Presentation (CTI)

OBJECTIVES: When assessing non-incremental efficacy and safety compared to relevant comparators, the Institut National d'Excellence en Santé et Services Sociaux (INESSS) performs a cost minimization analysis (CMA). When multiple comparators are present, their weighted average cost (WAC) is calculated using the reimbursement claims adjudicated by the public payor, the Régie de l’assurance maladie du Québec (RAMQ). These medico-administrative data are then used to estimate the respective proportions, potentially reflecting clinicians’, and patients' preferences. This approach is not commonly used by HTA agencies for CMA. The WAC method does not always minimize all costs and may yield different results compared to the least expensive comparator. The aim of this study is to measure the consequences of using the WAC approach compared with the least-cost comparator by estimating the relative difference in calculated costs.
METHODS: A review of INESSS’s reimbursement recommendations since January 2020 was conducted. The results are presented in a comparative table measuring the relative difference in costs between the two methods.
RESULTS: Of the 126 recommendations identified, 31 used a WAC approach to assess efficiency. A relative average difference of around +20 % (14 to 28%), compared with the least-cost approach, was observed.
CONCLUSIONS: This exercise highlights the cost differences that can result from the 2 approaches in the context of a CMA. The results show that using the WAC method increases the average cost of the comparator. Economic conclusions are now predominantly based on the least-cost comparator approach. However, INESSS continues to present results based on the WAC approach for decisions making purposes.