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Health Technology Assessment

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  1. Health Technology Assessment AnbanPillay Acting Cluster Manager: Health Economics and Financing National Department of Health

  2. Outline • Dispensing fee • International Benchmarking • Draft Guidelines on the Submission of Economic Analysis • Health Technology

  3. DISPENSING FEE

  4. Dispensing definition • 3 activities: • Evaluation of script (advice for OTC) • Preparation of medicine • Advising patient • Excludes: • Compounding & admixing • Delivery to patient – separate, transparent fee so patient can decide (but does include transport for emergency stock access)

  5. Principles • Appropriate: Affordability and availability • Viability: cover costs and fair return on investment (ROI) but appropriate volume (2,300 pm – pharmacist & assistant) • Closely approximate a professional fee (most flat rate) • Encourage appropriate incentives

  6. Costing • ‘Normative’ model/zero-based estimate: key informant interviews, supplier data • 100% dispensary only costs (fridge, etc.) • 43% of space related (rent, electricity, etc.) • 70% other costs (stationery, etc.) • ROI of 10% on R450,000 (NHRPL precedent) • Cross-check with stakeholder data • R21-R22 VAT exclusive

  7. Estimating income • Estimate average dispensing fee per item – target of costs + ROI • SEP bands critical: • Medical schemes (90% of market) • PSSA ‘mega-sample’ of pharmacies • Key issue: • 95% of volume have SEP< R250

  8. Recommended dispensing fee (VAT exclusive)

  9. Average dispensing fee

  10. Response after Promulgation of the Dispensing fee • PSSA prevented the implementation of the fee • MoH agreed provided that case is heard on urgent basis • Exchange of papers between parties • No date for court hearing

  11. International Benchmarking

  12. Process • Invitation for proposals on methodology • Review of proposals • Finalisation of draft methodology • Publication for comment • Review of comments • Finalisation of methodology • Implementation

  13. Methodology • Originator medicines • Generic Medicines

  14. Combination Drugs • Assessed based on individual active ingredients • TOTAL SEP = SUM OF COMPONENTS • Dual methodology may apply

  15. Different Trade Names • Same Manufacturer • Same actives • Different trade names • Lowest SEP applicable

  16. OTHER ISSUES • “Temporary” price reductions • Pharmacy administration fee – inappropriate • Price changes and new product price introductions

  17. Risk Sharing Proposals • Pharmaceutical industry has come up with a range of risk sharing • Proposals are related to rare diseases where therapy is expensive • Usually limited clinical evidence to support use of the therapy • Pricing committee needs to give approve such proposals

  18. Billing for Anaesthetic gases • Manufacturers of gases sell gases in ml or mg • Patients cannot be billed for gases in minutes • Low flow delivery available at private hospitals • Hospital groups have been informed that their billing systems are inappropriate

  19. Draft Guidelines on the Submission of Economic Analysis

  20. Key Areas • Details of the proposed drug and its proposed use • Data from comparative randomised trials • Modelled economic evaluation for main indication • Estimated extent of use and financial implications

  21. HEALTH TECHNOLOGY

  22. Health Technology Assessment • Quality • Safety • Efficacy • Cost • Cost Benefit / Cost Effectiveness

  23. Health Technology - Quality Assessment of the quality of health technology • Components of the devices • Stds for the component/s • Assessment of each component • Assessment of all components operating as unit

  24. Health Technology - Safety Assessment of the safety of health technology • Safety to the patient • Safety to the operator/ administrator • Safety of the environment

  25. Health Technology - efficacy Assessment of the efficacy of health technology • Does the health technology do what is claimed? • How well does it do this? • How well does the technology work compare to the technology that we currently have?

  26. Health Technology cost effectiveness/ cost benefit • Comparative effectiveness of the new technology compared to technology currently available • Comparative cost of the new technology compared to technology currently available

  27. Clinical and Health Technology Guidelines Is there a need for separate public and private sector guidelines

  28. GUIDELINES • Both clinical guidelines and health technology assessment guidelines are based on evidence based medicine. • Reasonable for the industry to adopt the public sector guidelines.

  29. THANK YOU