OBJECTIVES: The progression of health systems towards universal coverage depends on appropriate resource allocation. This study aims to analyze the factors impacting payer perception of unmet need and the subsequent prioritization of diseases with an associated ‘lifestyle’ component.

METHODS: Therapies for weight-loss, smoking cessation, type-2 diabetes mellitus (T2DM), and non-small cell lung cancer (NSCLC) approved by the European Medicines Agency were identified. Due to the high recognized unmet need, NSCLC was chosen as a positive control for high disease prioritization. HTA reports for these therapies were retrieved for HTA agencies in England, France, Germany, Sweden, Denmark, and Norway.

RESULTS: A total of 15 products were identified (obesity, n=6; smoking cessation, n=2; T2DM, n=4; NSCLC, n=3). For obesity, 11 out of 36 potential HTA reports were identified, with 6 positive decisions. The HTA reports stated that comorbidities were the primary treatment focus. For smoking cessation, 3 out of 12 potential HTA reports were identified, with 3 positive decisions. HTA reports noted the direct relationship between tobacco smoke and future diseases. For T2DM, 9 out of 24 potential HTA reports were identified, with 9 positive decisions. Although HTA reports noted a stigma associated with the lifestyle component of the disease, products were broadly reimbursed due to the complications of T2DM. NSCLC was the most broadly reimbursed disease area due to the poor prognosis and high mortality, with 13 out of 18 potential HTA reports being identified and 11 positive decisions.

CONCLUSIONS: Disease prioritization has historically been defined by diseases that have a direct, immediate, and quantifiable impact on payers´ budgets. The impact of comorbid conditions, unmet need, and patient experience are playing an increasing role in the allocation of payers´ HTA resources. Early engagement with payers will provide insight into the level of evidence required to demonstrate the public health benefit, increasing the likelihood of reimbursement.