Health technology assessment (HTA) has been growing in use over the past 40 years, especially in its impact on decisions regarding the reimbursement, adoption, and use of new drugs, devices, and procedures. In countries or jurisdictions with "pluralistic" healthcare systems, there are multiple payers or sectors, each of which could potentially benefit from HTA. Nevertheless, a single HTA, conducted centrally, may not meet the needs of these different actors, who may have different budgets, current standards of care, populations to serve, or decision-making processes. This article reports on the research conducted by an ISPOR Health Technology Assessment Council Working Group established to examine the specific challenges of conducting and using HTA in countries with pluralistic healthcare systems. The Group used its own knowledge and expertise, supplemented by a narrative literature review and survey of US payers, to identify existing challenges and any initiatives taken to address them. We recommend that countries with pluralistic healthcare systems establish a national focus for HTA, develop a uniform set of HTA methods guidelines, ensure that HTAs are produced in a timely fashion, facilitate the use of HTA in the local setting, and develop a framework to encourage transparency in HTA. These efforts can be enhanced by the development of good practice guidance from ISPOR or similar groups and increased training to facilitate local use of HTA.
Objectives
Economic evaluations of BIAsp have been published in the context of different countries. This study aimed to evaluate the financial impact from a perspective of patients treated by public providers of different adoption rates of Biphasic Insulin Aspart (BIAsp; NovoMix 30 FlexPen®) versus Biphasic Human Insulin (BHI; Mixtard Penfill®) in treating T2DM.
Methods
An Excel based 5-year budget impact model was built to estimate insulin treated patients by public providers using the local prevalence data. The published demographic, efficacy and adverse event data for ASEAN subgroup analyses of A1chieve study was applied. Both insulin acquisition costs and medical costs for major hypoglycaemia and other complications were applied with a 3% discount rate to the estimated corresponding incidence rates derived from the UKPDS equations. The projected adoption rates were based on the 2013 utilisation volume data. Other local specific considerations e.g. subsidized selling prices and co-payments were included in the analyses for an assumed size of eligible patients. Sensitivity analyses were conducted.
Results
The adoption rates of BIAsp were assumed to increase from 23.6% in 2013 to 30% or 36.5% in 2018 for base case and upside scenario, respectively. In comparison to base case scenario, increases in adoption rate of BIAsp were associated with a cumulative increase up to slightly greater than S$ 2.02M in insulin acquisition cost but a potential cumulative net saving up to approximately S$0.92M in overall total costs over 5 years, attributing to subsidized selling price of BIAsp assuming it is included standard drug list and its significantly lower major hypoglycaemia risk, respectively. Cost savings were predicted for other complications.
Conclusions
The wider adoption of BIAsp was predicted to result in net cost savings from patient perspective in Singapore. More cost saving would be estimated in analyses with reduced productivity loss from a societal perspective.
Objectives
Budget impact analysis (BIA) is a useful tool for reimbursement decision-makers in health technology assessments by authorities across different countries. This study aimed to evaluate the financial impact from the Ministry of Health (MOH) perspective of different adoption rates of Biphasic Insulin Aspart (BIAsp) versus Biphasic Human Insulin (BHI) in treating type 2 diabetes mellitus.
Methods
An Excel basfed 5-year budget impact model was built to estimate insulin treated patients by public providers using local prevalence data. The published demographic, efficacy and adverse event data for ASEAN subgroup analyses of A1chieve study was applied. Both insulin acquisition costs and other medical costs for complications e.g. major hypoglycaemia, myocardial infarction, stroke, end-stage renal disease, blindness and amputation were included at a discount rate of 3%. The incidence rates of these complications were derived from the established UKPDS equations. The adoption rates were assumed and projected from the 2013 utilisation volume data of BIAsp and BHI by public providers. Sensitivity analyses were conducted.
Results
The adoption rates of BIAsp were assumed to increase from 1.8% in 2013 to 4.5% or 6.9% in 2018 for base case and upside scenario, respectively. Compared to the base case, upside scenario of wider BIAsp adoption was associated with an increased insulin cost up to RM 8.2M which was offset by avoided complication costs resulting in an overall net budget saving of approximately RM 5.5M over 5 years, primarily driven by estimated reduction in major hypoglycaemia events for patients treated with BIAsp.
Conclusions
The higher and wider adoption of BIAsp would likely be associated with cost savings in Malaysia from the MOH perspective attributed to its superiority in H1Ac reduction and lower major hypoglycemia risk in comparison to BHI. More cost saving would be concluded if productivity loss is included from a societal perspective.
Conference abstract:
Objectives: To evaluate physician’s knowledge and adherence to asthma guideline adherence (GINA 2011) at emergency department of Hospital Pulau Pinang, Malaysia and to calculate cost of adhered and non-adhered prescriptions
Methods: A cross-sectional survey was conducted to evaluate knowledge of GINA, 2011 asthma guideline at emergency department of Hospital Pulau Pinang, Malaysia. A total of 810 patient prescriptions of 27 doctors (30 prescriptions per doctor) were viewed to asses doctor’s guideline adherence. Patients’ prescriptions were categorised in terms of asthma severity as mild, moderate and severe. Prescriptions were labelled as adhered or non-adhered in terms of doctor treatment according to patient asthma severity as recommended by CPG (GINA 2011). Cost of adhered and non-adhered was calculated according to asthma severity.
Results: Twenty two (81.5%) doctor’s had adequate GINA, 2011 asthma guideline knowledge (Mean 16.7, SD ± 1.5). Six hundred and twenty eight (77.5%) patients received guideline (GINA 2011) adhered pharmacotherapy. Six hundred and seventy eight (83.7%) patients asthma were classified as mild asthma, 128 (15.8%) patients were classified as moderate asthma and 4 (0.5%) patients were classified as severe asthma. Pearson correlation indicated no statistical significant association between asthma guideline adherence and asthma guideline knowledge score (p=0.27). Univariate analysis indicate that patients with age group 25-35 years and with hypertension as co-morbidity received significantly better pharmacotherapy (p=0.04, p=0.03 respectively). Total cost of 628 adhered prescriptions was RM 5792.87 whereas cost of 182 non-adhered prescriptions was RM 1759.09. Cost of single mild asthma adhered prescription (RM 9.18) was less as compared to non adhered mild asthma prescription (RM 10.39).
Conclusions: Emergency doctor’s had adequate GINA, 2011 asthma guideline knowledge. Majority of patients received GINA, 2011 asthma guideline adhered pharmacotherapy. Cost effective medication can significantly reduce socioeconomic burden related to asthma.
Objectives: Diabetes mellitus is a serious health problem. Medication adherence is a key determinant of therapeutic success in patients with diabetes mellitus. The purpose of this study was to assess medication adherence and its potential association with diabetes related knowledge in patients with type 2 diabetes mellitus.
Methods: This study was carried out at the outpatient clinics of a public sector teaching hospital in Sargodha, Pakistan. Besides demographic and disease-related questions, previously validated questionnaires, Morisky Medication Adherence Scale and Michigan diabetes knowledge test was used to assess the medication adherence and diabetes related knowledge, respectively. Descriptive statistics were used to determine the demographic and disease characteristics of the patients while Spearman rank correlation was employed to measure the association between medication adherence and knowledge.
Results: Three hundred and ninety two patients were interviewed. Out of 392 patients, 245 (62.5%) of the patients had average knowledge about diabetes while 282 (71.9 %) were categorized as poor adherent. Only 13 patients (3.3 %) were considered as good adherent in the study. The correlation coefficient between total scores of knowledge and total medication adherence score was 0.036 (p< 0.05), indicating a weak correlation between knowledge scores and adherence level.
Conclusions: Knowledge of diabetes mellitus among these patients was average; however, adherence to drug therapy was also poor. Patients’ knowledge about diabetes had positive association with medication adherence. Improving diabetes knowledge of people can result in better adherence, which may result in better control of diabetes.
Objectives: Medication adherence to treatment recommendations has major impact on health outcomes. Numerous interventions to improve medication adherence among the patients have been studied in clinical trials, including calendar packaging and patient reminder letters. Therefore, this study is aimed to explore hypertensive patient’s perceptions towards calendar packaging and its impact on medication adherence.
Methods: A qualitative method was adopted, whereby two focus group sessions were conducted among 16 conveniently sampled hypertensive patients from a community based non-governmental organisation in the state of Penang, Malaysia. A pre validated focus group guide was constructed and used for data collection. Collected data was transcribed verbatim and analysed by thematic content analysis to identify the emerging themes.
Results: Each focus group consisted of 8 hypertensive patients. Thematic content analysis resulted into 3 major themes (knowledge and familiarity with the medicines names and their packaging; perception about the packaging and labelling of medicines; knowledge and views of calendar packaging) and each theme was further divided into 2 sub themes. Majority of the hypertensive patients were not familiar with their medication names, however they were able to identify their medications based on the appearance and packaging. Participants agreed that calendar packaging is a great intervention to increase awareness among patients about regular medicine use and increase medication adherence.
Conclusions: The study concluded that hypertensive patients relied on the packaging and labelling on the medications to identify their medications. Thus, packaging and labelling of the medications play an important role in improving medication adherence and reduce medication errors. This finding can help to enhance the drug manufacturers to pay attention on the drug packaging in order to increase medication adherence among the patients.
Objectives: Systematic anticoagulation management clinic is now recommended to manage warfarinized atrial fibrillation (AF) patient. In Malaysia, the service is recently introduced as pharmacist managed Warfarin Medication Therapy Adherence Clinic (WMTAC). The objective of the present study was to assess the cost effectiveness of anticoagulation clinic in comparison with usual medical in Kuala Lumpur Hospital.
Methods: A Markov model built using the provider perspective and 20 year time horizon was used to assess the cost effectiveness. The base case analysis assumed a cohort of patients with AF 57 years of age with comorbid illnesses. Data sources include a 6 month retrospective cohort analysis of the effectiveness of the clinics, the cost of drugs, cost of personnel and space of the clinics, cost of monitoring and cost of adverse events were obtained from the local source and publications. The transition probabilities of these clinics outcomes were obtained from a literature search. Future costs were discounted by 3% to convert to present values. All costs were in Ringgit Malaysia (RM) based on year 2012.
Results: The results of a 20-year period model showed that UMC was dominated by the WMTAC in the same time period. The mean cost of the WMTAC was RM 5864 whereas the UMC cost was RM 6550. The sensitivity analysis showed that clinic treatment costs and effectiveness influenced the cost-effectiveness. If the cost of WMTAC was increased by 50% of the current cost, the WMTAC would not be a dominant intervention. WMTAC was also cost effective for a willingness to pay of RM32000.
Conclusions: The anticoagulation management service appears to cost less and provide greater effectiveness than usual care. In conclusion, the Markov model suggests that from the provider perspective the anticoagulation clinic is a more cost effective option than the usual medical clinic in Kuala Lumpur Hospital.
Study site: Medication Therapy Adherence Clinic, Hospital Kuala Lumpur, Malaysia