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Untangling the complexity of funding recommendations: a comparative analysis of health technology assessment outcomes in four European countries

Cerri, Karin H. and Knapp, Martin and Fernández, José-Luis (2015) Untangling the complexity of funding recommendations: a comparative analysis of health technology assessment outcomes in four European countries. Pharmaceutical Medicine, 29 (6). pp. 341-359. ISSN 1178-2595

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Identification Number: 10.1007/s40290-015-0112-8

Abstract

Objectives Health Technology Assessment (HTA) agencies produce recommendations that guide public funding of pharmaceuticals, based on various criteria. We explored factors that may contribute to explaining differences in coverage decisions by the National Institute for Health and Care Excellence (NICE) in England and Wales, the Scottish Medicines Consortium (SMC), the Dutch College voor Zorgverzekeringen (CVZ), and the French Haute Autorité de Santé (HAS). Methods A dataset of 977 HTA decisions made in 2004–2009 was created. A three-category outcome variable was used (decision to ‘recommend’, ‘restrict’ or ‘not recommend’ a technology). Multivariate analyses explored impacts of clinical, economic, process and socio-economic variables in their decision making. Results Relative to the CVZ and adjusting for a range of confounders, technologies were more likely to be recommended by NICE and HAS, and restricted or not-recommended by the SMC. Recommendation was significantly associated (p ≤ 0.10) with several variables: strength of clinical evidence (number of trials, use of active comparator-arm, demonstration of clinical superiority) orphan status and indication for cancer. Simultaneous assessment of multiple rather than single pharmaceuticals was associated with increased probability of restriction. Conclusions In this European multi-HTA study, appraisal outcomes differed significantly across HTA bodies. A range of evidence and non-evidence factors were associated with HTA decisions, confirming the value of comprehensive, multivariate analyses. Nevertheless, a large proportion of variance in HTA decisions remained unexplained, suggesting

Item Type: Article
Official URL: http://link.springer.com/journal/40290
Additional Information: © 2015 Springer International Publishing
Subjects: H Social Sciences > H Social Sciences (General)
Sets: Research centres and groups > Personal Social Services Research Unit (PSSRU)
Date Deposited: 24 Sep 2015 15:45
Last Modified: 11 Sep 2016 23:00
URI: http://eprints.lse.ac.uk/id/eprint/63722

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