Cerri, Karin H.
(2011)
Evidence, process or context? Examining the factors that
drive coverage decisions of pharmaceuticals by health
technology assessment bodies in Europe.
PhD thesis, London School of Economics and Political Science.
Abstract
In Europe, Health Technology Assessment (HTA) bodies produce coverage decisions
that guide public funding of pharmaceuticals. This thesis examines and weights those
factors that drive HTA coverage decisions, focusing on the National Institute for Health
and Clinical Excellence (NICE) in England and Wales, the Scottish Medicines
Consortium (SMC), the Dutch College voor Zorgverzekeringen (CVZ), and the French
Haute Autorité de Sante (HAS). To address the research question, a dataset of
approximately 1000 HTA coverage decisions by NICE, SMC, CVZ and HAS from the
period 2004-2009 was created, containing more than 30 clinical, economic, process and
socio-economic factors extracted from published HTA reports. A three-category
outcome variable was used, defined as the decision to ‘recommend’, ‘restrict’ or ‘not
recommend’ a technology. Multivariate analyses were conducted to assess the relative
contribution of the explanatory variables on coverage decisions both within and
between HTA bodies.
Results demonstrate that different combinations of clinical/economic evidence, process
and socio-economic factors drive HTA coverage decisions by NICE, SMC, CVZ and
HAS. In addition, the same factor may behave differently according to the nature of the
coverage decision. The analysis further suggests there is a significant difference
between HTA bodies in the probability of reaching a ‘restrict’ or ‘not recommend’
decision outcome relative to a ‘recommend’ outcome, adjusted for evidence, process
and context factors. This thesis contributes to the understanding of factors driving
HTA coverage decisions by examining multiple European HTA bodies, enhancing the
comprehensiveness of the factors examined through descriptive and multivariate
analyses and by identifying and weighting the key drivers of the coverage decisions
made by the four HTA bodies between 2004 and 2009. This research further provides
relevant insights to variation among HTA bodies in the determination of patient access
to pharmaceuticals, and implications for collaboration between European HTA bodies.
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