DISCORDANCE IN MARKET SHARE PARAMETERS IN BUDGET IMPACT ANALYSES: A REVIEW OF SUBMISSIONS IN THE BRAZILIAN PRIVATE HEALTHCARE SYSTEM
Author(s)
RODRIGO ANTONINI RIBEIRO, MSc, ScD, MD1, Julia Simoes Correa Galendi, PhD, MD2, Miriam A. Marcolino, MSc, ScD1, Helaine Capucho, MSc, ScD3;
1HEMAP Consulting, Porto Alegre, Brazil, 2HEMAP Consulting, São Paulo, Brazil, 3Interfarma, Brasilia, Brazil
1HEMAP Consulting, Porto Alegre, Brazil, 2HEMAP Consulting, São Paulo, Brazil, 3Interfarma, Brasilia, Brazil
OBJECTIVES: We aimed to review submissions for incorporation of medicines and immunobiologicals into the Brazilian Private Healthcare System (regulated by the Agência Nacional de Saúde Suplementar - ANS), comparing the market shares (MS) assumed in the submissions and those adopted in the ANS critical analysis reports (RAC), and to investigate the justifications for discordance.
METHODS: We included analyses published on the ANS website since 2022, when the current HTA procedures were implemented. Data collected included market shares from the 1st (MS_Y1) and the 5th (MS_Y5) estimated by the demandant and ANS, and textual data regarding justifications for the chosen MS.
RESULTS: In the 85 submissions available, there were differences in MS estimation in 61.2% of the submissions, with MS increases in 25 cases and decreases in 27. An asymmetric pattern was observed: when the budget impact (BI) estimated was negative (cost savings), market share reduction predominated (51.8% of cases, versus only 3.7% cases with an increase), therefore reducing projected savings; when BI was positive (increased spending), market share increase was frequent (41.4% of cases, versus 22.4% with a decrease), enlarging the recalculated budget impact. In submissions with positive BI (N=58), average absolute increase in MS_Y5 was 11.9%. In the subgroup where ANS increased MS (N=24), the absolute mean elevation was 37.3%. The most common therapeutic area was oncology/hematology. In this subgroup, considering only submissions with positive BI (N=41), MS_Y5 estimated by ANS had a wide variation, from 15% to 100% (mean 62.2%, SD 27.9%). Thematic analysis identified 16 categories of justifications, with "therapeutic gap" standing out as the primary justification for market share increase.
CONCLUSIONS: Market share estimations by ANS frequently increases the estimations by the proponent, in an unpredictable manner. Guidance for market shares estimation in Brazil is ANS submissions is warranted to enhance the predictability of the HTA submissions.
METHODS: We included analyses published on the ANS website since 2022, when the current HTA procedures were implemented. Data collected included market shares from the 1st (MS_Y1) and the 5th (MS_Y5) estimated by the demandant and ANS, and textual data regarding justifications for the chosen MS.
RESULTS: In the 85 submissions available, there were differences in MS estimation in 61.2% of the submissions, with MS increases in 25 cases and decreases in 27. An asymmetric pattern was observed: when the budget impact (BI) estimated was negative (cost savings), market share reduction predominated (51.8% of cases, versus only 3.7% cases with an increase), therefore reducing projected savings; when BI was positive (increased spending), market share increase was frequent (41.4% of cases, versus 22.4% with a decrease), enlarging the recalculated budget impact. In submissions with positive BI (N=58), average absolute increase in MS_Y5 was 11.9%. In the subgroup where ANS increased MS (N=24), the absolute mean elevation was 37.3%. The most common therapeutic area was oncology/hematology. In this subgroup, considering only submissions with positive BI (N=41), MS_Y5 estimated by ANS had a wide variation, from 15% to 100% (mean 62.2%, SD 27.9%). Thematic analysis identified 16 categories of justifications, with "therapeutic gap" standing out as the primary justification for market share increase.
CONCLUSIONS: Market share estimations by ANS frequently increases the estimations by the proponent, in an unpredictable manner. Guidance for market shares estimation in Brazil is ANS submissions is warranted to enhance the predictability of the HTA submissions.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HTA87
Topic
Health Technology Assessment
Topic Subcategory
Decision & Deliberative Processes, Value Frameworks & Dossier Format
Disease
No Additional Disease & Conditions/Specialized Treatment Areas