Pricing and reimbursement frameworks in Central Eastern Europe: a decision tool to support choices

Abstract

Aim: Given limited financial resources in the Central Eastern European (CEE) region, challenges in obtaining access to innovative medical technologies are formidable. The objective of this research was to develop a decision tree that supports decision makers and drug manufacturers from CEE region in their search for optimal innovative pricing and reimbursement scheme (IPRSs). Methods: A systematic literature review was performed to search for published IPRSs, and then ten experts from the CEE region were interviewed to ascertain their opinions on these schemes. Results: In total, 33 articles representing 46 unique IPRSs were analyzed. Based on our literature review and subsequent expert input, key decision nodes and branches of the decision tree were developed. Conclusion: The results indicate that outcome-based schemes are better suited to deal with uncertainties surrounding cost effectiveness, while non-outcome-based schemes are more appropriate for pricing and budget impact challenges.

Keywords:

• budget impact
• Central Eastern European region
• cost effectiveness
• innovative pricing and reimbursement schemes

Acknowledgements

The authors would like to thank the following experts for sharing their valuable experience about Pricing & Reimbursement schemes in CEE settings in their interviews with K Kolasa conducted in May 2014: M Kos (Slovenia), T Dominik (Slovakia), K Landa (Poland), D Danko (Hungary), V Zah (Serbia and CEE), J Zahalka (Czech Rep), M Niewada (Poland), M Psenkova (Slovakia), T Dolezal (Czech Rep) and J Skoupa (Czech Rep).

Disclaimer

The views presented in the manuscript are entirely of the authors not the institutions they represent.

Financial & competing interests disclosure

No financial contribution has been received for this study. K Kolasa has been employed by Astra Zeneca, Bristol Myeres Squibb, Biogen Idec and Lundbeck for Market Access roles in CEE settings. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• In order to promote the rights of patients to access new therapies, it is necessary for manufacturers and payers to reach a consensus regarding the way in which pricing and reimbursement schemes are developed and implemented.

• This is the first study to systematically investigate the applicability of innovative pricing and reimbursement schemes to the Central Eastern European region and the first attempt to develop a decision tree that takes manufacturers’ perspectives into account.

• The research indicates that cost–effectiveness issues are best addressed using outcome-based schemes. Uncertainty regarding cost–effectiveness is regarded as a high risk for negative reimbursement decision.

• If cost–effectiveness and budget impact pose a simultaneous challenge, conditional coverage schemes were deemed as attractive as non-outcome-based schemes such as price–volume agreements.

• When cost–effectiveness results do not pose a significant issue or were not taken into consideration in innovative pricing and reimbursement schemes decision making but where budget impact concerns remained, non-outcome-based schemes such as price–volume agreements received the most attention.

Notes