Presentation (CTI)

OBJECTIVES: In health economic evaluation, the concept of strict dominance refers to a strategy that is both more effective and less costly than a comparator. In France, demonstrating dominance can activate predefined terms of the master agreement between the French industry association and the Economic Committee for Health Products (CEPS), such as accelerated access (fast-track) or, guarantees ensuring alignment within the European price corridor for products with minor clinical added value. This study aims to assess whether dominance impacts pricing negotiation duration.
METHODS: A retrospective analysis was conducted on all the economic opinions published by the French Economic Evaluation and Public Health Commission (CEESP) between 2014 and June 2025. Only strictly dominant products were included. Non-invalidated cases were defined by the absence of a major methodological reservation and major global uncertainty. The duration of negotiations was estimated by the delay between the date of the HAS opinions and the price publication in the Official Journal (OJ).
RESULTS: Since 2014, among the 225 economic opinions issued by CEESP, 7.5% (17/225) of products revendicated strict dominance over their comparators. Out of the 17 opinions, 6 were not invalidated representing 2.7% of the economic dossiers evaluated, 4 have a price in the OJ allowing analysis. These 4 opinions show a wide variability in negotiation duration, ranging from 84 to 449 days. The only product eligible for fast track, Jakavi, is the one with the longest negotiation period.
CONCLUSIONS: Since 2021, dominance in economic opinions can be used as a negotiating tool. In practice, it remains relatively unused. This lack of use raises questions about the appropriation of medico-economic evaluation in pricing strategies. Further work is needed to better understand the barriers and encourage more systematic use of this high-potential tool.