Coverage and Pricing Recommendations of the French National Health Authority for Innovative Drugs: A Retrospective Analysis From 2014 to 2020

Pauline Kergall, Erwan Autin, Marlène Guillon and Valérie Clément
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Pauline Kergall: MRE - Montpellier Recherche en Economie - UM - Université de Montpellier
Erwan Autin: HAS - French National Health Authority
Marlène Guillon: MRE - Montpellier Recherche en Economie - UM - Université de Montpellier
Valérie Clément: MRE - Montpellier Recherche en Economie - UM - Université de Montpellier

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Abstract: This study provides a retrospective analysis of the recommendations of the French National Health Authority on the reimbursement and pricing of innovative drugs. Methods: The analysis includes drugs subjected to both economic and clinical evaluations in France from 2014 to 2020. Ordered logistic and quantile regressions are used to estimate the factors associated with the clinical value (SMR), the clinical added value (ASMR), and the incremental cost-utility ratio (ICUR) of innovative drugs. All variables used in the regression analyses are extracted from the Clinical and Economic Opinions for the 146 observations. Results: Regression analyses indicate that 2 of the 5 official criteria, the efficacy-adverse events balance of the drug and its function, are significantly associated with the SMR rating. The ASMR is positively associated with the disease severity, the quality-adjusted life-year (QALY) gain provided by the drug, and the validation of the ICUR in the Economic Opinion. At the first quartile of the ICUR distribution (approximately V50 000/QALY), higher ICUR levels are observed for drugs with a smaller target population and for drugs claimed as more innovative. Higher ICUR levels are also observed for pediatric drugs and for drugs with no therapeutic alternative at the third quartile of the distribution (approximately V240 000/QALY). Conclusions: Not all official criteria of the SMR are associated with actual ratings obtained. Regarding the ASMR, the results support the idea of a convergence between the 2 independent clinical and economic appraisal processes. Finally, the factors influencing the ICUR level vary across the distribution of ICUR.

Keywords: clinical added value; clinical benefit; drug pricing; economic evaluation; France; health technology assessment; incremental cost-utility ratio; reimbursement (search for similar items in EconPapers)
Date: 2021
Note: View the original document on HAL open archive server: https://hal.umontpellier.fr/hal-03515591v1
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Published in Value in Health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2021, 24 (12), pp.1784-1791. ⟨10.1016/j.jval.2021.06.013⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-03515591

DOI: 10.1016/j.jval.2021.06.013

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