BLOG SERIES 1/4: Associate Network Event - Reimbursement and Market Access (ENG)

During a networking event on 8 November 2017, hict’s HEMAR-team (Health Economics, Market Access and Reimbursement) organized a short brainstorm session around the newest trends and developments in health economics, from the perspective of the Belgian price and reimbursement dossiers.

Participants of this brainstorm session:

  • Dr. Karen Pien, medical information manager, specialist in management of health data and ICD expert FPS Health (FOD Gezondheid);
  • Dr. Peter Vander Eeckt, medical director Boehringer Ingelheim;
  • Katelijne Butaye, Market Access Consultant;
  • The hict HEMAR-team, represented by Ann Tanghe, Sebastian Vermeersch and Lieve Staessens.

The classic approach of applying for reimbursement is under ever-rising pressure

The number of innovative therapies that are made available is on the rise. It is getting more challenging to keep the balance between the available budgets and assuring access to promising, but sometimes expensive, new therapies. In practice, we see that managed entry agreements are becoming the new golden standard, while the health economic analyses at the base of each reimbursement case are losing importance. In particular, the cost-effectiveness analysis is under pressure. The importance of the size of the short-term budgetary impact outweighs the value of the inherently more technical and complex cost-effectiveness model, which mainly focusses on the broader, long-term impact.

This shift introduces some risks. The combination of cost-effectiveness analysis and budget impact analysis allows evaluators to weigh ‘value’ and ‘value for money’ objectively against the medical need and context. A cost-effectiveness analysis is often the only tool that allows evaluation of long-term effects and effects in a broader context than only the impact on pharmaceutical budgets. Even though managed entry agreements appear to be successful in assuring access to innovative therapies at an acceptable cost, they also reduce transparency and raise the risk of subjectivity. The long-term effects of this Belgian approach are not yet clear.

A plea for the preservation of existing tools and for additional support and the development of a formal framework

To counter this rising trend, we plea for additional support for the objective framework based on the balanced combination of the budget impact and the cost-effectiveness analyses. Quantifying ‘value’ outside the pharmaceutical budget, using mechanisms to handle uncertainties, and further development of the formal evaluation framework that allows these additional aspects to be integrated, offers a more objective, transparent and durable platform which can be used to base and evaluate managed entry agreements on.

By building on the strengths of the current system – the combination of assessment and appraisal and the use of managed entry agreements – with additional attention for more transparency and based on improved availability of basic data, a clear framework can be created, for both the evaluators and the innovative enterprises. Evaluators can base and motivate their decisions on the basis of an integrated and objective platform. Innovative enterprises have a clearer, more thorough integration of ‘value’, ‘value for money’ and ‘cost’ as a basis for a more objective evaluation of the value of the innovation. The approach also offers a solid base for international integration, and might be a good step towards translating the principal BENELUXA cooperation to a practical implementation.

Three challenges for a durable future

  • The development of an integrative price and reimbursement approach founded on a lifecycle management approach

Creative thinking to deal with the ever-present challenge of maximal utilization of limited budgets for qualitative, effective and efficient care, demands …

…an integrative drug policy.

… a policy that starts with a thorough, objective and broad evaluation of ‘value’, ‘value for money’ and ‘cost’, based on extensive health economic analyses.

… a policy that is open to innovative forms of managed entry agreements to enable innovation.

… a policy that is ready and able to evaluate the full therapy range on a regular basis, allowing innovation to be continuously  stimulated and financed.

  •  Data-based substantiation of each step

To allow such a policy to succeed, significant investments should be made in the transparent registration, processing and availability of basic information, which is needed to steer the policy. One example would be to make the national cost database accessible for everyone (on the ICD-level, not just the APR-DRG level), so health economic evaluations can simulate the reality as closely as possible. Granting access to the same basic information to all stakeholders avoids focusing the discussion on the inputs used for the analysis , allowing the discussion to focus on the more essential issues of cost impact and cost effectiveness. Additional effort should be directed to evidence-based research on the impact and results of for instance ‘pay for performance’ managed entry agreements, and the development of a platform for real-world data collection with respect for privacy, limited additional workload for registration and facilitation of cooperation and data exchange. 

  •  Multi-stakeholder cooperation as the engine of policy  

Healthcare is pre-eminently a multi-stakeholder domain. The design and implementation of a future-oriented policy should reflect this. Innovation is too often confronted with a debilitating fragmentation. The design and implementation of a future oriented health policy demands a joint effort and joint participation on all levels, and with all stakeholders. As a first step, investments could be made in neutral consultation bodies where stakeholders can exchange ideas.

 hict as a constructive partner

As innovative and engaged knowledge association, driven by optimization of the healthcare sector with a passion for building bridges between stakeholders, we are continuously searching for new projects that allow us to be architect-builders of the care of the future. We aver this vision as a team on a daily basis by designing, implementing and giving life to projects of today as a basis for better healthcare tomorrow.

Together with our broad network of associated consultants, we are eager to translate your healthcare questions and problems to concrete results. More information about hict, our team and our projects can be found on

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