Use of HTA for pharmaceutical reimbursement lesson learned from Thailand Netnapis Suchonwanich Advisor of HITAP , Thailand Former Deputy Secretary General of NHSO,Thailand
2002
pr pressu essure t e to o cons onsider der the he val alue ue for or money money of of heal health h inv nvest estment ent access and effectiveness Public Health Insurance adequacy efficacy Advanced New Technology m edicine
4 Pa y m ent m echa nism in UCs • Capitation in OP • DRG with global budget in IP Development of National List of Essential Medicines 1981 NLEM was first introduced cri riteri ria : only cost, safety, efficacy UHC was established in 2002 2004 ad added ed criter eria : effectiveness 2008 ad added ed criter eria a : cost-effectiveness
Development of National List of Essential Medicines in 2019 HTA ISAFE s FE score Academics The 22 National Expert Panels I- Information for each drug group S- Safety Industrial A- Administration restriction Nominate the items to be in NLED F- Frequency of drug administration E- Efficacy/ Effectiveness Public hearing HTA The Screening Working Group The he Heal ealth coordinate results from 24 working groups Econom onomic Wor orking ng cost-effectiveness, equity, national affordability. Group oup NLEM Subcommittee primary selection of ED Approval from Price e negot gotiat ation on 3 main public working ng Group oup health insurance schemes NLEM Committee make a final decision Process for listing : 21 wk. cycle
6 Source: Perez R, Chaikledkaew U, Youngkong S, Tantivess S, Teerawattananon Y. Health Technology Assessment Process Guidelines. Nonthaburi, Thailand: Health Intervention and Technology Assessment Program (HITAP); 2012.
What HTA provided for UCS development Evidence of cost effectiveness Value for m oney Ex : Thailand Increm ental cost-effectiveness ratio (ICER) Cost-effectiveness threshold = 160 ,0 0 0 THB/ QALY (5,0 0 0 USD) Budget im pact com pared current practice and new intervention Feasibility study
Using economic evaluation to inform NLEM development during 2007-2010 Cost-effectiveness study Finding Recom m endation HMG-CoA reductase Atorvastatin not Not included atorvastatin in the inhibitors cost-effective list Osteoporosis drugs not cost-effective Not included in the list not cost-effective Not included in the list Acetylcholinesterase inhibitors Peginterferon alfa-2a, 2b cost-effective Included in the list Tenofovir cost-effective Included in the list Oxaliplatin not cost-effective Price negotiation and included in the list
9 ICER 1. ICER 300,000 THB/QALY at current price 2. Negotiated price based on CE threshold C 3. Fina nal ne negot gotiated d pr price ba based d on on budge budget impa pact and nd affor orda dabi bility of of 3 3 Accept the technology if schem emes es ICER < 160,000 THB/QALY* *5,000 USD (1 USD = 35 THB)
Price negotiation model for NLEM Disease Drug name model Hep C Peginterferon Value based pricing Hep B Tenofovir Medicine patent pool Thai GPO manufactured Breast cancer (HER2+ ) Trastuzumab (440mg) Volume purchase with free for confirm FISH test Managed entry agreement Prostate Cancer Leuprorelin/Triptorelin Choose one price Breast cancer letrozole Compulsory licensing Compulsory licensing Breast cancer Doxetaxel Tax exemption for free good (originator) CA colon Oxaliplatin Market competition Gaucher type1 Imiglucerase Risk sharing with Managed entry agreement Diffused large B-cell lymphoma Rituximab Managed entry agreement Hep C Sofosbuvir, ledipasvir Voluntary licensing
11 Appraisal results and decision making • Imiglucerase for • PD-first policy Gaucher type 1 for ESRD
1 2 Using HTA to determine the value and prioritize each new product 0 8 /0 5 /6 2 Raltegravir Dolutegravir Ref. IRP project with IMS
The access to high costly medicines total
1. Interchangeable of biosim ilar products 2. Indication-based pricing from HTA im pact 3 . co-dependent technology
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