OBJECTIVES: Health technology management (HTM) has been described as ‘measures put in place to enhance the safe, effective, and cost-effective use of medicines thereby controlling utilization and expenditure’¹. HTM measures are becoming increasingly common as affordability is an ongoing issue for health systems, particularly with the introduction of high-cost medications for prevalent diseases. This review aims to further describe HTM and the significant impact these measures have on cost-effective prescribing in Ireland.

METHODS: This review will describe a number of examples of HTM, including;

1. Reimbursement application systems (eg. Lidocaine medicated plaster (Versatis®))
2. Best-value biological medicines (BVB) initiatives (eg. adalimumab and etanercept)
3. Managed access protocols (MAPs) for certain high-cost or high-budget impact medicines (eg. calcitonin gene-related peptide monoclonal antibodies (CGRP MABs))

RESULTS: The HTM approach may be applied to new or already reimbursed technologies. The introduction of a reimbursement application system for Versatis® ensured reimbursement was confined to patients with the licensed indication - this resulted in savings of approximately €2.75 million per month to the Health Service Executive (HSE)*.

The identification of BVBs for TNF-α inhibitors, adalimumab and etanercept, lead to a significant shift in prescribing from the originator products to the designated best-value biosimilars. In one year, this initiative resulted in combined estimated savings and avoided costs of €22.7 million².

The CGRP MABs are available subject to a managed access protocol; this ensures reimbursement is confined to the patient cohort for whom cost-effectiveness has been demonstrated. Since September 2021, just over 1,000 patients have been dispensed a CGRP MAB under the MAP.

CONCLUSIONS: Healthcare payers, such as the HSE, are increasingly recognising the benefits of HTM. This review highlights the significant efficiencies that can be achieved through HTM.