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先进治疗药物产品和健康技术评估——基于价值和可持续医疗保健的原则和实践。

Advanced therapy medicinal products and health technology assessment principles and practices for value-based and sustainable healthcare.

机构信息

Department of Economics, Stockholm School of Economics, Stockholm, Sweden.

Office of Health Economics, London, UK.

出版信息

Eur J Health Econ. 2019 Apr;20(3):427-438. doi: 10.1007/s10198-018-1007-x. Epub 2018 Sep 18.

Abstract

BACKGROUND

Advanced therapy medicinal products (ATMPs) are beginning to reach European markets, and questions are being asked about their value for patients and how healthcare systems should pay for them.

OBJECTIVES

To identify and discuss potential challenges of ATMPs in view of current health technology assessment (HTA) methodology-specifically economic evaluation methods-in Europe as it relates to ATMPs, and to suggest potential solutions to these challenges.

METHODS

An Expert Panel reviewed current HTA principles and practices in relation to the specific characteristics of ATMPs.

RESULTS

Three key topics were identified and prioritised for discussion-uncertainty, discounting, and health outcomes and value. The panel discussed that evidence challenges linked to increased uncertainty may be mitigated by collection of follow-on data, use of value of information analysis, and/or outcomes-based contracts. For discount rates, an international, multi-disciplinary forum should be established to consider the economic, social and ethical implications of the choice of rate. Finally, consideration of the feasibility of assessing the value of ATMPs beyond health gain may also be key for decision-making.

CONCLUSIONS

ATMPs face a challenge in demonstrating their value within current HTA frameworks. Consideration of current HTA principles and practices with regards to the specific characteristics of ATMPs and continued dialogue will be key to ensuring appropriate market access.

CLASSIFICATION CODE

I.

摘要

背景

先进治疗药物产品(ATMPs)开始进入欧洲市场,人们开始质疑它们对患者的价值,以及医疗保健系统应该如何为其买单。

目的

鉴于欧洲目前特定于卫生技术评估(HTA)方法的经济评估方法,确定并讨论 ATMP 面临的潜在挑战,并为这些挑战提出潜在的解决方案。

方法

专家小组审查了与 ATMP 特定特征相关的当前 HTA 原则和实践。

结果

确定并优先讨论了三个关键主题——不确定性、贴现率以及健康结果和价值。专家组讨论了与增加的不确定性相关的证据挑战可以通过收集后续数据、使用信息价值分析和/或基于结果的合同来减轻。对于贴现率,应建立一个国际多学科论坛,以考虑选择贴现率的经济、社会和伦理影响。最后,考虑评估 ATMP 除健康收益之外的价值的可行性也可能是决策的关键。

结论

ATMP 在当前 HTA 框架内证明其价值面临挑战。考虑到 ATMP 的特定特征,对当前 HTA 原则和实践的考虑以及持续的对话将是确保适当市场准入的关键。

分类代码

I.

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