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Analyzing The Revenues And Expenditures Of The Hungarian Health Insurance Fund Between 1993-2015
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VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 3 4 7 – A 7 6 6
studied markets (range 10-40%). The potential for the introduction of a biosimilar to trigger price negotiations was inconsistent across markets, although there was an acknowledged impact on the price of the original brand (range 0-40%). 8 out of 9 responders anticipated the market share for biosimilars to be > 25% in the next 5 years with oncology and immunology the most desirable areas for biosimilar penetration. Conclusions: The study has demonstrated a wide-variation in how markets approach biosimilar products; however, there are clearly signs of convergence in payer thinking as biosimilar usage expands. Respondents highlighted clinical advocacy and defensive approaches from reference product manufacturers as the main barriers to biosimilar uptake. PHP129 Measuring Of The Uncertainty In Reimbursement System For Medicinal Products Araja D Riga Stradins University, Riga, Latvia
Objectives: Promoting access to innovative, safe and effective medicinal products is defined as a priority of pharmaceutical policy in the European Union. At the same time, the inclusion of medicinal products in the schemes of early marketing authorisation and reimbursement should be further clarified in order to improve transparency and reduce uncertainty. The aim of this policy research was to identify the possibilities to measure the reduction of uncertainties in reimbursement system for medicinal products. Methods: The research was based on the literature review on topics of definitions, taxonomy and measuring of the uncertainty in health care, as well as conditions of the reimbursement system for medicinal products in Latvia. Results: The reimbursement system in Latvia operates under strictly limited financial resources; therefore a wide spectrum of financial tools has been implemented. Managed entry agreements, which are one of these tools, limit the uncertainties regarding to clinical and economic evidence of new medicines, fair price and budget impact, as well as eligible patients’ population. At the same time the decision making should be supported by the evidence of the real reduction of uncertainties. Different concepts and taxonomies relating to uncertainty in decision modelling exist, including stochastic, parameter and structural uncertainty. However, the methods of measuring uncertainties in models are not fully suitable to estimate the reduction of uncertainty around the clinical effectiveness and efficiency of a medicinal product in real life. Conclusions: Measuring of uncertainties is an important issue that has attracted by increasing attention in light of supporting the schemes of early marketing authorisation of medicinal products and their inclusion in reimbursement systems. The measures of uncertainties used in decision modelling should be adapted to flexible use in real life conditions. PHP130 Concentration Analysis Of Hungarian Health Care Providers Between 2006-2015 Csákvári T1, Turcsányi K1, Endrei D2, Sebestyén A3, Boncz I2 of Pécs, Zalaegerszeg, Hungary, 2University of Pécs, Pécs, Hungary, 3National Health Insurance Fund Administration, Pécs, Hungary
Currently the proportion of the two sub-heads in the chapter is 63.5%-29.3% in 2015. On expenditure side, we haven’t found any significant change in the ratio of inpatient care (63.5%±0.85%) to outpatient- (19.3%±1.01%) or to primary care (17.1%±0.95%). Proportion of acute care spending in the inpatient care started to decrease after 2004, with the growing proportion of the specialty care simultaneously, while chronic care hasn’t changed. On real-terms, there was a remarkable expenditure growth between 2002-2006, a significant decline between 2007-2010 and a slight increase after 2011. Conclusions: There was no clear policy regarding proportion of revenues coming from either health insurance contributions or state taxes (by the budget) in Hungary. On the expenditure side of the health insurance budget there was no significant changes in the proportion of spending on primary care, outpatient care and inpatient care.
PHP132 The Evolution Of Patient Access Schemes Spoors J1, Kusel J2 1RJW & Partners, Royston, UK, 2Costello Medical Consulting Ltd, Cambridge, UK
Objectives: To map the evolution of patient access schemes (PAS) submitted to NICE, track the various formats proposed by manufacturers and establish if there is an optimal way to design schemes to achieve market access. Methods: We conducted an analysis of NICE approved therapies with PAS applied (n= 65) and categorised them according to one of five categories: financial based, free stock, dose cap, response scheme or combined (financial and clinical). The analysis included technologies from the Single Technology Appraisal, Multiple Technology Appraisal and the Highly Specialised Technologies (HST) programmes. Results: The majority (50/65) of successful PAS submitted to NICE have been finance-based. Free stock was the next highest, with 9/65 successfully agreed PAS under this category. Dose capping schemes were agreed in 3/65 appraisals, combined (discount and rebate) were agreed in 2/65 appraisals and there has only been 1 response scheme. Interestingly, there has been an increase in schemes which are being agreed with payers outside the setting of a NICE appraisal. Conclusions: The focus from NICE on financial schemes is likely to be based on the notion that outcome schemes are notoriously burdensome to administer. However, driven by financial necessity through affordability challenges, European healthcare systems including the NHS are becoming better equipped to deal with complex schemes.The main reason driving this is the specialisation of pharmaceuticals; and in-particular, orphan and ultra-orphan drugs, where patients are able to be tracked on an individual basis. The key to a successful PAS is addressing payer uncertainty at the time of evaluation which can be either financial or clinical. Two successful schemes in the analysis have combined financial and outcomes-based elements to address payer uncertainty and secure NICE approval. It is likely that in order to address growing payer uncertainty at launch, manufacturers are going to have to offer more than pure financial discounts with PAS.
1University
Objectives: The aim of our study was to analyze the concentration of the Hungarian outpatient care, CT imaging, and the acute and chronic inptatient care providers’ reimbursement between the years 2006-2015. Methods: We used Lorenz curve to illustrate the contentration of the reimbursement paid by the Hungarian National Health Insurance Fund Administration (NHIFA). We ranked the providers and calculated the percentiles based on the amount of reimbursement in each type of health care. Gini index was also calculated for the examined health care services. Provider-level data derived from the Hungarian NHIFA database. The years 2006, 2010 and 2015 were investigated. Results: In 2015 the highest concentration was found in the outpatient (Gini: 0.736) and the acute inpatient care system (Gini: 0.697). CT (Gini: 0.468) and chronic inpatient care (Gini: 0.473) had lower contrentration. The top 25% of outpatient care providers spent 82.86%, 50% of them spent 96.86% of all outpatient reimbursement in 2015. Top quadrant of acute inpatient care providers had 79.71%, 50% of them had 96.11% in the same year. We found that in all four observed types of care, the top 50% got more than 80%, and the top 75% had more than 95% of the given type’s reimbursement in 2006, 2010 and 2015 as well. Since 2006 the concentration of the acute inpatient care system (Gini2006: 0.594, Gini2015: 0.697) increased the most, the other three types of care showed some improvement (Gini2006: 0.741, Gini2015: 0.736 in inpatient care, Gini2006: 0.52, Gini2015: 0.469 in CT imaging, Gini2006: 0.535, Gini2015: 0.473 in chronic inpatient care). Conclusions: Financing of acute inpatient, and outpatient care had the highest concentration in each observed year. Only half of the providers of these four types of health care spend more than 80% of health insurance reimbursement. PHP131 Analyzing The Revenues And Expenditures Of The Hungarian Health Insurance Fund Between 1993-2015 Csákvári T1, Turcsányi K1, Endrei D2, Sebestyén A3, Boncz I2 of Pécs, Zalaegerszeg, Hungary, 2University of Pécs, Pécs, Hungary, 3National Health Insurance Fund Administration, Pécs, Hungary
1University
Objectives: The aim of our study was to analyse the structure of revenues and expenditures of the Hungarian Health Insurance Fund between 19932015. Methods: We analyzed the structure of the Hungarian Health Insurance Fund, size and ratio of the sub-heads between 1993-2015. We calculated with nominal- and real values (at 2015 prices) as well. Data derived from the National Health Insurance Fund Administration and the National Health Care Centre. Results: We found significant changes in the ratio of the employee’s to employer’s contribution, and revenues coming from state taxes (by the budget). In 1993, 85.9% of the revenues chapter came from contributions, and 13.3% by the state budget. Ratio of contributions reached maximum in 1998 (97.7%), minimum in 2013 (41.6%).
PHP133 Taking In Account Research And Development Expenditures To Determine Prices Of Medicines In France: A Realistic Alternative Choice? Masia C, Nedellec E, Levy P Université Paris-Dauphine, Paris, France
Objectives: The objective is to determine advantages and limits of an analytic determination of the price of medicines exclusively based on research and development (R&D) spending in order to reconcile objectives of pharmaceutical companies, patients and health authorities. These costs can be divided into two aggregates : research (fundamental and applied) and development (clinical trials). These expenditures (generally spread on 10 years) come from a mixed funding between public and private sectors. Methods: Fixing the price of a drug according to its clinical benefit is a strong signal for pharmaceutical industries to innovate. However this value isn’t really objective. According to expert opinion 900M$ are spent in R&D for a new drug. On an upgrading rate of 11% : the amount of capitalized expenditures is about 1.5B$ per molecule. Development costs vary between therapeutic areas : 1.5B$ in pulmonology and 616M$ in virology. They are very different according to the size of the company (between 350M$ and 5.5B$ per molecule). R&D costs have been multiplied by 10 in 30 years whereas its productivity decreases since the 90’s. Results: Costs and earnings are not correlated in the time. We are not able to individualize the price of the investment by molecule, neither by country. Furthermore, with the externalization of research, biotechnology, open innovation, the R&D’s model tend to disappear. Verifications of these expenses by the state is almost impossible. Moreover from the patient point of view, it can be difficult to accept the price difference between incremental innovations or disruptive innovations. Conclusions: A price analyse might look interesting but would have différents limits. The will of the society to remunerate a clinic benefit over a clinic investment, could take in consideration its expenses, without making them the main characteristics when fixing a price. This model could allow new perspectives, especially with evolution about R&D. PHP134 Use Of Electronic Health Information Systems (Ehis) By Healthcare Professionals (Hcps) And The Perception Of Its Value In Reducing Medication Risks And Safety For Patients Narayanan S1, Bullman R2, Rucker LN3, Rausch P4 1Market Access Solutions, LLC, Potomac, MD, USA, 2NCPIE, Rockville, MD, USA, 3Enhance Value, Bethesda, MD, USA, 4Food and Drug Administration, Silver Spring, MD, USA
Objectives: Assess the use of eHIS by HCPs and the perception of its value in reducing medication risks and safety for patients. Methods: A cross-sectional online survey of HCPs was conducted (FDA cooperative-agreement #5U18FD004653-01)
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 3 4 7 – A 7 6 6
studied markets (range 10-40%). The potential for the introduction of a biosimilar to trigger price negotiations was inconsistent across markets, although there was an acknowledged impact on the price of the original brand (range 0-40%). 8 out of 9 responders anticipated the market share for biosimilars to be > 25% in the next 5 years with oncology and immunology the most desirable areas for biosimilar penetration. Conclusions: The study has demonstrated a wide-variation in how markets approach biosimilar products; however, there are clearly signs of convergence in payer thinking as biosimilar usage expands. Respondents highlighted clinical advocacy and defensive approaches from reference product manufacturers as the main barriers to biosimilar uptake. PHP129 Measuring Of The Uncertainty In Reimbursement System For Medicinal Products Araja D Riga Stradins University, Riga, Latvia
Objectives: Promoting access to innovative, safe and effective medicinal products is defined as a priority of pharmaceutical policy in the European Union. At the same time, the inclusion of medicinal products in the schemes of early marketing authorisation and reimbursement should be further clarified in order to improve transparency and reduce uncertainty. The aim of this policy research was to identify the possibilities to measure the reduction of uncertainties in reimbursement system for medicinal products. Methods: The research was based on the literature review on topics of definitions, taxonomy and measuring of the uncertainty in health care, as well as conditions of the reimbursement system for medicinal products in Latvia. Results: The reimbursement system in Latvia operates under strictly limited financial resources; therefore a wide spectrum of financial tools has been implemented. Managed entry agreements, which are one of these tools, limit the uncertainties regarding to clinical and economic evidence of new medicines, fair price and budget impact, as well as eligible patients’ population. At the same time the decision making should be supported by the evidence of the real reduction of uncertainties. Different concepts and taxonomies relating to uncertainty in decision modelling exist, including stochastic, parameter and structural uncertainty. However, the methods of measuring uncertainties in models are not fully suitable to estimate the reduction of uncertainty around the clinical effectiveness and efficiency of a medicinal product in real life. Conclusions: Measuring of uncertainties is an important issue that has attracted by increasing attention in light of supporting the schemes of early marketing authorisation of medicinal products and their inclusion in reimbursement systems. The measures of uncertainties used in decision modelling should be adapted to flexible use in real life conditions. PHP130 Concentration Analysis Of Hungarian Health Care Providers Between 2006-2015 Csákvári T1, Turcsányi K1, Endrei D2, Sebestyén A3, Boncz I2 of Pécs, Zalaegerszeg, Hungary, 2University of Pécs, Pécs, Hungary, 3National Health Insurance Fund Administration, Pécs, Hungary
Currently the proportion of the two sub-heads in the chapter is 63.5%-29.3% in 2015. On expenditure side, we haven’t found any significant change in the ratio of inpatient care (63.5%±0.85%) to outpatient- (19.3%±1.01%) or to primary care (17.1%±0.95%). Proportion of acute care spending in the inpatient care started to decrease after 2004, with the growing proportion of the specialty care simultaneously, while chronic care hasn’t changed. On real-terms, there was a remarkable expenditure growth between 2002-2006, a significant decline between 2007-2010 and a slight increase after 2011. Conclusions: There was no clear policy regarding proportion of revenues coming from either health insurance contributions or state taxes (by the budget) in Hungary. On the expenditure side of the health insurance budget there was no significant changes in the proportion of spending on primary care, outpatient care and inpatient care.
PHP132 The Evolution Of Patient Access Schemes Spoors J1, Kusel J2 1RJW & Partners, Royston, UK, 2Costello Medical Consulting Ltd, Cambridge, UK
Objectives: To map the evolution of patient access schemes (PAS) submitted to NICE, track the various formats proposed by manufacturers and establish if there is an optimal way to design schemes to achieve market access. Methods: We conducted an analysis of NICE approved therapies with PAS applied (n= 65) and categorised them according to one of five categories: financial based, free stock, dose cap, response scheme or combined (financial and clinical). The analysis included technologies from the Single Technology Appraisal, Multiple Technology Appraisal and the Highly Specialised Technologies (HST) programmes. Results: The majority (50/65) of successful PAS submitted to NICE have been finance-based. Free stock was the next highest, with 9/65 successfully agreed PAS under this category. Dose capping schemes were agreed in 3/65 appraisals, combined (discount and rebate) were agreed in 2/65 appraisals and there has only been 1 response scheme. Interestingly, there has been an increase in schemes which are being agreed with payers outside the setting of a NICE appraisal. Conclusions: The focus from NICE on financial schemes is likely to be based on the notion that outcome schemes are notoriously burdensome to administer. However, driven by financial necessity through affordability challenges, European healthcare systems including the NHS are becoming better equipped to deal with complex schemes.The main reason driving this is the specialisation of pharmaceuticals; and in-particular, orphan and ultra-orphan drugs, where patients are able to be tracked on an individual basis. The key to a successful PAS is addressing payer uncertainty at the time of evaluation which can be either financial or clinical. Two successful schemes in the analysis have combined financial and outcomes-based elements to address payer uncertainty and secure NICE approval. It is likely that in order to address growing payer uncertainty at launch, manufacturers are going to have to offer more than pure financial discounts with PAS.
1University
Objectives: The aim of our study was to analyze the concentration of the Hungarian outpatient care, CT imaging, and the acute and chronic inptatient care providers’ reimbursement between the years 2006-2015. Methods: We used Lorenz curve to illustrate the contentration of the reimbursement paid by the Hungarian National Health Insurance Fund Administration (NHIFA). We ranked the providers and calculated the percentiles based on the amount of reimbursement in each type of health care. Gini index was also calculated for the examined health care services. Provider-level data derived from the Hungarian NHIFA database. The years 2006, 2010 and 2015 were investigated. Results: In 2015 the highest concentration was found in the outpatient (Gini: 0.736) and the acute inpatient care system (Gini: 0.697). CT (Gini: 0.468) and chronic inpatient care (Gini: 0.473) had lower contrentration. The top 25% of outpatient care providers spent 82.86%, 50% of them spent 96.86% of all outpatient reimbursement in 2015. Top quadrant of acute inpatient care providers had 79.71%, 50% of them had 96.11% in the same year. We found that in all four observed types of care, the top 50% got more than 80%, and the top 75% had more than 95% of the given type’s reimbursement in 2006, 2010 and 2015 as well. Since 2006 the concentration of the acute inpatient care system (Gini2006: 0.594, Gini2015: 0.697) increased the most, the other three types of care showed some improvement (Gini2006: 0.741, Gini2015: 0.736 in inpatient care, Gini2006: 0.52, Gini2015: 0.469 in CT imaging, Gini2006: 0.535, Gini2015: 0.473 in chronic inpatient care). Conclusions: Financing of acute inpatient, and outpatient care had the highest concentration in each observed year. Only half of the providers of these four types of health care spend more than 80% of health insurance reimbursement. PHP131 Analyzing The Revenues And Expenditures Of The Hungarian Health Insurance Fund Between 1993-2015 Csákvári T1, Turcsányi K1, Endrei D2, Sebestyén A3, Boncz I2 of Pécs, Zalaegerszeg, Hungary, 2University of Pécs, Pécs, Hungary, 3National Health Insurance Fund Administration, Pécs, Hungary
1University
Objectives: The aim of our study was to analyse the structure of revenues and expenditures of the Hungarian Health Insurance Fund between 19932015. Methods: We analyzed the structure of the Hungarian Health Insurance Fund, size and ratio of the sub-heads between 1993-2015. We calculated with nominal- and real values (at 2015 prices) as well. Data derived from the National Health Insurance Fund Administration and the National Health Care Centre. Results: We found significant changes in the ratio of the employee’s to employer’s contribution, and revenues coming from state taxes (by the budget). In 1993, 85.9% of the revenues chapter came from contributions, and 13.3% by the state budget. Ratio of contributions reached maximum in 1998 (97.7%), minimum in 2013 (41.6%).
PHP133 Taking In Account Research And Development Expenditures To Determine Prices Of Medicines In France: A Realistic Alternative Choice? Masia C, Nedellec E, Levy P Université Paris-Dauphine, Paris, France
Objectives: The objective is to determine advantages and limits of an analytic determination of the price of medicines exclusively based on research and development (R&D) spending in order to reconcile objectives of pharmaceutical companies, patients and health authorities. These costs can be divided into two aggregates : research (fundamental and applied) and development (clinical trials). These expenditures (generally spread on 10 years) come from a mixed funding between public and private sectors. Methods: Fixing the price of a drug according to its clinical benefit is a strong signal for pharmaceutical industries to innovate. However this value isn’t really objective. According to expert opinion 900M$ are spent in R&D for a new drug. On an upgrading rate of 11% : the amount of capitalized expenditures is about 1.5B$ per molecule. Development costs vary between therapeutic areas : 1.5B$ in pulmonology and 616M$ in virology. They are very different according to the size of the company (between 350M$ and 5.5B$ per molecule). R&D costs have been multiplied by 10 in 30 years whereas its productivity decreases since the 90’s. Results: Costs and earnings are not correlated in the time. We are not able to individualize the price of the investment by molecule, neither by country. Furthermore, with the externalization of research, biotechnology, open innovation, the R&D’s model tend to disappear. Verifications of these expenses by the state is almost impossible. Moreover from the patient point of view, it can be difficult to accept the price difference between incremental innovations or disruptive innovations. Conclusions: A price analyse might look interesting but would have différents limits. The will of the society to remunerate a clinic benefit over a clinic investment, could take in consideration its expenses, without making them the main characteristics when fixing a price. This model could allow new perspectives, especially with evolution about R&D. PHP134 Use Of Electronic Health Information Systems (Ehis) By Healthcare Professionals (Hcps) And The Perception Of Its Value In Reducing Medication Risks And Safety For Patients Narayanan S1, Bullman R2, Rucker LN3, Rausch P4 1Market Access Solutions, LLC, Potomac, MD, USA, 2NCPIE, Rockville, MD, USA, 3Enhance Value, Bethesda, MD, USA, 4Food and Drug Administration, Silver Spring, MD, USA
Objectives: Assess the use of eHIS by HCPs and the perception of its value in reducing medication risks and safety for patients. Methods: A cross-sectional online survey of HCPs was conducted (FDA cooperative-agreement #5U18FD004653-01)