Impact of Publication of the French Commission for Economic and Public Health Evaluation (CEESP) Doctrine on the Conclusions of Its Economic Opinions

OBJECTIVES: Describe qualitatively the impact of the CEESP doctrine publication in July 2021, on published economic opinions conclusions.

METHODS: A retrospective descriptive analysis of the CEESP opinions issued 6 months before and after the doctrine publication was conducted based on an analysis grid built on key insights of the doctrine.

RESULTS: In total, 30 economic opinions were analyzed (16 published after the doctrine and 14 before). Fewer major methodological reservations were issued after the doctrine publication compared to before (19% versus 43%). While efficiency analysis scope revision by the CEESP could lead to a reservation before the doctrine, this was no longer the case after.

Besides, some inconsistencies in the doctrine application can still be highlighted: 25% of opinions post-doctrine with a reservation were not related to a specific methodologic element, and 19% of opinions with a reservation did not seem consistent with the impact of the methodological choice.

Since the doctrine publication, CEESP interpretations regarding ICER levels are more detailed and the information on the impact of treatment price on ICERs is frequently reported (69% versus 40%). Moreover, thanks to the framework of different possible conclusions type set in the doctrine, these are more predictable and understandable, especially when efficiency cannot be demonstrated. On the other hand, among the 17 opinions without reservations or major uncertainties, efficiency conditions are not clearly described but key drivers of the results are now frequently described (64% versus 50%): price decrease, population transposability, efficiency hypotheses.

CONCLUSIONS: Six months after the doctrine publication intended to bring clarity and consistency, CEESP opinions seem to be more legible, which should bring more insights for price negotiations. However, evaluation of the methodological quality and coherence of conclusions across opinions can still be improved.