Pericleous Louisa, Amin Mo, Goeree Ron
a Value and Access , Amgen Canada Inc , Mississauga , Ontario , Canada.
b Department of Clinical Epidemiology and Biostatistics (CEB) , McMaster University , Hamilton , Ontario , Canada.
J Med Econ. 2019 May;22(5):478-487. doi: 10.1080/13696998.2019.1582535. Epub 2019 Mar 4.
Both public and private insurers provide drug coverage in Canada. All payers are under pressure to contain costs. It has recently been proposed that private plans leverage the public health technology assessment (HTA) evaluation process in their decision-making.
The objectives of the current study were to examine use of public health technology assessments (HTAs) for private payer decision-making in the literature, to gather the perspectives of experts from both public and private insurers on this practice, and to summarize which value parameters of public evaluations can be used for private payer decision-making.
A targeted literature review was conducted to identify publications on the use of public HTA or cost-effectiveness data for private payer decision-making on pharmaceutical reimbursement. Concurrently, a roundtable meeting was organized with invited panelists, including private payer representatives and health economic consultants (total n = 9). The findings from both were synthesized and expressed in qualitative terms using the PICO framework.
The targeted review identified 20 studies meeting the inclusion criteria, primarily originating from the US and Canada. The panelists felt that, despite some similarities, there were substantial differences between both systems. The PICO framework highlighted the issues with transferability between the two systems. Most of the value parameters were either not applicable, needed to be added, needed to be adjusted, or their applicability to private payer systems needed to be confirmed.
Some components of public HTA may be relevant for private payers, however there are reservations that still exist on whether the HTA process in Canada, designed for a public system, can address the informational needs of private payers. Private insurers need to use caution in assessing which value parameters from public HTAs can be used and which need to be confirmed, ignored, enhanced, or adjusted. One size HTA does not fit all applications.
在加拿大，公共和私人保险公司均提供药品保险。所有付款方都面临着控制成本的压力。最近有人提议，私人保险计划在决策过程中利用公共卫生技术评估（HTA）的评估流程。
本研究的目的是审查文献中公共卫生技术评估（HTA）在私人付款方决策中的应用情况，收集公共和私人保险公司专家对这种做法的看法，并总结公共评估的哪些价值参数可用于私人付款方的决策。
进行了有针对性的文献综述，以确定关于使用公共HTA或成本效益数据进行私人付款方药品报销决策的出版物。同时，组织了一次圆桌会议，邀请了包括私人付款方代表和卫生经济顾问在内的小组成员（共9人）。将两者的研究结果进行综合，并使用PICO框架以定性方式表达。
有针对性的综述确定了20项符合纳入标准的研究，这些研究主要来自美国和加拿大。小组成员认为，尽管存在一些相似之处，但两个系统之间存在重大差异。PICO框架突出了两个系统之间可转移性的问题。大多数价值参数要么不适用、需要添加、需要调整，要么其对私人付款方系统的适用性需要确认。
公共HTA的某些组成部分可能与私人付款方相关，然而，对于为公共系统设计的加拿大HTA流程能否满足私人付款方的信息需求，仍存在保留意见。私人保险公司在评估公共HTA中的哪些价值参数可被使用以及哪些需要确认、忽略、增强或调整时需要谨慎。一种尺寸的HTA并不适用于所有应用。
