Internationally health economic evaluations are a fixed component of reimbursement decisions

Special ZEFQ issue: impact on decision-making processes and health care – a comparison of seven countries

Internationally health economic evaluations (HEEs) form a legally regulated fixed component in health-care decisions. This applies particularly to the drug sector. While HEEs are never directly implemented on a 1:1 basis in reimbursement regulations, they create transparency for all stakeholders in the system. These are some of the results presented in the journal issue, which was guest-edited by the German Institute for Quality and Efficiency in Health Care (IQWiG) and compiled contributions on the experience with HEE in seven countries.

Choice of countries allows for a multidimensional comparison

The editors selected a broad range of countries for this special issue of the German Journal for Evidence and Quality in Health Care (ZEFQ): Australia is the country with the longest experience and tradition in HEE; England and the Netherlands have internationally renowned research in HEE. Whereas health care in Germany and the Netherlands is contribution- and premium-funded and therefore corresponds to the Bismarck system, England, Australia and Sweden represent the tax-funded Beveridge system. A view on Brazil and Thailand allows for a comparison between (western) industrialized countries and emerging countries.

Focus on processes and effects, not on methods

The leading questions the authors from the respective countries were asked by the editors dealt less with the health economic methods used. The focus was rather on the question whether what is legally valid also has an effect on decision-making processes and thus on the actual health care.

All countries focus on drugs

One thing all countries have in common is that the focus of the HEE is clearly on drugs. With the exception of Germany, HEEs are a fixed component in decisions on regular reimbursement or the setting of reimbursement prices.

However, the effects of HEE differ considerably: In Australia a non-cost-effective drug is usually not included in the national formulary, whereas in the Netherlands almost no drug has ever been excluded from reimbursement, no matter how unfavourable the result of the HEE.

No mandatory exclusion of services following HEE

In Germany in particular it is often feared that an explicit threshold value will lead to a situation where necessary services could or even must be withheld from patients. However, a view on England and Thailand, where such threshold values exist, shows that this fear is unfounded: Even if the threshold value is exceeded in England, patients usually still receive access to the services via special budgets. In Thailand, the threshold values are also not implemented on a 1:1 basis.

In Germany, HEEs play practically no role in decisions on reimbursement. However, there are ongoing calls for HEEs, which do not subside in view of scarce financial resources. “We hope that this publication will broaden the national horizon and contribute to the debate on HEE in Germany”, says Andreas Gerber-Grote, Head of the Health Economics Department at IQWiG.

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