of comparator drug, the assumptions made where accurate data is lacking and in the selective reporting of results. In migraine, most studies are funded by the manufacturers of these drugs, who may clearly have biases: in general they only fund studies of expensive acute treatments, particularly the triptans, and there is very little consideration of less expensive long-term prophylactic therapies or non-pharmacological interventions.…”

The Pharmaceutical Industry and Health Reform: Lessons From Europe

“…Although there is evidence of the influence of economic evaluation on particular decisions in European countries, it is not yet a formal requirement. 6 Australia remains the only country that requests evidence of cost-effectiveness before granting reimbursement, although such plans in Canada are well advanced.…”