Accuracy of budget impact estimations and impact on patient access: a hepatitis C case study

Joost W. Geenen, Cornelis Boersma, Olaf H. Klungel () and Anke M. Hövels
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Joost W. Geenen: Utrecht University
Cornelis Boersma: University of Groningen, University Medical Center Groningen
Olaf H. Klungel: Utrecht University
Anke M. Hövels: Utrecht University

The European Journal of Health Economics, 2019, vol. 20, issue 6, No 7, 857-867

Abstract: Abstract Background High budget impact (BI) estimates of new drugs limit access to patients due to concerns regarding affordability and displacement effects. The accuracy and methodological quality of BI analyses are often low, potentially mis-informing reimbursement decision making. Using hepatitis C as a case study, we aim to quantify the accuracy of the BI predictions used in Dutch reimbursement decision-making and to characterize the influence of market-dynamics on actual BI. Methods We selected hepatitis C direct-acting antivirals (DAAs) that were introduced in the Netherlands between January 2014 and March 2018. Dutch National Health Care Institute (ZIN) BI estimates were derived from the reimbursement dossiers. Actual Dutch BI data were provided by FarmInform. BI prediction accuracy was assessed by comparing the ZIN BI estimates with the actual BI data. Results Actual BI, from 1 Jan 2014 to 1 March 2018, was €248 million whilst the BI estimates ranged from €388–€510 million. The latter figure represents the estimated BI for the reimbursement scenario that was adopted, implying a €275 million overestimation. Absent incorporation of timing of regulatory decisions and inadequate correction for the introduction of new products were main drivers of BI overestimation, as well as uncertainty regarding the patient population size and the impact of the final reimbursement decision. Discussion BI in reimbursement dossiers largely overestimated actual BI of hepatitis C DAAs. When BI analysis is performed according to existing guidelines, the resulting more accurate BI estimates may lead to better informed reimbursement decisions.

Keywords: Hepatitis C; Budget impact; Budget impact accuracy; Direct-acting antivirals; Affordability; Pharmaceuticals (search for similar items in EconPapers)
JEL-codes: H51 I18 (search for similar items in EconPapers)
Date: 2019
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Citations: View citations in EconPapers (1)

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DOI: 10.1007/s10198-019-01048-z

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