THE IMPACT OF MODIFYING FACTORS ON ICER FOR PHARMACEUTICAL REIMBURSEMENT RECOMMENDATIONS IN KOREA OVER 10 YEARS

Author(s)

Kim HJ, Jang J, Lee SM, Jung Y, Yoon N, Kim TK, Hwang EJ, Kim K
HIRA (Health Insurance Review & Assessment Service), Gangwon-do, Korea, Republic of (South)

OBJECTIVES: Health Insurance Review & Assessment Service (HIRA) is in charge of pharmaceutical reimbursement review and decision-making based on the Pharmaceutical Benefit Committee (PBC)’s recommendation. HIRA stipulated PBC to deliberate several factors for recommendation; clinical usefulness, cost-effectiveness, budget impact, foreign countries’ reimbursement & price status, etc. While ICER is deemed the main determining factor and the others are involved as modifiers for its flexibility, to what extent they influence on the flexibility of acceptable ICER hasn’t been studied. This study aims at investigating impact of other factors on ICER in PBC’s positive recommendation in a retrospective manner.

METHODS: PBC’s positive recommendations having considered ICER from 2007 to 2016 were analyzed. Dependent variable was ICER value in million KRW. The independent variables of interest were absence of alternative (no, limited or others) disease severity (expected life expectancy less than 2 years or not), reimbursement & price of foreign countries (number of reimbursed countries, ratio of proposed price to average price of overseas), budget impact, and diseases causing catastrophic financial burden without reimbursement (cancer, rare disease). Univariate and multivariate regression analyses were conducted.

RESULTS: A total of 42 cases were accepted by PBC and the average ICER was 24.6 millions KRW per QALY. In univariate analysis, all variables showed significant association with ICER. However, in multivariate regression analysis, three variables; absence of alternative, disease severity and cancer, rare diseases significantly increased ICER(p<0.05). The most influencing factor raising ICER was catastrophic disease, followed by disease severity, no alternative, and limited alternatives. The degree of impact were in 17, 14, 12, 8 millions KRW per QALY.

CONCLUSIONS: This study confirmed that most of the factors were considered as modifiers of ICER on PBC’s deliberation in positively recommended cases. The coefficient estimates of variables probably give an impression to any stakeholders seeking reasonable approximate ICER threshold for pharmaceuticals

Conference/Value in Health Info

2017-11, ISPOR Europe 2017, Glasgow, Scotland

Value in Health, Vol. 20, No. 9 (October 2017)

Code

PHP140

Topic

Health Policy & Regulatory

Topic Subcategory

Reimbursement & Access Policy

Disease

Multiple Diseases, Oncology, Rare and Orphan Diseases

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