{"title":"An empirical study looking at the potential impact of increasing cost-effectiveness threshold on reimbursement decisions in Thailand","authors":"Wanrudee Isaranuwatchai , Yi Wang , Budsadee Soboon , Kriang Tungsanga , Ryota Nakamura , Hwee-Lin Wee , Siobhan Botwright , Wannisa Theantawee , Jutatip Laoharuangchaiyot , Thanakrit Mongkolchaipak , Thanisa Thathong , Pritaporn Kingkaew , Yot Teerawattananon","doi":"10.1016/j.hlpt.2024.100927","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>There has been lots of debate regarding an appropriate value of cost-effectiveness threshold (CET). To our knowledge, Thailand is the only country which has explicit CET and has increased the CET. Therefore, Thailand is in a unique position to help answer the question of what happened when CET was increased. The study objectives were to explore the impact of increasing CET on the submitted medicine price by industry and the decision to be included in the National List of Essential Medicine in Thailand.</div></div><div><h3>Methods</h3><div>Retrospective secondary data analyses were conducted using data from economic evaluation reports being reviewed by the National Drug Subcommittee. In total, 55 reports were included in the analysis, which represented 295 observations as each report could have more than one medicine for different indication and/or target population. The intervention of interest was the change in CET policy from 100,000 THB/QALY in 2008 to 120,000 THB/QALY in 2010 to 160,000 THB/QALY in 2013.</div></div><div><h3>Results</h3><div>There is no evidence suggesting the increase in CET affected the submitted medicine prices (price change=19%, p-value=0.457) or increased the likelihood of a positive reimbursement decision (OR=1.596, p-value=0.532). There were other factors which may influence medicine prices and reimbursement decision.</div></div><div><h3>Conclusions</h3><div>The change in the CET did not significantly affect health resource allocation. The findings do not support whether the current CET value in Thailand should be increased. Future research should continue to monitor the submission and re-analyse the current work as more data become available using both quantitative and qualitative approaches.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"13 6","pages":"Article 100927"},"PeriodicalIF":3.4000,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Health Policy and Technology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S221188372400090X","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEALTH POLICY & SERVICES","Score":null,"Total":0}
引用次数: 0
Abstract
Background
There has been lots of debate regarding an appropriate value of cost-effectiveness threshold (CET). To our knowledge, Thailand is the only country which has explicit CET and has increased the CET. Therefore, Thailand is in a unique position to help answer the question of what happened when CET was increased. The study objectives were to explore the impact of increasing CET on the submitted medicine price by industry and the decision to be included in the National List of Essential Medicine in Thailand.
Methods
Retrospective secondary data analyses were conducted using data from economic evaluation reports being reviewed by the National Drug Subcommittee. In total, 55 reports were included in the analysis, which represented 295 observations as each report could have more than one medicine for different indication and/or target population. The intervention of interest was the change in CET policy from 100,000 THB/QALY in 2008 to 120,000 THB/QALY in 2010 to 160,000 THB/QALY in 2013.
Results
There is no evidence suggesting the increase in CET affected the submitted medicine prices (price change=19%, p-value=0.457) or increased the likelihood of a positive reimbursement decision (OR=1.596, p-value=0.532). There were other factors which may influence medicine prices and reimbursement decision.
Conclusions
The change in the CET did not significantly affect health resource allocation. The findings do not support whether the current CET value in Thailand should be increased. Future research should continue to monitor the submission and re-analyse the current work as more data become available using both quantitative and qualitative approaches.
背景关于成本效益阈值(CET)的适当值,一直存在很多争论。据我们所知,泰国是唯一一个明确规定了 CET 并提高了 CET 的国家。因此,泰国处于一个独特的位置,有助于回答提高 CET 后会发生什么的问题。研究目标是探讨提高 CET 对行业提交的药品价格以及决定是否列入泰国《国家基本药物目录》的影响。研究方法利用国家药品小组委员会正在审查的经济评估报告中的数据进行了回顾性二手数据分析。共有 55 份报告被纳入分析,代表了 295 项观察结果,因为每份报告都可能包含一种以上针对不同适应症和/或目标人群的药品。结果没有证据表明 CET 的增加影响了提交的药品价格(价格变化=19%,P 值=0.457)或增加了做出积极报销决定的可能性(OR=1.596,P 值=0.532)。还有其他一些因素可能会影响药品价格和报销决定。研究结果并不支持是否应提高泰国目前的 CET 值。今后的研究应继续监测提交的数据,并在获得更多数据后采用定量和定性方法对当前工作进行重新分析。
期刊介绍:
Health Policy and Technology (HPT), is the official journal of the Fellowship of Postgraduate Medicine (FPM), a cross-disciplinary journal, which focuses on past, present and future health policy and the role of technology in clinical and non-clinical national and international health environments.
HPT provides a further excellent way for the FPM to continue to make important national and international contributions to development of policy and practice within medicine and related disciplines. The aim of HPT is to publish relevant, timely and accessible articles and commentaries to support policy-makers, health professionals, health technology providers, patient groups and academia interested in health policy and technology.
Topics covered by HPT will include:
- Health technology, including drug discovery, diagnostics, medicines, devices, therapeutic delivery and eHealth systems
- Cross-national comparisons on health policy using evidence-based approaches
- National studies on health policy to determine the outcomes of technology-driven initiatives
- Cross-border eHealth including health tourism
- The digital divide in mobility, access and affordability of healthcare
- Health technology assessment (HTA) methods and tools for evaluating the effectiveness of clinical and non-clinical health technologies
- Health and eHealth indicators and benchmarks (measure/metrics) for understanding the adoption and diffusion of health technologies
- Health and eHealth models and frameworks to support policy-makers and other stakeholders in decision-making
- Stakeholder engagement with health technologies (clinical and patient/citizen buy-in)
- Regulation and health economics