In summary, critical elements of a budget-impact analysis are the estimates of treat- ment shares over the analysis time horizon both with and without the new drug in the treatment mix. If data for treatment shares with the current treatment mix are available for the reimbursement-eligible population, then the reimbursement- eligible population should be used for estimating the budget impact along with treatment shares for the new drug and redistribution of treatment shares from the current drugs for the reimbursement-eligible population. However, when the only available data for treatment shares with the current treatment mix come from the total condition population, then the total condition population could be used for estimating the budget impact along with treatment shares for the new drug and redistribution of treatment shares from the current drugs for the total condition pop- ulation. It is very important that the selection of the population included in the budget-impact analysis be consistent with that used for the estimates of treatment shares. In addition, whatever assumptions are made about the current and projected treatment mixes and populations for the base-case estimates in the analysis, the users should be allowed to change those assumptions to apply to their jurisdiction or health plan. Examples of how to structure the computer program for the analysis to allow the user to make these changes are shown in Chap. 10.
Exercises
Exercise 4.1 Identify a new drug that is coming to market soon. What are the potential competitors for this new drug? How might you obtain the current treatment mix estimates for the competitors with which this new drug will compete?
Exercise 4.2 Discuss how off-label use of drugs might affect the current treat- ment mix that would be considered in a budget-impact analysis for a new drug.
Exercise 4.3 A new drug is being developed to treat patients with diabetes who are not controlled on metformin. How might you identify the new drug’s potential competitors and analyze administrative health-care claims data in order to estimate the current treatment mix upon which this new drug will enter?
Exercise 4.4 A new fixed-dosed, triple-therapy combination drug is being developed for treatment of chronic obstructive pulmonary disease. Identify poten- tial competitors for this new drug and discuss how you will estimate the current treatment mix.
Exercise 4.5 Disease X is a rare condition for which there are no currently approved treatments. Discuss what treatments should be considered within the cur- rent treatment mix and how might the current treatment shares be estimated?
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Exercise 4.6 Discuss how reimbursement restrictions such as prior authoriza- tion, prescription from a specialist only, and proof of prior use of two other drugs might influence the current and projected treatment mixes.
Exercise 4.7 Choose a condition in which a new drug may be approved for treat- ment. Design a worksheet in Excel that can be used within a budget-impact analysis to present current and projected treatment mixes for examining the drug’s impact.
Exercise 4.8 How might determining current and projected treatment mixes differ in acute versus chronic conditions? List issues that a developer of a budget- impact analysis might need to consider differently among these two condition types.
Exercise 4.9 A new drug that is highly effective in treating condition X will be approved in the coming months. A budget-impact analysis is being built to under- stand the impact of this new drug. The current market is crowded with treatments that are going generic in the next year such that before the year is over, all competi- tor treatments will be generic. Discuss the impact that these generics will have on the uptake of the new drug. Discuss issues to consider and features to be built within the budget-impact analysis.
Exercise 4.10 A new drug is being approved that would be an add-on therapy for treating HIV. Treatments in HIV are typically regimens composed of three to four drugs. Discuss how one would determine the treatment regimens to be considered within a budget-impact analysis for assessing the impact of this new add-on drug. How would the current and projected treatment mixes be estimated? Set up budget scenar- ios up to 5 years to present the current and projected mixes in an Excel worksheet.
Reference
Mahlich J, Nishi M, Saito Y. Modeling the budget impact of long-acting injectable paliperidone palmitate in the treatment of schizophrenia in Japan. Clinicoecon Outcomes Res. 2015;7:267–
72. doi:10.2147/CEOR.S85514.
4 Estimating the Treatment Mix
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© Springer International Publishing AG 2017
J. Mauskopf et al., Budget-Impact Analysis of Health Care Interventions, DOI 10.1007/978-3-319-50482-7_5
Estimating Treatment-Related Costs
Thor-Henrik Brodtkorb, Stephanie Earnshaw, and Josephine Mauskopf
Abstract Estimating treatment-related costs for drugs includes estimating the drug acquisition costs as well as costs for administration, diagnostic testing, monitoring, and treatment of side effects. Acquisition costs may be from published price lists or may be negotiated privately at the national or plan level. In addition, the cost to the budget holder may be modified by patient co-payments, manufacturer discounts or rebates, or patient coinsurance. Costs for administration, diagnostic testing, moni- toring, and treatment of side effects can generally be estimated using resource use based on the requirements stated in the drug label and unit costs from standard cost- ing sources. In this chapter, we present a description of each of these types of costs and methods for estimating them.
Keywords Acquisition • Co-payments • Discounts • Rebates • Dispensing fee • Administration • Diagnostic tests • Monitoring • Side effects
Once the population and corresponding treatment mix estimates have been determined, the next step in a budget impact analysis is to estimate the treat- ment-related costs for all treatments in the treatment mix with and without the
Chapter Goal
To show how to estimate acquisition, administration, monitoring, side effect, and other treatment-associated costs, with suggestions about data sources and the type of costs to include.
T.-H. Brodtkorb (*) • J. Mauskopf • S. Earnshaw
RTI Health Solutions, RTI International, Ljungskile, Sweden e-mail: tbrodtkorb@rti.org
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new drug.1 If other types of treatment such as surgery, psychotherapy, or physical therapy are treatment options for the reimbursement-eligible population, they should be included in the current treatment mix, and their treatment-related costs should also be estimated. Treatment-related costs include not only the acquisition cost of the current and new drugs and the cost of performing other nondrug modalities, but they also may include other types of costs. The follow- ing cost categories should be included if applicable:
• Drug acquisition and administration costs or nondrug treatment costs
• Costs of diagnostic tests to determine eligibility for the drug or nondrug treatment
• Costs of monitoring for safety and efficacy while taking the drug or monitoring of nondrug treatment
• Costs of treatment of side effects or complications associated with the drug or nondrug treatment
In this chapter, we describe methods for estimating each cost category, focusing only on drug-related costs.