Country: THE NETHERLANDS | Region: EUROPE | Type: PPMA
- At PPMA 2020, EVERSANA’s Dr. Magdi Stino and Alan Crowther came together to detail some recent trends and share approaches for using Health Technology Assessment (HTA) data when decision making, leveraging information from the Pricentric HTA database
- Looking specifically at the UK, Germany, France, Canada, and Brazil, Dr. Stino went on to assess the recommendation types for all therapeutic areas over the span of the last decade, in order to see how they might be changing over time
- Alan Crowther went on to analyze congruence between the product recommendations and the HTA bodies, across both developed and emerging markets
AMSTERDAM, The Netherlands – During PPMA’s virtual broadcast on Friday, a panel on trends in Health Technology Assessment (HTA) decisions was moderated by Alan Crowther, General Manager at EVERSANA, and Dr. Magdi Stino, Director of Pricentric HTA at EVERSANA.
Crowther and Dr. Stino came together to detail some recent trends and share approaches for using HTA data for decision making, leveraging information from the Pricentric HTA database, pulling data from a subset of markets to assess the trends over the last 10 years.
HTA Outcome Trends
Looking specifically at the UK, Germany, France, Canada, and Brazil, Dr. Stino went on to assess the rating and recommendation types over the span of the last decade, in order to see how they might be changing over time. To do this, he assessed the first product decision for each assessed indication for each HTA body, focusing generally on all therapeutic areas and then for oncology.
Dr. Stino noted how in the UK and Canada, there is a definite trend of conditional recommendations increasing over time. On the other hand, full recommendations and non-recommendations are decreasing; a trend which is particularly noticeable in the UK.
While these HTA bodies seem to be increasingly restrictive, they can also be seen as more permissive in the sense that decisions which would have previously received a non-recommendation are now being optimized through the conditional recommendation channel.
Further, Dr. Stino assessed France and Germany – who both use a rating framework– over the same time period and found that the Medical Service Rendered (SMR) rating in France stayed relatively consistent over the time period, despite wavering slightly.
In Germany, all quantifiers of benefit gradually increased over time, particularly the “No Additional Benefit” rating, which entails a drug being reimbursed but with price restrictions.
Across all four agencies and markets, the general volume of drugs is increasing, noted Dr. Stino.
Zooming in on the UK, the analyzed data showed that conditional recommendations are actively replacing both recommendations and non-recommendations. In oncology in particular, the same pattern is true. However, in this therapeutic area they seem to be more directly replacing full recommendations – suggesting that the UK market might be becoming more restrictive for oncology products.
Next, zooming in on the French and German markets, he noted a clear upward trend in initial SMR “Important” ratings in oncology, but explained that comparing total counts vs. percentages provides a different picture.
As such, analyzing the data and taking volume increase into account, the initial decisions, especially in Germany, have remained steady over time.
Time to Initial Decision
Following on from the previous data, Dr. Stino questioned how decision times may be changing within these same agencies by looking at the median time to first product decision/rating for the first assessed indication from the product approval date.
The time to decision in Canada, for all therapeutic areas, looks like it may be decreasing, barring a few spikes “here and there”, according to Dr. Stino. Likewise, zooming in on the UK for all therapeutic areas, the pattern withstands.
Focusing on oncology specifically, Canada’s pan-Canadian Oncology Drug Review (pCODR) also appeared to be taking less time to make conditional recommendations and non-recommendations. However, against the grain, full recommendations appear to be taking longer to come to fruition.
Cross referencing this with the UK, Dr. Stino noted that the median time decrease is consistent with the Canadian trend. Most recommendations show decreasing time to decision, whereas full recommendations are increasingly taking longer. This denotes an interesting pattern and suggests that by being more restrictive HTAs are also speeding up the decision-making process with increased restrictions.
Concluding the data analysis, Dr. Stino suggested that companies that accept these restrictions will have a faster time to market but will be restricted on price or limitations on the reimbursable patient population.
Congruence Between HTA Bodies
Taking over, Alan Crowther went on to analyze the congruence between the product recommendations and the HTA bodies, across both developed and emerging markets.
EVERSANA found that there was a group of 17 product-indication pairings, including two products with multiple indication and two sets of products with the same indication, that were assessed by all of the studied markets.
The UK’s National Institute for Health and Care Excellence (NICE) had “high” congruence with Canada’s Common Drug Review (CDR) and pCODR, but less so with Brazil’s National Committee for Health Technology Incorporation (CONITEC).
Stringing the data sets together, Alan noted that not only were the HTA decisions and conditional recommendations increasing as per Dr. Stino’s findings, but that the decisions in the UK and Canada often concern the same drugs – that is, they are evaluating the same products.
Crowther’s key analysis found that ultimately, knowing the outcome for either the UK or Canada’s HTA assessment would provide insight into the likelihood that the other body would make the same decision, but the correlation between NICE and CONITEC was not present.
Despite not having high congruence – the UK and Brazilian agencies had six matches and 12 mismatches – most NICE decisions were found to be conditional recommendations. As such, if a product was assessed by CONITEC, it would be fair to assume that it would receive a conditional recommendation from NICE, noted Alan Crowther.
Looking further into the data, CONITEC and pCODR did not have enough overlapping decisions to be able to analyze their relationship effectively, and CONITEC and CDR were ultimately found to have low congruence.
Ultimately, Crowther describes how these insights suggest the possibility of predictive power in following HTA decisions across multiple agencies.
Leveraging the information, three key actions can assist in refining market access strategies, based on similar HTA trend assessments:
- Identify all initial decisions made by each HTA for the same therapeutic area and indications. Use this information to identify trends in decision and rating types, as well as the time to decision.
- Analyze and identify matched pairs of HTA bodies and assess the congruence between each pair.
- Analyze results and develop an action plan. When building a predictive market access model, it is critical to look at specific HTA trends and congruence as part of that model.
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