在新药早期获益评估中确定轻微、显著和主要治疗效果的方法学途径。
Methodological approach to determine minor, considerable, and major treatment effects in the early benefit assessment of new drugs.
作者信息
Skipka Guido, Wieseler Beate, Kaiser Thomas, Thomas Stefanie, Bender Ralf, Windeler Jürgen, Lange Stefan
机构信息
Institute for Quality and Efficiency in Health Care (IQWiG), 50670, Cologne, Germany.
出版信息
Biom J. 2016 Jan;58(1):43-58. doi: 10.1002/bimj.201300274. Epub 2015 Jul 2.
At the beginning of 2011, the early benefit assessment of new drugs was introduced in Germany with the Act on the Reform of the Market for Medicinal Products (AMNOG). The Federal Joint Committee (G-BA) generally commissions the Institute for Quality and Efficiency in Health Care (IQWiG) with this type of assessment, which examines whether a new drug shows an added benefit (a positive patient-relevant treatment effect) over the current standard therapy. IQWiG is required to assess the extent of added benefit on the basis of a dossier submitted by the pharmaceutical company responsible. In this context, IQWiG was faced with the task of developing a transparent and plausible approach for operationalizing how to determine the extent of added benefit. In the case of an added benefit, the law specifies three main extent categories (minor, considerable, major). To restrict value judgements to a minimum in the first stage of the assessment process, an explicit and abstract operationalization was needed. The present paper is limited to the situation of binary data (analysis of 2 × 2 tables), using the relative risk as an effect measure. For the treatment effect to be classified as a minor, considerable, or major added benefit, the methodological approach stipulates that the (two-sided) 95% confidence interval of the effect must exceed a specified distance to the zero effect. In summary, we assume that our approach provides a robust, transparent, and thus predictable foundation to determine minor, considerable, and major treatment effects on binary outcomes in the early benefit assessment of new drugs in Germany. After a decision on the added benefit of a new drug by G-BA, the classification of added benefit is used to inform pricing negotiations between the umbrella organization of statutory health insurance and the pharmaceutical companies.
2011年初,德国通过《药品市场改革法案》(AMNOG)引入了新药早期效益评估。联邦联合委员会(G-BA)通常委托医疗保健质量与效率研究所(IQWiG)进行此类评估,该评估旨在检验一种新药相对于当前标准疗法是否具有额外效益(与患者相关的积极治疗效果)。IQWiG需要根据负责的制药公司提交的一份卷宗来评估额外效益的程度。在此背景下,IQWiG面临着一项任务,即制定一种透明且合理的方法来实施如何确定额外效益的程度。在存在额外效益的情况下,法律规定了三个主要的程度类别(轻微、相当、重大)。为了在评估过程的第一阶段将价值判断限制在最低限度,需要一种明确且抽象的实施方法。本文仅限于二元数据的情况(2×2表格分析),使用相对风险作为效应量度。为了将治疗效果归类为轻微、相当或重大的额外效益,该方法规定效应的(双侧)95%置信区间必须超过与零效应的指定距离。总之,我们认为我们的方法为在德国新药早期效益评估中确定二元结局的轻微、相当和重大治疗效果提供了一个稳健、透明且因此可预测的基础。在G-BA就一种新药的额外效益做出决定后,额外效益的分类用于为法定医疗保险总机构与制药公司之间的定价谈判提供信息。