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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?

Author information

1
School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
2
Canadian Agency for Drugs and Technologies in Health, Ottawa, ON, Canada.
3
Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.
4
Institute of Health Policy, Management and Evaluation and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
5
Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.

Abstract

BACKGROUND:

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.

OBJECTIVES:

To describe the reimbursement-based economics approach.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

cost-effectiveness; drug reimbursement; triptan

PMID:
26178290
DOI:
10.1111/head.12585
[Indexed for MEDLINE]

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