farmàcia hospitalària. oriol de solà-morales 20110416
DESCRIPTION
Presentació en el decurs de la II Trobada de Farmacèutics d'Hospital de Catalunya que es va celebrar a Món Sant Benet el 15 i 16 d'Abril de 2011.TRANSCRIPT
Agència d’Informació, Avaluació i Qualitat en Salut (AIAQS)
www.aatrm.net
Oriol Solà-Morales, HTA Director
II Trobada de Farmacèutics d’Hospital de CatalunyaSCFH- Sociietat Catalana de Farmàcia HospitalàriaMont St Benet, 16 d’Abril de 2011
Estratègies de Gestió per fer front a la crisi econòmica:
l’avaluació de fàrmacs
12.117.772.605 €
Interanual Gener 2011
Outline
• Algunes reflexions generals• Algunes propostes
algunes reflexions generals
Spain’s Healthcare System
• 17+2 Health Care Systems
• EU 15+12 Health Care Systems
Total Health Expenditure x capita (PPP)
- €
200 €
400 €
600 €
800 €
1.000 €
1.200 €
1.400 €
1.600 €
1.800 €
2.000 €
1960 1965 1970 1975 1980 1985 1990 1995 2000
Financial ‘crunch’: expenditure in public prescriptions
Financial ‘crunch’: % Change in public prescriptions
Preus de Referència
Partides de despesa
Partides de despesa
Effect of reforms
• Austalia (Pharma benefit adv Board): +14% anual
• Canada (Ontario): +10% anual (15% 2001)
Registry & Financing of drugs
Registry Price Financing
AEMPS Ministry Cabinet DoH / Insurer
FDA: Security & Efficacy
EMA: quality, safety & efficacy
CMS: Reasonable & NecessaryCatSalut: appropriate adjustment of supply to the health needs of citizensNHS UK: comprehensive range of services
CAIAQ: safety, effectiveness & efficiency
The impact of healthcare on health
McKeown, Determinants of health, 1978
Benefits of new treatments
Seruga, Annals Oncology 2010
Survival after Bone Marrow Graft
autologous heterologous
Which is the current paradigm?
Innovation
cost
?
What the industry wants(HTAi Policy Forum, June 2010)
• Regulation only linked to scientific considerations, not economical
• All eligible patients have access, without restrictions
• Early dialogue with HTA/payers to align expectations and reduce development uncertainty
• Reduce the development costs• Accept alternatives forms of evidence
What the industry wants(HTAi Policy Forum, June 2010)
• Regulation only linked to scientific considerations, not economical
• Eliminates equity and distributive justice
• All eligible patients have access, without restrictions• No budget limits considerations
• Early dialogue with HTA/payers to align expectations and reduce development uncertainty
• Will that affect price seemingly?
• Reduce the development costs• Introduces market imperfections
• Accept alternatives forms of evidence• Reduces security? Are there any compensations? Risk Sharing?
algunes propostes
oferta
Cost= Preu x Volum (C=P*Q)
Collaboration with the industry
Horizon Scanning
‘competence’ / renovation
Methodological evaluation / introduction
Rearrangement /‘Quality’ Evaluation
time
use
For who?
Registry Price Reimbursement
AEMPS Cabinet Insurer
Prescription Only
Non prescription / OTC
Pharmacies -----
PromoterInsurer / Manager/ Physician
MSyPS /AEMPS
Hospital Manager
Physician
Hospital
Pharmacies
Spain’s Healthcare System
Risk Sharing
• Qui el vol?• Qui paga?• Com es financia / qui el financia?• Com es distribueix el risc?
• Estm preparats?
demanda
• Formació continuada• Guíes farmacoterapèutiques• Guies de Pràctica Clínica
• Copagament
• Racionar:− Denial− Delusion− Defusion− Deterrance− Delay
• Arquitectura de decisions• Avaluació de Tecnologies
Arquitecura de decisions
Nudge (Thaler i Sundstein)
• Incentivar: conèixer qui utilitza, qui escull, qui paga i qui obté els beneficis d’una intervenció;
• Entendre els mapes mentals: transformar les variables de decisió complexes en variables assimilables pel decisor;
• Accions per defecte: determinar quines són les accions que es realitzaran quan hi hagi falta d’acció–decisió;
• Esperar l’error: determinar què es farà quan l’usuari no segueixi l’opció considerada prioritària perquè reavaluï si la seva decisió és coherent amb l’escenari o ha estat fruit d’un error;
• Estructurar decisions complexes: en cas de decisions en què intervinguin concurrentment múltiples variables, intentar presentar les possibilitats de decisió estructurades per grups categòrics de dificultat creixent.
HTA, Technologies and Choice
Rationalise PrioritiseEmpower
Rationalise PrioritiseEmpower
HTA, Technologies and Choice
1. Effective (efficacious)
2. Secure3. Efficient
Opportunity cost Appropriate
Mix> Equity
HTA, Technologies and Choice
Efficacy >
Security >
RoA >
Cost >
CAIAQ Criteria
Results
NO YES‘PAS’ Population (Q)
Reimbursement (P)
Dimensions to consider
Volume
Age
Life Stile
Demand
Waiting Time
Socioeconomic
Occupational
Dependency
Severity
Use Services
‘Sick pay’
Adequacy
Cost
Variability
Ethical/Legal
Net effect
Solution Time
CAIAQ Approach
Forecast
n. drugs orphan Low High Patients €/patient
Budget Impact 13 12 20.909.270 35.767.550 859 24.335
• Assume 5/10.000 inhab• Spain= 22.500 affected
• Estimated Budget impact: 505M€ (4%)
Creating Value
This suggests that the producer or source of value must understand the relative knowledge of potential users and the context in which the evaluation of novelty and appropriateness will take place
Lepak, Acad Manag Rev 2007
Creating Value
• Value is …..− is subjective and related to individual WTP−WTP > production cost−Related to
novelty appropriateness
−Related to competitive advantage, dynamic capabilities organisational knowledge
• Buyers ….−Must have specialised knowledge−Cannot be separated from their context
Where?
ContextImplementation
FundsKnowledge
PROS CONS
Local
Context specific Adjusted to needs
Participation Implementation
Limited Knowledge Disconnected from innovation
Limited resources (k&l) Atomisation
Low productivity
Regional Context specific
Adjusted to priorities More resources available
Participation Implementation Limited funding
National
More Available Funds Adjusted to policy Broad Knowledge
Experts
Dispersonalised
Not context specific Implementation
Coordination
International Diversity ‘Sector specific productivity’
Disconnected from policy Disconnected from ‘realpolitik’
Conclusions
En el context actual cal
1. revisar les mesures que afecten a la oferta i a la demanda
2. facilitar (estructurar) la presa de decisions3. prendre les decisions