Biotechnology Healthcare - September/October 2008 - (Page 41)

tiveness at the table in the major initiatives going on,” says Neumann, director of the Center for the Evaluation of Value and Risk in Health at the Institute for Clinical Research and Health Policy Studies, at Tufts Medical Center in Boston. “There’s still skepticism — maybe confusion — whether we could do cost-effectiveness even if we got over the political hurdles.” Three years ago, Neumann outlined the need for more costeffectiveness research in his book, Using Cost-Effectiveness Analysis to Improve Health Care. While there’s been no revolution in the field in the United States since then, Neumann says there has been a distinct shift in tone as some costeffectiveness research begins to stream into the healthcare arena. Part of that information is coming from the cost and value data that the Academy of Managed Care Pharmacy (AMCP) has encouraged health plans to request from drug companies, aka the AMCP Format for Formulary Submissions. “There is not yet enough documented evidence about its impact, but it appears to be influential,” says Neumann of the AMCP initiative. Cost-effectiveness data are “informing decisions about tiering for drugs, informing clinical guidelines at some level, and we do see more of the health plans adopting the AMCP format guidelines. WellPoint is a leader here, saying ‘We’re going to use cost-effectiveness and we’re going to start requiring it.’ That’s new. The field is moving forward, and there are some signs of progress — but there is still controversy.” Big MCOs “are now in the game,” he adds. There are some groups that know how to do this — evaluating economic studies and receiving AMCP dossiers and looking at effective.’” With NICE, you can have that conversation. There’s a them.” Further complicating the move collective buy-in with a single nato cost-effectiveness analysis, tional system. And in the United though, is the debate about analyti- Kingdom, there’s a tradition of health economists — capable praccal standards. There has been a growing stack titioners of this craft — arguing this of statements and position papers for many years.” Ten years, to be exact, says Caron the broad use of cost and benefit analysis, Neumann says. But ole Longson, director of the Centre for Health Technology there has also been Evaluation at NICE. some pushback on the And she is quick to use of key metrics, like agree with Neumann QALYs. In Germany’s that this experience has draft guidelines, for exbeen invaluable as the ample, officials have recapacity to offer scienjected QALYs in favor tific advice develops. of alternative “effiShe believes that the inciency” measures. teraction with Novartis “Take HIV/AIDS as “A national institute will make the overall an example,” he says. [for comparative efsystem even better. An efficiency standard fectiveness studies] would call for treating ought to be focused “ONUS IS ON US” people with HIV/AIDS on clinical effective“We see this as an exwith the best, most cost- ness,” says Gail tremely important deeffective strategy for Wilensky, PhD. Costvelopment,” one that managing this condi- effectiveness, she says, is too controvertion, but would not digets developers focused sial for it to tackle. rectly compare a drug earlier in the process on for HIV with a drug for, say, de- understanding and exploring the pression, using a metric such as kind of information that bodies like QALY. For diabetes, rather than NICE look for in determining the using QALYs, there might be a cost-effectiveness of a therapy, says comparison of alternative strategies Longson. on the basis of incremental costs “When it comes to an organizaper unit of blood sugar controlled. tion such as NICE, proof of conIt’s a technical debate, but it’s an im- cept, quality, safety, efficacy, are all portant one.” absolutely necessary, but not suffiAnd it’s always a very sensitive cient,” she adds. “We’re also lookdebate, especially when a variety of ing for effectiveness comparators; payers are expected to reach indi- how does this new technology look vidual conclusions that could easily up against technology already being upset patient groups. used?” “It seems to be hard to do costAnd it won’t stop with Novartis’ effectiveness in a big way without a psoriasis drug. Other developers are single-payer system,” says Neu- talking to NICE about following mann. “No private plan wants to be suit. the one to deny something to say It all boils down to whether it’s a ‘We’re not going to pay for that good product that works and works thing that works but is not cost- well against what’s out there, LongSEPTEMBER/OCTOBER 2008 · BIOTECHNOLOGY HEALTHCARE 41

Table of Contents Feed for the Digital Edition of Biotechnology Healthcare - September/October 2008

Biotechnology Healthcare - September/October 2008 Openers Editorial/David B. Nash, MD, MBA Contents At a Glance: Multiple Sclerosis Drug Track Personalized Medicine Healthcare Reform’s Effects on Biologic Access Breast Cancer Status Testing: A Crapshoot With Deadly Odds Trends, Issues, and Perspectives In the Management of MS So High-Tech, Yet So Simple The Evolution of Ascertaining the Value Proposition Specialty Pharmacy Employer to Employer Health Plan Confidential Trends

Biotechnology Healthcare - September/October 2008

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