PURPOSE:

Our objective is to outline the challenges when modelling and evaluating pharmaceutical therapies for conditions with comorbidities, and present possible solutions.

Comorbidities are common in older patients with complex long-term health conditions such as type-2 diabetes, chronic kidney disease, and cardiovascular diseases. Pharmaceutical therapies that are effective for one condition may have benefits for comorbidities due to the clinical correlations between these conditions and comorbidities. This could be through direct treatment effects or indirectly by improving overall health of the patient. Such factors are challenging for health technology assessment (HTA) as modelling all comorbidities would require multifaceted models with high data demands. It also presents a policy challenge as therapy benefit is typically valued on one rather than multiple indications.

DESCRIPTION:

MV will outline the challenge of, and seek audience views on, comorbidities in HTA (8 minutes). She will draw on her consulting experience for how Payers consider comorbidities, such as with subgroup analyses and covariate models. AA will describe the risk equations approach to comorbidities in diabetes and cardiovascular modelling (12 minutes). In diabetes these model longitudinal A1C trajectory and its effect on stroke, myocardial infarction, foot ulcer and other comorbidities. He will describe challenges from Payers about insufficient trial data on patients with multiple conditions. NL will give an academic and charities perspective on using an American Diabetes Association sponsored cost-effectiveness model in type-2 diabetes (12 minutes). She will explain how choice of comorbidities to model was made and how they were modelled. HT will give an academic and assessor’s perspective on comorbidities in HTA models submitted to the UK National Institute for Health and Care Excellence (NICE) (12 minutes). He will also use an academic example for routine monitoring in type-2 diabetes, chronic kidney disease and hypertension to indicate future research directions in multimorbidity modelling for HTA.