Conditional reimbursement context: An economic evaluation including a risk-sharing scheme
A hybrid-modeling study that evaluated the clinical outcomes, cost-effectiveness, and budget impact of biologic rheumatoid arthritis drugs as a treatment mix and individually for biologic-naïve patients in Finland has been recently published. The assessment includes also certolizumab pegol with and without a hypothetical efficacy-based risk-sharing scheme applied at the treatment initiation.
The study publication “Modeled Health Economic Impact of a Hypothetical Certolizumab Pegol Risk-Sharing Scheme for Patients with Moderate-to-Severe Rheumatoid Arthritis in Finland” is open access. The study reported that surplus provided by the risk-sharing scheme could fund treatment for 6% more Finnish rheumatoid arthritis patients. Furthermore, clinical effectiveness, quality-adjusted life years and working days would be gained with the risk-sharing scheme.
Based on the rapid literature review, this study was the first formal assessment of risk-sharing in Finland. The work was started as early as year 2010 and it has been presented in several congresses and other events and meetings, says ESiOR’s CEO Erkki Soini.
Wider context: since January 2017, the Finnish Pharmaceuticals Pricing Board (FPPB) has considered risk-sharing scheme proposed as part of new reimbursement applications on a drug-by-drug basis. The general framework there is an agreement-based and confidential conditional reimbursement that needs to be separately applied from the FPPB. All new reimbursement applications are not accepted to the agreeing process.
Health economic evaluations and outcomes research are expected to have a more important role in the not-too-distant future, because the risk-sharing possibility is available in open care and hospital access, interest of current care working groups in health economic issues, and the planned launch of Isaacus, a Finnish data operator that is expected to provide nationally representative well-being data from different information sources and registers on a one-stop-shop basis.