Four years of early benefit assessment of new drugs in Germany: a qualitative study on methodological requirements for quality of life data

Christine Blome (), Matthias Augustin, Hidayet Metin and David Lohrberg
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Christine Blome: University Medical Center Hamburg-Eppendorf
Matthias Augustin: University Medical Center Hamburg-Eppendorf
Hidayet Metin: Janssen-Cilag GmbH
David Lohrberg: University Medical Center Hamburg-Eppendorf

The European Journal of Health Economics, 2017, vol. 18, issue 2, No 5, 193 pages

Abstract: Abstract Background Since 2011, an early benefit assessment (EBA) of new drugs constricts free price setting in Germany. According to the Pharmaceutical Market Restructuring Act (AMNOG), pharmaceutical companies are obliged to demonstrate added benefit of new drugs over comparative treatment. Benefit is usually evaluated by the Institute for Quality and Efficiency in Health Care (IQWiG). The final appraisal is made by the Federal Joint Committee, Germany’s highest-ranking decision body in the health sector, triggering drug prize negotiations between companies and statutory health insurance funds. One of four evaluation criteria is quality of life (QoL). QoL outcomes have, however, only rarely been pivotal in EBAs. Objective This study determined methodological requirements for QoL measurement and data presentation in the EBA. Design In a qualitative content analysis, documents of all EBAs completed by 2014 were searched for the term QoL. Relevant passages of all EBAs of 2011–2013 were independently extracted and reduced to key content by two researchers. Recurring patterns were identified and verified through comparison with EBAs of 2014. Results We identified a range of requirements regarding QoL assessment, analysis, presentation, and interpretation, which go beyond official regulations. Disease-specific questionnaires are preferred and have to be validated according to certain standards and in the respective patient group. Effects must exceed the minimal important difference, which in turn must be validated in compliance with specific requirements. Often, instruments were not accepted as QoL measures, sometimes inconsistently across EBAs. Another frequent reason for non-acceptance of QoL data was that more than 30 % of randomized patients could not be analyzed due to missing data. Conclusions Non-compliance with methodological requirements for QoL evidence impairs chances for positive benefit evaluation.

Keywords: AMNOG; Quality of life; Qualitative research; Health technology assessment; Early benefit assessment; Comparative effectiveness research (search for similar items in EconPapers)
JEL-codes: I18 (search for similar items in EconPapers)
Date: 2017
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DOI: 10.1007/s10198-016-0765-6

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