Untangling the Complexity of Funding Recommendations: A Comparative Analysis of Health Technology Assessment Outcomes in
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ORIGINAL RESEARCH ARTICLE
Untangling the Complexity of Funding Recommendations: A Comparative Analysis of Health Technology Assessment Outcomes in Four European Countries Karin H. Cerri1,2 • Martin Knapp1 • Jose-Luis Fernandez1
Published online: 11 September 2015 Springer International Publishing Switzerland 2015
Abstract Objectives Health Technology Assessment (HTA) agencies produce recommendations that guide public funding of pharmaceuticals, based on various criteria. We explored factors that may contribute to explaining differences in coverage decisions by the National Institute for Health and Care Excellence (NICE) in England and Wales, the Scottish Medicines Consortium (SMC), the Dutch College voor Zorgverzekeringen (CVZ), and the French Haute Autorite´ de Sante´ (HAS). Methods A dataset of 977 HTA decisions made in 2004–2009 was created. A three-category outcome variable was used (decision to ‘recommend’, ‘restrict’ or ‘not recommend’ a technology). Multivariate analyses explored impacts of clinical, economic, process and socio-economic variables in their decision making. Results Relative to the CVZ and adjusting for a range of confounders, technologies were more likely to be recommended by NICE and HAS, and restricted or not-recommended by the SMC. Recommendation was significantly
Electronic supplementary material The online version of this article (doi:10.1007/s40290-015-0112-8) contains supplementary material, which is available to authorized users. & Karin H. Cerri [email protected] 1
London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
2
Janssen Pharmaceutica NV, Beerse, Belgium
associated (p B 0.10) with several variables: strength of clinical evidence (number of trials, use of active comparator-arm, demonstration of clinical superiority) orphan status and indication for cancer. Simultaneous assessment of multiple rather than single pharmaceuticals was associated with increased probability of restriction. Conclusions In this European multi-HTA study, appraisal outcomes differed significantly across HTA bodies. A range of evidence and non-evidence factors were associated with HTA decisions, confirming the value of comprehensive, multivariate analyses. Nevertheless, a large proportion of variance in HTA decisions remained unexplained, suggesting that greater transparency of decision making is needed, along with associated further research.
Key Points European HTA agencies included in this analysis significantly differed in their decision making, after adjusting for a range of factors including the scoping and decision-making process, evidence considered, and socio-economic differences. The strength of the evidence demonstrating the clinical value of the pharmaceutical, together with the therapeutic area which it targets, have a significant role in HTA decisions. ‘Untangling’ the complexity of payer decision making was limited given that multivariate analyses could only explain between 13 and 30 % of the observed variability in decision making, despite taking i
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