APPLYING THE INSTITUTE FOR CLINICAL AND ECONOMIC REVIEW’S (ICER) METHODOLOGY TO CANADA- AN IMPROVED WAY TO TAKE INTO CONSIDERATION DRUG AFFORDABILITY CHALLENGES?
Author(s)
Mouallif S1, Chiva-Razavi S2, Barbeau M3
1University of Montreal, Montreal, QC, Canada, 2Novartis Pharmaceutical Canada Inc., Dorval, QC, Canada, 3Novartis Pharmaceuticals Canada Inc., Dorval, QC, Canada
OBJECTIVES: In Canada, drug prices and healthcare system affordability are under high scrutiny in order to better meet the needs of Canadians. Current health technology assessments (HTA), do not consider financial capacity of Canadian payers. In contrast, the United States’ Institute for Clinical and Economic Review (ICER) combines cost-effectiveness evaluations and an assessment of the affordability of a new therapy. The affordability concept is translated into an annual budget impact threshold that represents the maximum willingness to pay for a treatment. This study aimed to adapt ICER's affordability budget impact threshold to the Canadian environment and determine whether it could be a relevant tool for payers. METHODS: The affordability budget impact threshold was calculated according to ICER’s methodology using Canadian and Quebec data such as drug and healthcare spending, gross domestic products, etc. The primary data source was the Canadian Institute for Health Information. RESULTS: Following the ICER methodology, the estimated annual affordability threshold for each new drug was estimated to be $36.2 million in Canada, and $9.9 million for Quebec. To further adapt to a Canadian perspective, both thresholds were divided specifically for public and private payers, resulting in thresholds of $21 and $15.2 million, respectively. For Quebec, the thresholds were estimated to $4.5 and $5.4 million for public and private payers, respectively. CONCLUSIONS: The ICER methodology adapted to a Canadian perspective is a novel approach that could allow payers to have an improved vision of the drug value, and provide them with more tools to make funding decisions based on the budget constraints. In addition, the affordability threshold, if incorporated into HTA recommendations could lead to more integrated, potentially faster and complete recommendations. It could, by the same time, reduce the need of bureaucratic discussions that may arise following official HTA recommendations in Canada.
Conference/Value in Health Info
2017-11, ISPOR Europe 2017, Glasgow, Scotland
Value in Health, Vol. 20, No. 9 (October 2017)
Code
PHP131
Topic
Health Policy & Regulatory
Topic Subcategory
Reimbursement & Access Policy
Disease
Multiple Diseases