Generating comparative evidence on new drugs and devices before approval

Huseyin Naci, Maximilian Salcher-Konrad, Aaron Kesselheim, Beate Wieseler, Lise Rochaix, Rita Redberg, Georgia Salanti, Emily Jackson, Sarah Garner, T Scott Stroup and Andrea Cipriani
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Huseyin Naci: LSE - London School of Economics and Political Science
Maximilian Salcher-Konrad: LSE - London School of Economics and Political Science
Aaron Kesselheim: HMS - Harvard Medical School [Boston]
Beate Wieseler: Institute for Quality and Efficiency in Health Care
Rita Redberg: UCLA - University of California [Los Angeles] - UC - University of California
Georgia Salanti: UNIBE - Universität Bern = University of Bern = Université de Berne
Emily Jackson: LSE - London School of Economics and Political Science
Sarah Garner: University of Manchester [Manchester]
T Scott Stroup: Columbia University [New York]
Andrea Cipriani: University of Oxford

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Abstract: Fewer than half of new drugs have data on their comparative benefits and harms against existing treatment options at the time of regulatory approval in Europe and the USA. Even when active-comparator trials exist, they might not produce meaningful data to inform decisions in clinical practice and health policy. The uncertainty associated with the paucity of well designed active-comparator trials has been compounded by legal and regulatory changes in Europe and the USA that have created a complex mix of expedited programmes aimed at facilitating faster access to new drugs. Comparative evidence generation is even sparser for medical devices. Some have argued that the current process for regulatory approval needs to generate more evidence that is useful for patients, clinicians, and payers in health-care systems. We propose a set of five key principles relevant to the European Medicines Agency, European medical device regulatory agencies, US Food and Drug Administration, as well as payers, that we believe will provide the necessary incentives for pharmaceutical and device companies to generate comparative data on drugs and devices and assure timely availability of evidence that is useful for decision making. First, labelling should routinely inform patients and clinicians whether comparative data exist on new products. Second, regulators should be more selective in their use of programmes that facilitate drug and device approvals on the basis of incomplete benefit and harm data. Third, regulators should encourage the conduct of randomised trials with active comparators. Fourth, regulators should use prospectively designed network meta-analyses based on existing and future randomised trials. Last, payers should use their policy levers and negotiating power to incentivise the generation of comparative evidence on new and existing drugs and devices, for example, by explicitly considering proven added benefit in pricing and payment decisions.

Date: 2020-03
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Published in The Lancet, 2020, 395 (10228), pp.986-997. ⟨10.1016/S0140-6736(19)33178-2⟩

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Working Paper: Generating comparative evidence on new drugs and devices before approval (2020)
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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:halshs-02875099

DOI: 10.1016/S0140-6736(19)33178-2

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