The variety of innovative technologies with the potential to revolutionize the delivery of health care means that the policy toolbox will need several pricing and payment models, adapted in their design and implementation according to the specific situation. Although there are examples of novel pricing and payment models, the lack of appropriate data infrastructure, legal barriers and unwillingness to adapt current systems often prevent their use.

Therefore, the overall objectives of the Health Innovation Next Generation Pricing Models (HI – PRIX) project are:

• to map and formulate new pricing and payment schemes that can be used across technology classes, therapeutic areas, setting and healthcare systems/geographies together with a related set of principles that may guide successful adjustment and flexible implementation to the context of use;
• to investigate the impact on competitiveness, innovation, equity and affordability of a pipeline of contracting modalities for health innovations;
• to address the challenges and concerns of payers, manufacturers, healthcare professionals, and patients about different models of pricing by sustaining an effective dialogue across stakeholders’ groups about the trade-offs between affordability, innovation and patient access.

Through theoretical models, quantitative simulation, qualitative research work and case-studies, this three-year project structured around 10 WPs, will generate new evidence on the role of public sector in R&D and indirect medical and environmental costs in pricing and reimbursement determinations, on the pricing dynamics over pharmaceutical products’ lifecycle, on the impact of policies and incentives on the competitiveness, innovativeness and equity in the healthcare system.

Funder: European Commission

Horizon Europe Partners:

• Universita Commerciale Luigi Bocconi (UB), Italy (Coordinator)

• Universitaet Hamburg (UHAM), Germany

• Austrian Institute for Health Technology Assessment GmbH (AIHTA GmbH), Austria

• Escuela Andaluza de Salud Publica (EASP), Spain

• Universite Libre de Bruxelles (ULB), Belgium

• Fundacio Clinic per a la Recerca Biomedica (FCRB-CERCA), Spain

• Erasmus Universiteit Rotterdam (EUR), The Netherlands

• Universidade Nova de Lisboa (UNL), Portugal

• Ecole d'Economie de Paris – Paris School Of Economics (PSE), France

• Vilniaus Universitetas (VU), Lithuania

• Fundacion Publica Andaluza Progreso Y Salud (AETSA - FPS), Spain

Associated partners:

• Office of Health Economics (OHE), UK

• Imperial College of Science Technology and Medicine (ICL), UK

• London School of Economics and Political Science (LSE), UK

• Agenzia Italiana del Farmaco (AIFA), Italy

• Autoridade Nacional do Medicamento e Produtos da Saude IP (INFARMED), Portugal

• Servei Catala de la Salut (CATSALUT), Spain

RETENTION aims to develop an innovative platform to support enhanced clinical monitoring and interventions aimed at improving the clinical management of patients with chronic Heart Failure, reducing their mortality and hospitalisation rates, and improving their quality of life, safety, and well-being.

The project exploits the technological convergence of state-of-the-art technologies, to develop innovative, transparent, and sophisticated decision-making capabilities and deliver personalized effective interventions for advance heart failure diseases. This is achieved through:

• Introducing daily patient monitoring of Heart Failure patients outside hospitals in order to collect different types of clinical, behavioural and real-world data for them.
• Analysing the collected data, using novel data analytics and artificial intelligence technologies, with the aim to identify patterns and associations in the data that can improve the clinical management of patients, reduce hospitalisations and death rate and improve their quality of life.
• Assessing the potential of using remote Heart Failure Patients monitoring, including patient safety and quality and the necessity for remote monitoring and support for a continually increasing older adult population living with complex, multimorbid conditions and presenting health services with an ever-increasing strenuous demand.

Funder: European Commission

Horizon 2020 Partners:

• Institute Of Communication And Computer Systems (ICCS), Greece (Coordinator)

• Onaseio Kardiocheirourgiko Kentro (OCSC), Greece

• Alma Mater Studiorum - Universita di Bologna (UNIBO), Italy

• Universitaetsklinikum Essen (UKESSEN), Germany

• Servicio Madrileno de Salud (SERMAS), Spain

• Ethniko Kai Kapodistriako Panepistimio Athinon (NKUA), Greece

• Idryma Technologias Kai Erevnas (FORTH), Greece

• London School Of Economics And Political Science (LSE), United Kingdom

• Sphynx Technology Solutions AG (SPHYNX), Switzerland

• Datamed Healthcare Integrator Oloklironmena Systimta Pliroforikis Stinygeia Kai Pronoia Anonymos Etaireia (DATAMED), Greece

• I2GROW: Innovation To Grow Srl (I2GROW), Italy

• AEGIS IT Research GMBH (AEGIS), Germany

• Siemens SRL (Siemens SRL), Romania

• Eunomia Limited (EUNOMIA LIMITED), Ireland

MTRG team members: Panos Kanavos, Hala Hourani, Erica Visintin, Olina Efthymiadou

Visit the RETENTION website

IMPACT HTA places strong emphasis on methodological improvements in the conduct of HTA and aims to produce tangible deliverables and toolkits that are immediately actionable by health care decision-makers and HTA agencies. Specifically, the overall objectives of IMPACT HTA are to:

• Contribute to the understanding of variations in costs and health outcomes within and across countries, the rationale and criteria for decision-making across different settings as well as the factors and preferences that shape HTA recommendations;
• Cevelop and disseminate innovative methodologies, toolkits and processes aiming to aid decision-making and improve efficiency in resource allocation in a number of areas including: extrapolation from RCT data; the development of a common and comparable dataset on health and social care costs across EU countries; quality of life measurement with emphasis on patient preference elicitation; methods of value assessment of medical technologies, including multi-criteria decision analysis; and how non-randomised studies can inform health economic evaluations; and
• Develop and disseminate tools facilitating EU-wide collaboration across Member State governments, HTA agencies, health care professionals, patients and the broader stakeholder community.

The thematic areas of focus of IMPACT HTA include:

• The use of randomized controlled trial (RCT) and observational/registry data in economic evaluation;
• The development of a costing methodology and a creation of a core dataset of (health and social care) costs for facilitating cross border comparisons in economic evaluation;
• Capturing health preferences across different patient diagnoses using the EQ-5D-5L;
• The analysis and interpretation of non-randomised studies to inform health economic evaluation;
• The use of multi-criteria value methods and their relevance for HTA decision-making;
• A model to analyse the determinants of HTA decision-making across countries and therapeutic areas ;
• Economic evaluation methods for hospital-based assessments;
• Measuring the fiscal impact of new healthcare interventions and incorporating this into HTA processes; and
• HTA appraisal for orphan medicinal products.

Funder: European Commission – Horizon 2020

Partners:

• The London School of Economics and Political Science – LSE Health (LSE), UK (coordinator)
• The Andalusian School of Public Health (EASP), Spain
• University of Castilla-La Mancha (UCLM), Spain
• Universitaet Bielefeld (UNIBI), Germany
• National Institute for Health and Care Excellence (NICE), UK
• Instituto Superior Técnico (IST), Portugal
• Paris School of Economics (PSE), France
• Università Cattolica del Sacro Cuore (UCSC), Italy
• Assistance Publique-Hôpitaux de Paris (AP-HP), France
• Istituto Superiore di Sanità (ISS), Italy
• Università Commerciale Luigi Bocconi (UB), Italy
• University of Edinburgh (UEDIN), UK
• Inštitut za Ekonomska Raziskovanja (IER), Slovenia
• Agencja Oceny Technologii Medycznych i Taryfikacji (AOTMiT), Poland
• Tandvårds- och läkemedelsförmånsverket (TLV), Sweden

MTRG team members: Panos Kanavos, Aris Angelis, Erica Visintin, Hala Hourani, Anna-Maria Fontrier, Mackenzie Mills and Olina Efthymiadou

Outputs: 

Summary of results
Final Workshop (agenda, presentations & recording) 

Visit the Impact HTA website

• Accurate mapping of NCD research can assist governments in understanding the most fruitful approaches to investing in an area which has direct economic consequences as well as social benefits. In addition, collaboration between public and private entities may further spread benefits and ensure greater likelihood of success. A broader perspective on currently existing national and European approaches to NCD funding might also be of great benefit to European countries in fine tuning their national strategies towards the development of more innovative solutions to the growing problem of NCDs. At EU level, NCD funding strategies are characterized by strong visions and policies. But there is also a need for new incentives in NCD R&D funding for the purpose of encouraging innovation and research that leads to better understandings of disease areas and also to new prevention strategies and improved treatments.

  MAPPING NCD  maps European countries’ NCD research activities, investment and initiatives, and also quantifies their impact in five key disease areas: cardiovascular disease, chronic respiratory diseases, diabetes, cancer and mental health.  As a package, MAPPING NCD comprises a detailed qualitative survey of each of the five identified disease areas, a bibliometric analysis and an impact assessment.

  Funder: European Union – 7th Framework Programme (FP7)

  Partners:

  • London School of Economics (Coordinator - UK)
  • Technische Universitaet Berlin (Germany)
  • Escuela Andaluza de Salud Publica Granada (Spain)
  • Université Paris Est-Créteil (France)
  • King’s College London (UK)
  • Università Commerciale Luigi Bocconi (Italy)
  • Estonian Research Council (Estonia)

  MTRG team members: Panos Kanavos, John Wright, Erica Visintin and Hala Hourani.

  Outputs:

  Final Deliverable
  Brochure
  Critical Appraisal: Cancer
  Critical Appraisal: Cardiovascular Diseases
  Critical Appraisal: Chronic Respiratory Diseases
  Critical Appraisal: Diabetes
  Critical Appraisal: Mental Health Disorders

Advance-HTA aims to broaden the spectrum, complement and address areas of intense methodological debate in the application, use and implementation of HTA. It also aims to improve HTA methods, which can be taken further by competent authorities nationally whilst supplementing the work of supra-national bodies (e.g. EUnetHTA) towards a common understanding of choices in health care decision-making. For this purpose, ADVANCE-HTA focused on six distinct areas:

• Value for money and the different approaches surrounding current thresholds for resource allocation. Advance-HTA systematically explored alternative means of assessing value for money and trace the implications for the conduct of HTA and the use of cost-effectiveness data to inform decision-making.
• Value assessment and the factors that need to be considered and incorporated beyond cost effectiveness, such as burden of disease, disease severity, quality of the data and evidence produced, and the implications these are having on the continuous assessment of new health technologies and relative effectiveness. Advance-HTA aimed to explore new tools and methodologies in this domain, for example Multi-Criteria Decision Analysis, and investigate their adoption and implementation.
• Assessment of rare diseases and the quality of the evidence required for and the methods associated with these assessments,relying on new data providing a more realistic understanding of the socio-economic benefits of orphan drugs. Advance-HTA developed and validated a framework to support decision-making relating to orphan drugs for rare diseases, by means of a Discrete Choice Experiment.
• Elicitation of preferences and the robustness of the evidence derived from more realistic settings, by drawing on the wider EU citizenship and from within the patient community. Advance-HTA created new data that will incorporate patient-relevant values into widely used tools of quality-of-life measurement, such as the EQ-5D.
• Medical devices and the suitability of current HTA tools across different categories, including diagnostics. Advance-HTA consolidated the current methods for assessing HTA in medical devices in different settings, address their suitability and propose how current tools can be modified or adapted in order to arrive at more robust methods of assessment.
• HTA implementation and capacity building in settings outside Europe (Latin America and Eastern Europe), where HTA is beginning to be considered explicitly in decision-making. Advance-HTA created a framework for HTAs at different levels by benchmarking with evidence from countries that have developed such frameworks.

Funder: European Union – 7th Framework Programme (FP7)

Partners:

• The London School of Economics and Political Science – LSE Health (LSE), UK
• The London School of Hygiene and Tropical Medicine (LSHTM), UK
• Istituto Superiore di Sanità (ISS), Italy
• University of Castilla-La Mancha (UCLM), Spain
• The Institute for Economic Research (IER), Slovenia
• Technische Universität Berlin (TU Berlin), Germany
• The Andalusian School of Public Health (EASP), Spain
• Pan American Health Organisation (PAHO), USA
• The European Brain Council (EBC), Belgium
• University Paris-Est Créteil (UPEC), France
• National Institute for Health and Clinical Excellence (NICE) - International, UK
• Agency for Health Technology Assessment (AOTM), Poland
• The Dental and Pharmaceutical Benefits Agency (TLV), Sweden

MTRG team members: Panos Kanavos, Elena Nicod, Aris Angelis and Hala Hourani.

Output: 

Final Deliverable

A major challenge in the care of patients with rare diseases of yesterday and today, is a full and continuous access to accurate and up to date information on the treatment options. The project RARE-Best-Practices responds to the information needs of health professionals, patients, policy makers in the field of rare diseases, by creating a system of easily accessible resources for the development, evaluation, dissemination and implementation of guidelines for clinical practice, with the ultimate goal of improving the clinical management of rare diseases.

The MTRG led the project’s work package 5 - “Rare diseases technologies and value assessment”- whereby the team focused on:

• Understanding the criteria used by competent authorities in selected Member States in assessing the value of orphan medicines relying on evidence-based medicine (EBM) and cost-effectiveness analysis (CEA) in each jurisdiction
• Drawing on a selection of orphan drug appraisals in a number of EU countries over the January 2006 to December 2012 period and across therapeutic classes, to determine the criteria used to evaluate these drugs and the way clinical practice guidelines are developed across the selected sample of drugs; and
• Exploring Best Practices based on the evidence collected and share these across EU Member States.

Funder: European Union – 7th Framework Programme

Partners:

• Istituto Superiore di Sanità - National Centre for Rare Diseases (coordinator)
• Jamarau
• Karolinska Institutet
• Healthcare Improvement Scotland
• London School of Economics and Political Science
• National Research Council
• EURORDIS, European Organisation for Rare Diseases
• Associazione per la Ricerca sull'Efficacia dell'Assistenza Sanitaria Centro Cochrane Italiano
• Universitaetsklinikum Freiburg
• Bulgarian Association for Promotion of Education and Science
• Fundación Canaria de Investigación y Salud
• Universiteit Maastricht - Institute for Public Health Genomics (IPHG)
• Newcastle University Upon Tyne
• The European Academy of Paediatrics
• Instituto de Salud Carlos III

MTRG team members: Panos Kanavos, Victoria Tzouma and David Tordrup

Outputs:

Tordrup D, Tzouma V, Kanavos P. Orphan drug considerations in Health Technology Assessment in eight European countries. Rare Dis Orphan Drugs 2014; 1(3):83-9

Visit the RARE Best Practices website