Medico-economic Evaluation of Health Products in the Context of the Social Security Financing Act for 2012

¹ EA 2694, Université Lille 2 ; DRCI, CHRU de Lille, Lille, France
² Laboratoires Lilly, Neuilly-sur-Seine, France
³ CEPS, Ministère des affaires sociales et de la santé, Paris, France
⁴ Laboratoire Novartis Pharma, Rueil-Malmaison, France
⁵ DGCIS, Ministère du redressement productif, Paris, France
⁶ Medtronic, Boulogne Billancourt, France
⁷ AP-HP, CHU Paris Sud, Paris, France
⁸ Laboratoire Sanofi-Aventis, Paris, France
⁹ Laboratoires Lilly, Suresnes, France
¹⁰ Caisse nationale d’Assurance maladie, Paris, France
¹¹ CEMKA-EVAL, Bourg-la-Reine, France
¹² FEFIS, Boulogne, France
¹³ Boston Scientific, Saint-Quentin-en-Yvelines, France
¹⁴ SNITEM, Courbevoie, France
¹⁵ Les entreprises du médicament, Paris, France
¹⁶ DGOS, Ministère des affaires sociales et de la santé, Paris, France
¹⁷ AP-HP, Paris, France
¹⁸ ESSEC, Cergy Pontoise, France
¹⁹ Haute autorité de santé, Saint-Denis la Plaine, France
²⁰ Laboratoire MSD Chibret, Courbevoie, France
²¹ Inserm, Paris, France
²² DGCIS, Paris, France

Correspondence and offprints: Benoît Dervaux, DRCI, CHRU de Lille, 1 rue Oscar Lambret, 59037 Lille Cedex, France E-mail: benoit.dervaux@chru-lille.fr

Received: 15 March 2013
Accepted: 7 May 2013

Abstract

The participants in round table 6 of the Giens Workshops 2012 drafted recommendations based on the collective interpretation of important elements of the decree concerning the medico-economic evaluation of health products published a few days earlier (02 October 2012). The medico-economic evaluation (MEE), becomes an additional determinant for fixing the prices of health products by the Health products economic committee (Comité économique des produits de santé, CEPS) via the hierarchisation of treatment strategies, and thus modifies the market access conditions.

Limiting the analysis to medicinal products and medical devices for which a major, important or moderate improvement in the medical service rendered (ASMR) or of the expected service (ASA) has been requested and presenting a significant budget impact on the Social Security expenses, excludes health products with ASMR or ASA with a lower level requested which often create complex price fixing problems and often have a major budget impact. This latter concept remains to be defined in detail. The MEE envisaged for the first registration must include the need to confirm or refute the initial hypotheses especially concerning the actual position in the therapeutic strategy at the time of renewal of the registration. For the first registration, the conventional reference to European prices guaranteeing a minimum price to innovative medicinal products, the medico-economic models submitted by the industry to the French Drug Authority (Haute autorité de santé, HAS) must be used to guide the compilation of new data to be requested at the time of the registration renewal and to negotiate the level of the discounts in the framework of a price-volume agreement, if applicable. The MEE will allow comparing the result of the analysis to the model hypothesis at the time of the renewal of the registration, which may contribute to the renegotiation (either up or down) of the price of health goods.

The costs related to obtaining new data must be controlled. In order for the MEE to allow confirming the relationship between the price requested and the benefit expected, the group privileges the definition of reference values with an indicative and non-normative value, likely to evolve with time rather than a threshold.

Concerning the evaluation procedure: the time to market access must not be lengthened; while the possibility of regular meetings between the industry and the HAS is recommended to avoid methodological divergences. A transitory period should allow the implementation of the entire evaluation procedure which must also take into account the specificities of health products registered before the 3 October 2013.