engleski

Rational decision making in the allocation of extremely expensive drugs

OBJECTIVES: To present a method of health- economic analysis and allocation based on a marginal approach under budget constraints. METHODS: We show that a detailed comparative a priori incremental cost-effectiveness analysis provides the necessary input for budget impact analysis about the proper order of introduction of new therapies. By arranging the therapies according to the cost-effectiveness rule and taking into account multiple constraints (most importantly the budgetary constraint), the standard of care maximises the health value for the patient. We show the method on the example of a Croatian standard of care for the treatment of hepatitis C virus (HCV) infection. Final parameters were estimated by Monte Carlo simulations. RESULTS: New HCV therapies, approved by the European Medicine Agency in 2015, have high efficacy, shorter duration, and are better tolerated than alternative interventions. Patient subpopulations were differentiated by their response to previous treatment and fibrosis METAVIR score. Depending on patient subpopulation, different therapies, including the dual therapy of pegylated interferon and ribavirin, are found to be cost- effective in comparison to alternatives. CONCLUSION: We showed that introduction of new therapies on the market based on marginal analysis would result in a significant increase of successfully treated patients under budget constraint. This economic evaluation is an example of negotiations’ starting point between pharma industry and health management organisations, as well as for an introduction of specific contracts between them.

allocation, decision making, pharmacoeconomics

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