항암제 경제성평가에서 점증적 비용-효과비와 의사결정
Decision Making Based on Incremental Cost-Effectiveness Ratio for Anticancer Drugs
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Objectives: To discuss potential problems of reimbursement decision making for anti-cancer drugs based on incremental cost-effectiveness ratio (ICER), and to examine alternative approaches that can replace ICER. Methods: Literature review was conducted for peer-review journals published from 2006 and 2010 using a structured search strategy. Web-site search was carried out for documentation provided by health technology assessment institutes for selected countries including England, Canada, and Australia. Results: To improve access to anti-cancer drugs, two alternative approaches for ICER criteria were discussed: variable ICER threshold and multi-criteria decision analysis (MCDA). Variable ICER threshold indicates to use different ICER threshold for different types of disease or population to reflect distinct characteristics, expectation, and value associated with specific disease or population. MCDA suggests to use multiple criteria such as rare condition, equity, equality, needs, as well as efficiency, in order to fully reflect social value of medicine. Pros and cons of these alternative approaches were discussed. Conclusion: To employ these alternative approaches in reimbursement and/or pricing decision making for anti-cancer drugs, specific methods to operationalize and measure each criterion of MCDA and disease-specific ICER value should be developed. Further, the developed methods requires consensus by members of society.
Abstract
Objectives: To discuss potential problems of reimbursement decision making for anti-cancer drugs based on incremental cost-effectiveness ratio (ICER), and to examine alternative approaches that can replace ICER. Methods: Literature review was conducted for peer-review journals published from 2006 and 2010 using a structured search strategy. Web-site search was carried out for documentation provided by health technology assessment institutes for selected countries including England, Canada, and Australia. Results: To improve access to anti-cancer drugs, two alternative approaches for ICER criteria were discussed: variable ICER threshold and multi-criteria decision analysis (MCDA). Variable ICER threshold indicates to use different ICER threshold for different types of disease or population to reflect distinct characteristics, expectation, and value associated with specific disease or population. MCDA suggests to use multiple criteria such as rare condition, equity, equality, needs, as well as efficiency, in order to fully reflect social value of medicine. Pros and cons of these alternative approaches were discussed. Conclusion: To employ these alternative approaches in reimbursement and/or pricing decision making for anti-cancer drugs, specific methods to operationalize and measure each criterion of MCDA and disease-specific ICER value should be developed. Further, the developed methods requires consensus by members of society.
참고문헌 (32)
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