Use of HTA for pharmaceutical reimbursement lesson learned from - - PowerPoint PPT Presentation

Use of HTA for pharmaceutical reimbursement

lesson learned from Thailand

Netnapis Suchonwanich Advisor of HITAP , Thailand Former Deputy Secretary General of NHSO,Thailand

2002

pr pressu essure t e to

• cons
• nsider

der the he val alue ue for

• r money

money of

• f heal

health h inv nvest estment ent

access and effectiveness

efficacy

adequacy Public Health Insurance

New m edicine Advanced Technology

Development of National List of Essential Medicines

4  1981 NLEM was first introduced cri riteri ria : only cost, safety, efficacy  2004 ad added ed criter eria : effectiveness  2008 ad added ed criter eria a : cost-effectiveness UHC was established in 2002

Pa y m ent m echa nism in UCs

• Capitation in OP
• DRG with global budget in IP

Development of National List of Essential Medicines

in 2019

The 22 National Expert Panels for each drug group

Nominate the items to be in NLED

The Screening Working Group

coordinate results from 24 working groups cost-effectiveness, equity, national affordability.

NLEM Subcommittee

primary selection of ED

The he Heal ealth Econom

• nomic Wor
• rking

ng Group

• up

Price e negot gotiat ation

• n

working ng Group

• up

Academics Industrial Public hearing

NLEM Committee

make a final decision

Approval from 3 main public health insurance schemes

HTA

Process for listing : 21 wk. cycle

ISAFE s FE score

I- Information

S- Safety A- Administration restriction F- Frequency of drug administration E- Efficacy/ Effectiveness HTA

6

Source: Perez R, Chaikledkaew U, Youngkong S, Tantivess S, Teerawattananon Y. Health Technology Assessment Process Guidelines. Nonthaburi, Thailand: Health Intervention and Technology Assessment Program (HITAP); 2012.

What HTA provided for UCS development

 Evidence of cost effectiveness  Value for m oney Ex : Thailand  Increm ental cost-effectiveness ratio (ICER)

Cost-effectiveness threshold = 160 ,0 0 0 THB/ QALY (5,0 0 0 USD)

 Budget im pact com pared current practice and new intervention  Feasibility study

Using economic evaluation to inform NLEM development during 2007-2010

Cost-effectiveness study Finding Recom m endation HMG-CoA reductase inhibitors Atorvastatin not cost-effective Not included atorvastatin in the list Osteoporosis drugs not cost-effective Not included in the list Acetylcholinesterase inhibitors not cost-effective Not included in the list Peginterferon alfa-2a, 2b cost-effective Included in the list Tenofovir cost-effective Included in the list Oxaliplatin not cost-effective Price negotiation and included in the list

• 1. ICER 300,000

THB/QALY at current price

C

• 2. Negotiated price based on CE

threshold Accept the technology if ICER < 160,000 THB/QALY*

• 3. Fina

nal ne negot gotiated d pr price ba based d on

• n budge

budget impa pact and nd affor

• rda

dabi bility of

• f 3

3 schem emes es

*5,000 USD (1 USD = 35 THB)

9

ICER

Price negotiation model for NLEM

Disease Drug name model

Hep C Peginterferon Value based pricing Hep B Tenofovir Medicine patent pool Thai GPO manufactured Breast cancer (HER2+ ) Trastuzumab (440mg) Volume purchase with free for confirm FISH test Managed entry agreement Prostate Cancer Leuprorelin/Triptorelin Choose one price Breast cancer letrozole Compulsory licensing Breast cancer Doxetaxel Compulsory licensing Tax exemption for free good (originator) CA colon Oxaliplatin Market competition Gaucher type1 Imiglucerase Risk sharing with Managed entry agreement Diffused large B-cell lymphoma Rituximab Managed entry agreement Hep C Sofosbuvir, ledipasvir Voluntary licensing

Appraisal results and decision making

11

• Imiglucerase for

Gaucher type 1

• PD-first policy

for ESRD

• Ref. IRP project with IMS

8 /0 5 /6 2

1 2

Using HTA to determine the value and prioritize each new product

Raltegravir Dolutegravir

total

The access to high costly medicines

• 1. Interchangeable of biosim ilar products
• 2. Indication-based pricing from HTA im pact

3 . co-dependent technology