OBJECTIVES

Drugs with an ICER above the Irish cost-effectiveness threshold may subsequently be reimbursed. Reimbursement may follow a HTA-informed price negotiation process and/or consideration of factors outside the assessment process described in the Irish Health (Pricing and Supply of Medical Goods) Act 2013. This study determined if price negotiations are more frequent for drugs for cancer, than those for orphan or other conditions.

METHODS

Drugs submitted to the NCPE for assessment between 2012-17 with an ICER above the threshold of €45,000/QALY which were subsequently reimbursement were included. The occurrence of price negotiations was determined from publicly available information on the NCPE website and through direct communication with the Corporate Pharmaceutical Unit. The details of the prices negotiated or other commercially sensitive information were not available. The percentage of drugs for cancer (Cancer) with a price negotiation was compared to the percentage of drugs for orphan diseases (Orphan) and all others (Non-cancer/Non-orphan).

RESULTS

Forty-three drugs were included: Cancer (n=13), Orphan (n=12) and Non-cancer/Non-orphan (n=18). A price negotiation took place for 74% of these drugs with the following breakdown: Cancer 62%, Orphan 67%, Other 89%. Analysis did not identify a therapeutic group most likely to have a price negotiation (comparing Cancer and Orphan χ2 = 0.071, p = 0.790; Cancer and Other χ2 = 0.230, p = 0.072; Orphan and Other χ2 = 2.222, p = 0.136).

CONCLUSIONS

Based on this analysis drugs for cancer were not more likely to enter a price negotiation process compared to those for orphan diseases or other categories. Where a drug was subsequently reimbursed without a price negotiation, factors other than cost-effectiveness may have been more heavily weighted in the decision-making process. The implications of this for the health service would be useful to explore further.