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SIMILARITIES AND DIFFERENCES BETWEEN FIVE EUROPEAN DRUG REIMBURSEMENT SYSTEMS

Published online by Cambridge University Press:  19 September 2012

Margreet Franken ,
Maïté le Polain ,
Irina Cleemput  and
Marc Koopmanschap
Margreet Franken
Affiliation:
Institute of Health Policy and Management, Erasmus University email: franken@bmg.eur.nl
Maïté le Polain
Affiliation:
Belgian Health Care Knowledge Centre
Irina Cleemput
Affiliation:
Belgian Health Care Knowledge Centre, Hasselt University
Marc Koopmanschap
Affiliation:
Institute of Health Policy and Management, Erasmus University
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Abstract

Objectives: The aim of our study is to compare five European drug reimbursement systems, describe similarities and differences, and obtain insight into their strengths and weaknesses and formulate policy recommendations.

Methods: We used the analytical Hutton Framework to assess in detail drug reimbursement systems in Austria, Belgium, France, the Netherlands, and Sweden. We investigated policy documents, explored literature, and conducted fifty-seven interviews with relevant stakeholders.

Results: All systems aim to balance three main objectives: system sustainability, equity and quality of care. System impact, however, is mainly assessed by drug expenditure. A national reimbursement agency evaluates reimbursement requests on a case-by-case basis. The minister has discretionary power to alter the reimbursement advice in Belgium, France, and the Netherlands. All systems make efforts to increase transparency in the decision-making process but none uses formal hierarchical reimbursement criteria nor applies a cost-effectiveness threshold value. Policies to deal with uncertainty vary: financial risk-sharing by price/volume contracts (France, Belgium) versus coverage with evidence development (Sweden, the Netherlands). Although case-by-case revisions are embedded in some systems for specific groups of drugs, systematic (group) revisions are limited.

Conclusions: As shared strengths, all systems have clear objectives reflected in reimbursement criteria and all are prepared to pay for drugs with sufficient added value. However, all systems could improve the transparency of the decision-making process; especially appraisal lacks transparency. Systems could increase the use of (systematic) revisions and could make better use of HTA (among others cost-effectiveness) to obtain value for money and ensure system sustainability.

Keywords

Drug reimbursementDecision makingHealth policyPharmaceutical economicsCountry comparison
Type
POLICIES
Information
International Journal of Technology Assessment in Health Care , Volume 28 , Issue 4 , October 2012 , pp. 349 - 357
Copyright
Copyright © Cambridge University Press 2012

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References

REFERENCES

1.Anell, A. Priority setting for pharmaceuticals. The use of health economic evidence by reimbursement and clinical guidance committees. Eur J Health Econ. 2004;5:28–35.CrossRefGoogle ScholarPubMed
2.Cohen, J, Faden, L, Predaris, S, et al.Patient access to pharmaceuticals: An international comparison. Eur J Health Econ. 2007;8:253–266.CrossRefGoogle ScholarPubMed
3.Cohen, J, Stolk, E, Niezen, M. The increasingly complex fourth hurdle for pharmaceuticals. Pharmacoeconomics. 2007;25:727–734.CrossRefGoogle ScholarPubMed
4.Dreyer, NA, Garner, S. Registries for robust evidence. JAMA. 2009;302:790.CrossRefGoogle ScholarPubMed
5.Drummond, M, Jönsson, B, Rutten, F, et al.Reimbursement of pharmaceuticals: Reference pricing versus health technology assessment. Eur J Health Econ. 2011;12:263–271.CrossRefGoogle ScholarPubMed
6.Garattini, L, Cornago, D, De Compadri, P. Pricing and reimbursement of in-patent drugs in seven European countries: A comparative analysis. Health Policy. 2007;82:330–339.CrossRefGoogle ScholarPubMed
7.Garrison, LP Jr, Neumann, PJ, Erickson, P, et al.Using real world data for coverage and payment decisions: The ISPOR Real World Data Task Force Report. Value Health. 2007;10:326–335.CrossRefGoogle ScholarPubMed
8.Grandfils, N.Drug price setting and regulation in France. Paris: IRDES Institute for Research and Information in Health Economics; 2008. Report No.: Working Papers DT 16.Google Scholar
9.Harris, A, Buxton, M, O'Brien, B, et al.Using economic evidence in reimbursement decisions for health technologies: Experience of 4 countries. Expert Rev Pharmacoecon Outcomes Res. 2001;1:7–12.CrossRefGoogle ScholarPubMed
10.Hutton, J, McGrath, C, Frybourg, JM, et al.Framework for describing and classifying decision-making systems using technology assessment to determine the reimbursement of health technologies (fourth hurdle systems). Int J Technol Assess Health Care. 2006;22:10–18.CrossRefGoogle ScholarPubMed
11.Klein, R. Priorities and rationing: Pragmatism or principles? BMJ. 1995;311:761.CrossRefGoogle ScholarPubMed
12.Kristensen, FB, Lampe, K, Chase, DL, et al.Practical tools and methods for health technology assessment in Europe: Structures, methodologies, and tools developed by the European network for Health Technology Assessment, EUnetHTA. Int J Technol Assess Health Care. 2009;25:1–8.CrossRefGoogle ScholarPubMed
13.Le Pen, C, Priol, G, Lilliu, H. What criteria for pharmaceuticals reimbursement? Eur J Health Econ. 2003;4:30–36.CrossRefGoogle ScholarPubMed
14.Levy, AR, Mitton, C, Johnston, KM, et al.International comparison of comparative effectiveness research in five Jurisdictions: Insights for the US. Pharmacoeconomics. 2010;28:813–830.CrossRefGoogle ScholarPubMed
15.Van Ganse, E, Chamba, G, Bruet, G, Becquart, V, Stamm, C, Lopes, S, Marty, Ch. PPRI Pharma Profile France 2008. Pharmaceutical Pricing and Reimbursement Information; Commissioned by the European Commission, Directorate-General Health and Consumer Protection and Austrian Federal Ministry of Health, Family and Youth. WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies. Gesundheit Österreich GmbH.Google Scholar
16.Niezen, M, de Bont, A, Stolk, E, et al.Conditional reimbursement within the Dutch drug policy. Health Policy. 2007;84:39–50.CrossRefGoogle ScholarPubMed
17.OECD Health Data 2010 [Online]. Paris: Organisation for Economic Co-operation and Development. 2010. http://www.irdes.fr/EcoSante/DownLoad/OECDHealthData_FrequentlyRequestedData.xls (accessed December 12, 2010).Google Scholar
18.Sermet, C, Andrieu, V, Godman, B, et al.Ongoing pharmaceutical reforms in France: Implications for key stakeholder groups. Appl Health Econ Health Policy. 2010;8:7–24.CrossRefGoogle ScholarPubMed
19.Sorenson, C. The role of HTA in coverage and pricing decisions: A cross-country comparison. Euro Observer. 2009;11:1–11.Google Scholar
20.Stevens, A, Milne, R. Health technology assessment in England and Wales. Int J Technol Assess Health Care. 2004;20:11–24.CrossRefGoogle ScholarPubMed
21.Stolk, EA, Poley, MJ. Criteria for determining a basic health services package. Recent developments in The Netherlands. Eur J Health Econ. 2005;6:2–7.CrossRefGoogle ScholarPubMed
22.TLV. Hypertension: A review of medicines for lowering blood pressure. Solna: The Dental and Pharmaceutical Benefits Agency; 2008.Google Scholar
23.Vuorenkoski, L, Toiviainen, H, Hemminki, E. Decision-making in priority setting for medicines-A review of empirical studies. Health Policy. 2008;86:1–9.CrossRefGoogle ScholarPubMed
24.Vuorenkoski, L, Toiviainen, H, Hemminki, E. Drug reimbursement in Finland-A case of explicit prioritizing in special categories. Health Policy. 2003;66:169–177.CrossRefGoogle ScholarPubMed
25.Wirtz, V, Cribb, A, Barber, N. Reimbursement decisions in health policy – Extending our understanding of the elements of decision-making. Health Policy. 2005;73:330–338.CrossRefGoogle ScholarPubMed