Trends in the use of cost-minimization analysis in Economic Assessments submitted to the SMC

Abstract

the G-BA website. 104 molecules that had gone through the AMNOG procedure were identified and further categorized in order to determine whether they had submitted direct, indirect, or both types of comparisons. The G-BA publications by means of the classification score were used to source and quantify the outcome of the decision. RESULTS: 16 out of the 104 analyzed molecules were found to have submitted indirect comparisons. Out of these, the G-BA decisions recognized that 6 molecules had mild or significant overall added benefit. All of these 6 molecules presented both direct and indirect comparisons. On the other hand, molecules that only submitted indirect comparisons were found to have no additional benefit. The most common reasons for dismissals of indirect comparisons by IQWiG were the inappropriate patient population selection, the choice of inappropriate bridge comparators, and that population uniformity was not guaranteed. CONCLUSIONS: These results demonstrate that submission of indirect comparisons alone are unlikely to result in a positive added benefit classification by IQWiG and the G-BA. However, if the indirect comparison is coupled with a direct comparison, the outcome of the assessment by the G-BA is more likely to result in a positive added benefit classification.

Economic methods used in health technology assessment

“…Heintz et al, 2016). These fi ndings are in compliance with other research studies on this topic such as Brockis et al (2006) or Mathes et al (2013). The cost-utility analysis (CUA) is mostly preferred and widely accepted because it enables a comparison between different indications and types of health technology, especially in state-funded health care systems.…”

“…In this review, the product is a medical device and it refers to a class II device (e.g., blood pressure monitors, contact lenses, pregnancy test kits, single-use surgical instruments, catheters), a class III device (e.g., ventilators, cardiac monitors, hip implants, knee implants, lasers, chlamydia test kits, glucose meters), or a class IV device (e.g., defi brillators, pacemakers, coronary stents, HIV test kits, neurosurgical shunts) that requires product licensing for general marketing purposes. The original research articles or clinical studies, however, were considered only back to the years of 2014-2016 since several review studies on this topic had been made before or even in this period, e.g., (Cooper et al, 2013;Craig et al, 2014;Markewicz, van Til, & Ijzerman, 2014;Mathes et al, 2013;Pham et al, 2014;Rotter, Foerster, & Bridges, 2012;Stephens, Handke, & Dshi, 2012).…”

“…CUA is used when interventions can infl uence the health related quality of life and the length of life (Canadian Agency for Drugs and Technologies in Health, 2006). In addition, CUA aims at a higher level of standardization because the same denomination is used for all types of health technology and the methods to determine it can be better standardized (Mathes et al, 2013). As the survey study (Heintz et al, 2016) reveals, most European countries use CUA as the main type of economic analysis.…”

“…CEA results can be only compared with the results of other technologies that are expressed in the same outcome measure. In addition, there might be ethical issues about the low acceptance of valuing health in monetary units in some societies (Mathes et al, 2013). Both CEA and CUA are expressed as an incremental cost-effectiveness ratio (ICER), i.e., the ratio of change in costs to the change in effects (What is the incremental cost-effectiveness ratio (ICER, 2017).…”

“…The problem is that complete standardization of economic evaluations cannot be performed since the methods should be fl exible enough to be compatible with different problems in different contexts (Mathes et al, 2013;Soltes & Gavurova, 2015). In addition, as Rotter, Foerster, and Bridges (2012) argue, several different approaches can be potentially applied in decision modelling.…”