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Headache. 2015 Jul-Aug;55 Suppl 4:236-47. doi: 10.1111/head.12585. Epub 2015 Jul 14.

Reimbursement-Based Economics--What Is It and How Can We Use It to Inform Drug Policy Reform?

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School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Canadian Agency for Drugs and Technologies in Health, Ottawa, ON, Canada.
Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.
Institute of Health Policy, Management and Evaluation and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.



In Ontario, approximately $3.8 billion is spent annually on publicly funded drug programs. The annual growth in Ontario Public Drug Program (OPDP) expenditure has been limited to 1.2% over the course of 3 years. Concurrently, the Ontario Drug Policy Research Network (ODPRN) was appointed to conduct drug class review research relating to formulary modernization within the OPDP. Drug class reviews by ODPRN incorporate a novel methodological technique called reimbursement-based economics, which focuses on reimbursement strategies and may be particularly relevant for policy-makers.


To describe the reimbursement-based economics approach.


Reimbursement-based economics aims to identify the optimal reimbursement strategy for drug classes by incorporating a review of economic literature, comprehensive budget impact analyses, and consideration of cost-effectiveness. This 3-step approach is novel in its focus on the economic impact of alternate reimbursement strategies rather than individual therapies.


The methods involved within the reimbursement-based approach are detailed. To facilitate the description, summary methods and findings from a recent application to formulary modernization with respect to the drug class tryptamine-based selective serotonin receptor agonists (triptans) used to treat migraine headaches are presented.


The application of reimbursement-based economics in drug policy reforms allows policy-makers to consider the cost-effectiveness and budget impact of different reimbursement strategies allowing consideration of the trade-off between potential cost savings vs increased access to cost-effective treatments.


cost-effectiveness; drug reimbursement; triptan

[Indexed for MEDLINE]

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