Cost-effectiveness analyses (CEAs) of new drugs should focus on how well they achieve key business drivers for benefits plans, according to recently published TELUS Health guidelines entitled Getting Value for Money from Private Payer Drug Plans: Considering More Than Just Costs.
The document says cost-effectiveness measures differ for public payers and private ones because their objectives are different. Public plans focus more on reducing healthcare costs, whereas private payers are looking to improve work productivity. Hence, using the same CEAs across the two categories creates fallacies and produces inefficient plans.
For plans that align with private payer goals, the guidelines say, CEA models should demonstrate how a drug can increase productivity and reduce absenteeism.
Productivity loss should be calculated using a friction-cost approach, which is on average three months of lost productivity if an employee leaves due to illness, says the TELUS Health document.
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The guidelines also recommend including allied healthcare provider costs, such as chiropractic, physiotherapy and massage, and other out-of-hospital costs not covered by public healthcare.
Similarly, pharmaceutical companies can tailor their approaches to enhance the value proposition of their products for private payer drug plans. Companies' CEA models should consider productivity costs, incorporate appropriate comparators and demonstrate their products’ impact on health-related quality of life using cost-utility analyses, say the TELUS Health guidelines.
