Exploring the misalignment on the value of further research between payers and manufacturers. A case study on a novel total artificial heart

Abstract

Payers and manufacturers can disagree on the appropriate level of evidence that is required for new medical devices, resulting in high societal costs due to decisions taken with sub‐optimal information. A cost‐effectiveness model of a hypothetical total artificial heart was built using data from the literature and the (simulated) results of a pivotal study. The expected value of perfect information (EVPI) was calculated from both the payer and manufacturer perspectives, using net monetary benefit and the company's return on investment respectively. A function was also defined, linking effectiveness to market shares. Additional constraints such as a minimum clinical difference or maximum budget impact were introduced into the company's decisions to simulate additional barriers to adoption. The difference in the EVPI between manufacturers and payers varied greatly depending on the underlying decision rules and constraints. The manufacturer's EVPI depends on the probability of being reimbursed, the uncertainty on the (cost‐)effectiveness of the technology, as well as other parameters relating to initial investments, operating costs and market dynamics. The use of Value of information for both perspectives can outline potential misalignments and can be particularly useful to inform early dialogs between manufacturers and payers, or negotiations on conditional reimbursement schemes.

Pushing the boundaries of evaluation, diffusion, and use of medical devices in Europe: Insights from the COMED project

“…In two other Supplement papers, COMED researchers investigated methodological aspects concerning early‐stage health economic modeling. Federici and Peccchia focused on the methods to deal with uncertainty at early stages of a technology life‐cycle, when evidence is still sparse (Federici & Pecchia, 2022). A cost‐effectiveness model of a hypothetical total artificial heart was built using data from the literature and the (simulated) results of a pivotal study.…”

An approach to quantify parameter uncertainty in early assessment of novel health technologies

“…To demonstrate the utility of PBA in this setting, we used a simplified version of a previous cost‐effectiveness model of a hypothetical new TAH versus Syncardia. Full details of the model are provided elsewhere in this supplement (Federici & Pecchia, 2021), and summarized here. The model was structured as a discrete‐time semi‐Markov model with three states, alive with TAH support (TAH), alive after transplantation (HTx), and dead (Figure 3).…”