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The European Journal of Health Economics
Published in: The European Journal of Health Economics 1/2018

Open Access 01-01-2018 | Original Paper

Using health technology assessment to assess the value of new medicines: results of a systematic review and expert consultation across eight European countries

Authors: Aris Angelis, Ansgar Lange, Panos Kanavos

Published in: The European Journal of Health Economics | Issue 1/2018

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Abstract

Background

Although health technology assessment (HTA) systems base their decision making process either on economic evaluations or comparative clinical benefit assessment, a central aim of recent approaches to value measurement, including value based assessment and pricing, points towards the incorporation of supplementary evidence and criteria that capture additional dimensions of value.

Objective

To study the practices, processes and policies of value-assessment for new medicines across eight European countries and the role of HTA beyond economic evaluation and clinical benefit assessment.

Methods

A systematic (peer review and grey) literature review was conducted using an analytical framework examining: (1) ‘Responsibilities and structure of HTA agencies’; (2) ‘Evidence and evaluation criteria considered in HTAs’; (3) ‘Methods and techniques applied in HTAs’; and (4) ‘Outcomes and implementation of HTAs’. Study countries were France, Germany, England, Sweden, Italy, Netherlands, Poland and Spain. Evidence from the literature was validated and updated through two rounds of feedback involving primary data collection from national experts.

Results

All countries assess similar types of evidence; however, the specific criteria/endpoints used, their level of provision and requirement, and the way they are incorporated (e.g. explicitly vs. implicitly) varies across countries, with their relative importance remaining generally unknown. Incorporation of additional ‘social value judgements’ (beyond clinical benefit assessment) and economic evaluation could help explain heterogeneity in coverage recommendations and decision-making.

Conclusion

More comprehensive and systematic assessment procedures characterised by increased transparency, in terms of selection of evaluation criteria, their importance and intensity of use, could lead to more rational evidence-based decision-making, possibly improving efficiency in resource allocation, while also raising public confidence and fairness.
Appendix
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Footnotes
1
Other HTA agencies exist on regional level (e.g. UVEF is responsible for HTAs in the Veneto region).
 
2
RedETS is the Spanish Network of regional HTA agencies coordinated by Institutde Salud Carlos III (ISCIII) and could be regarded as the National HTA advisory body at federal level. However, at this (federal) level it does not assess pharmaceuticals, but mostly non-drug health technologies, such as screening programmes and medical devices. Although the ICP, led by the Dirección General de Farmacia under the Ministry of Health, is the committee responsible for the assessment of drugs, producing mandatory decisions at federal level regarding the reimbursement and pricing of pharmaceuticals, the vast majority of economic evaluations for drugs are conducted at autonomous community level by regional HTA agencies.
 
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Metadata
Title
Using health technology assessment to assess the value of new medicines: results of a systematic review and expert consultation across eight European countries
Authors
Aris Angelis
Ansgar Lange
Panos Kanavos
Publication date
01-01-2018
Publisher
Springer Berlin Heidelberg
Published in
The European Journal of Health Economics / Issue 1/2018
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-017-0871-0

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