Pharmaceutical Executive Europe IMS Health Economics Supplement - December 2007 - (Page 5) BUDGET IMPACT ANALYSES through the financial — and indeed other— consequences of its take-up. When new interventions become available, the priority for budget holders is to allocate and plan for their budgetary impact and then, for some therapies, to consider the workload or capacity implications. Money is one thing, but having sufficient capacity to accommodate change is another. For example, if a new treatment — say a more effective anaesthetic where a patient takes hardly any time to go under and recover — greatly assists the throughput of an operating theatre then the availability of operating theatre time is likely to expand. Whilst this may be seen as a potential benefit, it is important to consider whether there are enough nurses, doctors and surgeons to make use of the freed-up schedules, and the extra costs that will be incurred in that budget period by bringing operations forward and reducing waiting times. Cost savings in one area may be offset by cost increases elsewhere. the matrix for potential switching. The key is to make the tool as transparent and accessible as possible, so that users can easily manipulate it and the audience can ‘buy into it’ and see how numbers flow through the model. Although no standardized form of BIA has yet been agreed, most compare a range of alternative scenarios defined by a set of interventions rather than specific individual technologies. A ‘reference scenario’ is also defined, which is the current mix of interventions for the chosen population and sub-groups. This current mix may include ‘no intervention’, as well as interventions that might, or might not, be replaced by the new treatment. Proper design of the analytical framework is a crucial step in BIA and the design must take into account the current understanding of the nature of the health condition and the evidence regarding the current and new technologies. be given the new intervention in the time horizon of interest. However, specifying who is included in this population is not obvious. It depends, of course, on the approved indication (use), but it also reflects: ● local intended restrictions on use (and reimbursement) ● possible off-label or beyond-restriction use ● induced demand (that is, the proportion of previously untreated patients who now seek treatment because of improved outcomes, greater convenience, or fewer sideeffects) ● the speed and extent to which practitioners adopt the technology or change usage patterns of existing ones. Considering all the options A wealth of possibilities The BIA tool therefore has extended possibilities: one is to present budget holders with valuable workload/capacity information alongside financial impact. Presenters — sometimes the HEOR professionals themselves — may therefore use the opportunity this presents to highlight other effects of the new treatment that may interest the customer. This can be of great value in a sales environment. BIA tools themselves are generally built in Microsoft Excel and involve three fundamental steps or components: 1. Estimating the number of eligible patients for the new therapy in the relevant catchment area; 2. Determining the likely uptake and substitution from this population (that is, how many patients on an existing treatment will switch into it and how many will start treatment for the first time?); 3. Multiplying the Step 2 numbers by the cost information. At a conceptual level, then, BIA is relatively straightforward. But when the medical complexity of the area in question is taken into account, complications can start to arise, both in terms of the drug’s likely effects and www.pharmexeceurope.com The introduction of a new technology or treatment sets in motion various marketplace dynamics, which may include product substitution as well as market expansion. Before comparisons can be made, these must be modelled explicitly with reasonable and justifiable assumptions. Thus, the analysis should consider how the existing mix of interventions is likely to change when the new one is made available. For example, the new intervention might become an add-on or replacement for some or all of the current treatments. These constitute the new scenarios. There are several other ‘dimensions’ that must also be considered, including acuteness of the health condition; whether the condition is self-limiting; and the type of intervention (for example, preventative, curative, palliative, onetime, ongoing, or periodic). These dimensions will affect the degree to which time dependence is important in the design; how the size of the population is estimated; the unit of analysis (episode vs patient, for example); how the intervention uptake is addressed; and the choice of modelling technique. The population to be included in a BIA should be all patients who might …evidence from HEOR practitioners suggests that BIAs are frequently a ‘last minute’ affair from which full value is not always extracted in the sales environment. The budget impact model must be designed to enable the effect of alternative assumptions about the nature and size of the treated population to be examined. Notably, the analytical framework should allow for population sub-groups to be considered so that budget impact information can be made specific to these segments. Such aspects as disease severity or stage, comorbidities, age, gender, and other characteristics that might affect access to the new intervention, or its impact on the budget, must all be factored into the equation. Understanding change Generally, BIA is an analysis of change. If, for example, a new cholesterolreducing wonder drug replaces everything else being prescribed, but costs twice as much, then the pharma company will produce a base case budgetary estimate of the numbers receiving the current mix of treatment at the current cost. That number will 5 http://www.pharmexeceurope.com
Table of Contents Feed for the Digital Edition of Pharmaceutical Executive Europe IMS Health Economics Supplement - December 2007 Pharmaceutical Executive Europe IMS Health Economics Supplement - December 2007 Contents Budget Impact Analyses: BIAs: The Fifth Hurdle? Evidence and Effectiveness: Redressing the Balance Commercializing HEOR: Adding Value Pharmaceutical Executive Europe IMS Health Economics Supplement - December 2007 Pharmaceutical Executive Europe IMS Health Economics Supplement - December 2007 - Pharmaceutical Executive Europe IMS Health Economics Supplement - December 2007 (Page 1) Pharmaceutical Executive Europe IMS Health Economics Supplement - December 2007 - Pharmaceutical Executive Europe IMS Health Economics Supplement - December 2007 (Page 2) Pharmaceutical Executive Europe IMS Health Economics Supplement - December 2007 - Contents (Page 3) Pharmaceutical Executive Europe IMS Health Economics Supplement - December 2007 - Budget Impact Analyses: BIAs: The Fifth Hurdle? (Page 4) Pharmaceutical Executive Europe IMS Health Economics Supplement - December 2007 - Budget Impact Analyses: BIAs: The Fifth Hurdle? (Page 5) Pharmaceutical Executive Europe IMS Health Economics Supplement - December 2007 - Budget Impact Analyses: BIAs: The Fifth Hurdle? (Page 6) Pharmaceutical Executive Europe IMS Health Economics Supplement - December 2007 - Evidence and Effectiveness: Redressing the Balance (Page 7) Pharmaceutical Executive Europe IMS Health Economics Supplement - December 2007 - Evidence and Effectiveness: Redressing the Balance (Page 8) Pharmaceutical Executive Europe IMS Health Economics Supplement - December 2007 - Commercializing HEOR: Adding Value (Page 9) Pharmaceutical Executive Europe IMS Health Economics Supplement - December 2007 - Commercializing HEOR: Adding Value (Page 10)
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