Effectiveness and Cost Help to Make Coverage Decisions

Study suggests countries that use these two criteria can also incorporate other factors
By Jane Parry
HealthDay Reporter

TUESDAY, Oct. 6 (HealthDay News) -- Countries using evidence-based cost-effectiveness and effectiveness to help make drug coverage decisions show how these factors can successfully support decision making and can also be adapted to the specific conditions of other countries, according to a study in the Oct. 7 issue of the Journal of the American Medical Association.

Fiona M. Clement, Ph.D., of the University of Calgary in Canada, and colleagues analyzed data from the Common Drug Review of Canada, the National Institute for Health and Clinical Excellence in the United Kingdom, and Australia's Pharmaceutical Benefits Advisory Committee to identify common ground in evidence-based coverage.

The researchers found that, of the 199 submissions to the U.K. regulatory body, 174 (87.4 percent) were recommended, compared to 60 out of 121 (49.6 percent) in Canada and 153 out of 282 (54.3 percent) in Australia, with all three sharing the same issue with uncertainty about clinical effectiveness due to poor studies. Although all three agencies consider evidence of effectiveness and cost-effectiveness, other issues, such as their attitude to "me-too" drugs and pricing, affect their decision making.

"Perhaps the main lesson from the experience of the three countries is that systematic, durable, and widely accepted decisions can be made using comparative effectiveness and cost-effectiveness, although it is evident that other information beyond these two criteria can be incorporated into decision making," the authors write.

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