A NEW METHODOLOGY TO DEFINE THE SCOPE OF THE FRENCH « LISTE-EN-SUS »

Author(s)

Motte A, Mourlat B, Kujas P, Eliaszewicz M
French ministry of Health, Paris, France

OBJECTIVES: The French “liste-en-sus” was implemented to support an equal access to innovative and higly-priced medicines. The methodology to define the scope of this list has been updated recently. Listing or delisting is now decided per therapeutic indication and no longer by product. Our aim is to assess the relevance of listed therapeutic indications in accordance with the updated methodology. METHODS: Using the health technology assessment published by the Transparency Committee, we gathered for each medicine included on the liste-en-sus (excluding blood-derived products) until march 1st, 2015 : assessment date, marketing authorization date, medical benefit and improvement in medical benefit (IMB) scores and medicine comparator. We selected therapeutic indications wich fulfilled both criteria : no IMB and the comparator is financed by diagnosis-related groups (DRGs). Using the French medicalized information system program, we identified International classification of diseases (ICD-10) codings groups and we collected expenditures corresponding to these indications in France in 2013. RESULTS: The liste-en-sus includes 214 indications. IMB is available in 87% of cases. 6% of indications have been evaluated before 2005. Another 7% are extensions of indication and they have not been assessed yet as marketing authorization has been granted recently. Among the 32% of indications showing no IMB, the comparator is financed by DRGs in 7% of cases (16 indications or 11 medicines). The 12 ICD-10 codings groups corresponding to these 16 indications show an expenditure of EUR 450.5 million. This amount represents 16% of the total expenditures (EUR 2.8 billion) for all medicines included on the liste-en-sus in 2013. CONCLUSIONS: From now on, all indications including extensions of indication have to be evaluated before being registered on the liste-en-sus by analyzing the health technology assessment published. 16 therapeutic indications are not matching the criteria defined in the new methodology.

Conference/Value in Health Info

2015-11, ISPOR Europe 2015, Milan, Italy

Value in Health, Vol. 18, No. 7 (November 2015)

Code

PHP7

Topic

Economic Evaluation, Epidemiology & Public Health, Health Policy & Regulatory

Topic Subcategory

Cost/Cost of Illness/Resource Use Studies, Disease Classification & Coding, Health Disparities & Equity, Pricing Policy & Schemes, Reimbursement & Access Policy

Disease

Multiple Diseases

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