Access with Evidence Development Schemes A Framework for Description and Evaluation

• Published in: PharmacoEconomics Vol. 28; no. 2; pp. 143 - 152
• Main Authors: McCabe, Christopher J., Stafinski, Tania, Edlin, Richard, Menon, Devidas
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.02.2010; Springer Healthcare | Adis; Wolters Kluwer Health, Inc; Springer Nature B.V
• Series: PharmacoEconomics
• Subjects: Biomedical Technology - economics; Care and treatment; Conference Paper; Cost control; Decision Making; Design; Diagnosis; Economic aspects; Efficiency; Evidence-Based Medicine; Formularies; Health Administration; Health care industry; Health Economics; Health insurance; Health Services Accessibility - economics; Health-policy; Humans; Innovations; Insurance Coverage; Interpretation and construction; Laws, regulations and rules; Medical innovations; Medical policy; Medical technology; Medicine; Medicine & Public Health; Multiple sclerosis; Patients; Pharmacoeconomics and Health Outcomes; Public Health; Public Opinion; Quality of Life Research; R&D; Reimbursement; Reimbursement Mechanisms - economics; Reimbursement Mechanisms - trends; Research & development; Research design; Risk sharing; Studies; United Kingdom; United Kingdom > UK; Budget Impact; Test Criterion; Intellectual Property Right; Expand Disability Status Scale; Governance Arrangement
• ISSN: 1170-7690; 1179-2027; 1179-2027
• DOI: 10.2165/11530850-000000000-00000

There is an inevitable tension between robust reimbursement processes and providing speedy access to new and novel technologies, given uncertainties about key pieces of evidence and subsequent concerns regarding their overall efficiency. The public perception of these treatments as ‘breakthrough’, combined with substantial clinical pressure, has led to healthcare payers looking for schemes that allow the new technology to be made available to (some) patients, while (at least partially) protecting the principles of their reimbursement decision-making processes. Current literature on these schemes is almost completely descriptive and provides little help in planning future schemes. We propose a framework for evaluating current schemes and informing the design of future schemes. We examine the value of the framework using the UK Multiple Sclerosis Risk-Sharing Scheme as a case study.