Clinical Opinion in Rapid Review: How Much Value Does It Add to Positive Reimbursement Decisions? A Retrospective Analysis of Outcomes From Rapid Reviews Developed by Axis Consulting

Speaker(s)

Leroy J1, Rouncivell L1, Dooley B1, McGrath E2
1AXIS Healthcare Consulting Ltd, Dublin, Dublin, Ireland, 2AXIS Healthcare Consulting Ltd, Dublin 2, Ireland

Presentation Documents

BACKGROUND: The National Centre for Pharmacoeconomics (NCPE) conducts health technology assessments (HTAs) of pharmaceutical products in Ireland. The Rapid Review is a preliminary step in the drug reimbursement process, resulting in a recommendation for reimbursement, rejection at the submitted price, or needing a full HTA. Local expert clinical opinion (CO) is often used to inform reimbursement submissions to the NCPE.

OBJECTIVES: To assess the added value of incorporating CO into Rapid Review dossiers (RRD).

METHODS: A retrospective analysis was conducted on RRDs in Ireland between 2021 and 2023 (n=38). RRDs were categorised into two groups: those including CO and those without. The formats of CO examined included surveys, in-depth interviews (IDIs), and advisory boards. Data sources comprised internal consultancy records, payer feedback, and secondary literature. Outcomes were compared between the two groups.

RESULTS: Of the 38 RRDs analysed, 28 (73.7%) included CO of the above 3 types, written surveys (n=2), IDIs (n=18), and advisory boards (n=8). Among these, 13 RRDs (46.4%) received positive reimbursement recommendations:

  • IDIs: 6 out of 18 RRDs (33.3%) received positive recommendations.
  • Advisory Boards: 6 out of 8 RRDs (75%) received positive recommendations.
  • Surveys: 1 out of 2 RRDs (50%) received positive recommendations.
In contrast, five out of 10 RRDs (50%) without CO received positive reimbursement recommendations.

CONCLUSIONS: This analysis indicates that incorporating CO, mainly through advisory boards, can enhance the likelihood of positive reimbursement recommendations in Rapid Reviews. However, the overall impact is modest. The study's limitations include a small sample size and a focus on a single consultancy in Ireland. Future research should involve larger samples and multiple consultancies to better understand the role of CO in reimbursement decisions. Despite these limitations, the findings suggest that while CO is beneficial, other factors also play a critical role in successful reimbursement outcomes.

Code

HTA280

Topic

Clinical Outcomes, Health Policy & Regulatory, Methodological & Statistical Research

Topic Subcategory

Clinician Reported Outcomes, Reimbursement & Access Policy, Survey Methods

Disease

No Additional Disease & Conditions/Specialized Treatment Areas