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Impact of Comparative Effectiveness Research on Drug Development Strategy and Innovation

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Decision Making in a World of Comparative Effectiveness Research

Abstract

Food and Drug Administration approval of a new drug, or new indication for an existing drug, is a necessary but increasingly insufficient condition for market access in the United States. Payers evaluate a drug’s clinical safety and effectiveness profile in relation to existing standards of care. The collected evidence is referred to here as comparative effectiveness research (CER). Augmented with evidence from cost-effectiveness and budget-impact studies, CER elucidates a drug’s value, which, in turn, helps inform payer pricing and reimbursement decisions. Such decisions can reach back to impact clinical development programs and hence future innovation, as they indicate key value parameters that payers, health-care providers, and patients are seeking in new pharmaceutical products. In this chapter, we address what CER delivers in terms of information regarding the value of pharmaceutical products, to whom that information is directed, and the impact that CER can have on drug development strategy and biomedical innovation.

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Notes

  1. 1.

    The practice of first prescribing the most cost-effective drug to a patient (usually this is the least costly) and then prescribing a more costly drug if the first drug does not work.

  2. 2.

    The practice of imposing limits on the numbers of prescriptions that can be filled, or dosing per prescription.

References

  1. Schondelmeyer S, Purvis L (2016) Trends in retail prices of prescription drugs widely used by older Americans, 2006 to 2013 February 2016. http://www.aarp.org/content/dam/aarp/ppi/2016-02/RX-Price-Watch-Trends-in-Retail-Prices-Prescription-Drugs-Widely-Used-by-Older-Americans.pdf

  2. Berndt ER, Newhouse JP (2012) Pricing and reimbursement in US pharmaceutical markets. Oxford Handbook of the Economics of the Biopharmaceutical Industry. doi: 10.1093/oxfordhb/9780199742998.013.0008

  3. Cohen J (2013) Comparative effectiveness research: does it matter? Clin Ther 35(4):371–379. http://www.sciencedirect.com/science/article/pii/S0149291813000088

  4. Garber A, Sox H (2010) The role of costs in comparative effectiveness research. Health Aff 29(10):1805–1811

    Article  Google Scholar 

  5. Milne CP, Cohen JP, Felix A, Chakravarthy R (2015) Impact of postapproval evidence generation on the biopharmaceutical industry. Clin Ther 37(8):1852–1858

    Article  PubMed  Google Scholar 

  6. Cohen J (2015) Known knowns and unknowns of U.S. drug pricing. PLoS Med. November 2015. http://blogs.plos.org/yoursay/2015/11/10/known-knowns-and-unknowns-of-u-s-drug-pricing/

  7. Howard D, Bach P, Berndt E, Conti R (2015) Pricing in the market for anticancer drugs. J Econ Perspect 29(1):139–162

    Article  PubMed  Google Scholar 

  8. Arrow K (1963) Uncertainty and the welfare economics of medical care. Am Econ Rev 53(5):941–973

    Google Scholar 

  9. Schneider E, Timbie J, Fox S, van Busum K, Caloyeras J (2013) Dissemination and adoption of comparative effectiveness research findings when findings challenge current practices. Office of the Assistant Secretary for Planning and Evaluation (ASPE) Report. 2013. https://aspe.hhs.gov/legacy-page/dissemination-and-adoption-comparative-effectiveness-research-findings-when-findings-challenge-current-practices-142166

  10. Donnelly J (2010) Health Policy Brief. Health Affairs 1–5. https://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=27

  11. Pollack A (2011) Medicare coverage for breast cancer drug ends in some states. New York Times, 6 Jan 2011. http://prescriptions.blogs.nytimes.com/2011/01/06/medicare-coverage-for-breast-cancer-drug-ends-in-some-states/

  12. Deutsch H (2015) Don’t believe what PBMs are saying – the truth behind formulary exclusion lists. https://www.pm360online.com/dont-believe-what-pbms-are-saying-the-truth-behind-formulary-exclusion-lists/ PM360, Dec 21, 2015

  13. Bruen B, Docteur E, Lopert R, Cohen JP, DiMasi J, Dor A, Neumann P, Desantis R, Shih C (2015) The impact of reimbursement policies and practices on healthcare technology innovation. Final report for the Impact of Reimbursement Policies and Practices on Healthcare Technology Innovation project. Washington, U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation

    Google Scholar 

  14. Sullivan S, Yeung K, Vogeler C, Ramsey S, Wong E, Murphy C, Danielson D, Veenstra D, Garrison L, Burke W, Watkins J (2015) Design, implementation, and first-year outcomes of a value-based drug formulary. J Manag Care Spec Pharm 21(4):269–275

    Article  PubMed  Google Scholar 

  15. Hyry H, Stern A, Cox T, Roos J (2014) Limits on the use of health economic assessments for rare diseases. Q J Med 107:241–245

    Article  CAS  Google Scholar 

  16. Guidance for public, industry, and CMS staff, coverage with evidence development. http://www.cms.gov/Medicare/Coverage/Coverage-with-Evidence-Development/index.html Nov 20, 2014

  17. Cohen JP, Dong J, Lu CY, Chakravarthy R (2015) Restricting access to Amyvid: medicare coverage criteria inconsistent for drugs and diagnostics. Br Med J. http://dx.doi.org/10.1136/bmj.h3333

  18. Garrison L, Towse A, Briggs A, de Pouvourville G, Grueger J, Mohr P, Severens JL, Siviero H, Sleeper M (2013) Performance-based risk-sharing arrangements – Good practices for design, implementation and evaluation: report of the ISPOR good research practices for performance-based risk-sharing arrangements task force. Value Health 16:703–719

    Article  PubMed  Google Scholar 

  19. Miller J (2015) Novartis, Roche find `outcome-based’ drug pricing an elusive dream. Reuters. 12 Nov 2015. http://www.reuters.com/article/2015/11/12/us-roche-novartis-drug-pricing-idUSKCN0T11MM20151112

  20. DiMasi JA, Caglarcan E, Wood-Armany M (2001) The emerging role of pharmacoeconomics in the R&D decision-making process. PharmacoEconomics 19(7):753–766

    Article  CAS  PubMed  Google Scholar 

  21. Ahlawat H, Chierchia G, van Arkel P (2013) Becoming a launch powerhouse. In: Beyond the storm: Launch excellence in the new normal. McKinsey. Insight into Pharmaceuticals and Medical Products series. 2013. http://www.mckinsey.com/~/media/McKinsey/dotcom/client_service/Pharma%20and%20Medical%20Products/PMP%20NEW/PDFs/PMP_Beyond_the_storm_Launch_excellence_in_the_new_normal

  22. Chalkidou K (2010) The (Possible) impact of comparative effectiveness research on pharmaceutical industry decision making. Clin Pharmacol Ther 87(3):264–266

    Article  CAS  PubMed  Google Scholar 

  23. Davolt S (2011) AstraZeneca, WellPoint Partner to Offset CER Deficit. http://aishealth.com/blog/pharmacy-benefit-management/astrazeneca-wellpoint-partnership-help-lay-foundation-cer AISHealth, Feb 14

  24. Largent E, Pearson S (2012) Which orphans will find a home? The rule of rescue in resource allocation for rare diseases. Hastings Cent Rep 42:27–34

    Article  PubMed  Google Scholar 

  25. Bach P, Pearson S (2015) Payer and policy maker steps to support value-based pricing for drugs. JAMA 314(23):2503–2504. doi:10.1001/jama.2015.16843

    Article  CAS  PubMed  Google Scholar 

  26. Sorenson C, Drummond M, Burns L (2013) Evolving reimbursement and pricing policies for devices in Europe and the United States should encourage greater value. Health Aff 32(4):788–796

    Article  Google Scholar 

  27. Neumann P, Pei-Jung L, Greenberg D et al (2006) Do drug formulary policies reflect evidence of value? Am J Manag Care 12:30–36

    PubMed  Google Scholar 

  28. Dean B, Ko K, Graff J, Localio A, Wade R, Dubois R (2013) Transparency in evidence evaluation and formulary decision-making: from conceptual development to real-world implementation. Pharm Ther 38(8):465–483

    Google Scholar 

  29. Neumann P, Weinstein M (2010) Legislating against use of cost-effectiveness information. N Engl J Med 363:1495–1497

    Article  PubMed  Google Scholar 

  30. Neumann P, Greenberg D (2009) Is the United States ready for QALYs? Health Aff 28(5):1366–1371

    Article  Google Scholar 

  31. Nelson H, Tyne K, Naik A et al (2009) Screening for breast cancer: systematic evidence review update for the US Preventive Services Task Force. Agency for Healthcare Research and Quality 2009 Evidence Syntheses, No. 74

    Google Scholar 

  32. Moloney R, Mohr P, Hawe E, Shah K, Garau M, Towse A (2015) Payer perspectives on future acceptability of comparative effectiveness and relative effectiveness research. Int J Technol Assess Health Care 31(1/2):90–98

    Article  PubMed  PubMed Central  Google Scholar 

  33. Schneeweiss S, Gagne J, Glynn R, Ruhl M, Rassen J (2011) Assessing the comparative effectiveness of newly marketed medications: methodological challenges and implications for drug development. J Clin Pharmacol Ther 90:777–790

    Article  CAS  Google Scholar 

  34. Mullard A (2016) Industry R&D returns slip. Nat Rev Drug Discov 15(7). doi:10.1038/nrd.2015.41

  35. Schaeffer S, McCallister E (2015) Paying the piper. BioCentury 2015. Sept 1. http://www.biocentury.com/biotech-pharma-news/coverstory/2014-09-01/22nd-biocentury-back-to-school-issue-time-to-try-new-pricing-schemes-a1

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Correspondence to Joshua P. Cohen .

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Cohen, J.P., DiMasi, J.A., Kaitin, K.I. (2017). Impact of Comparative Effectiveness Research on Drug Development Strategy and Innovation. In: Birnbaum, H., Greenberg, P. (eds) Decision Making in a World of Comparative Effectiveness Research. Adis, Singapore. https://doi.org/10.1007/978-981-10-3262-2_6

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  • DOI: https://doi.org/10.1007/978-981-10-3262-2_6

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