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Use of Health Technology Assessment for the Continued Funding of Health Technologies: The Case of Immunoglobulins for the Management of Multifocal Motor Neuropathy

Author

Listed:
  • Constanza Vargas

    (University of Technology Sydney)

  • Rebecca Addo

    (University of Technology Sydney)

  • Milena Lewandowska

    (University of Technology Sydney)

  • Philip Haywood

    (University of Technology Sydney)

  • Richard Abreu Lourenco

    (University of Technology Sydney)

  • Stephen Goodall

    (University of Technology Sydney)

Abstract

Introduction Funding decisions for many health technologies occur without undergoing health technology assessment (HTA), in particular, without assessment of cost effectiveness (CE). Immunoglobulins in Australia are an interesting case study because they have been used for a long time for various rare disorders and their price is publicly available. Undertaking an HTA enables us to assess CE for an intervention for which there is limited clinical and economic evidence. This study presents a post-market review to assess the CE of immunoglobulins for the treatment of multifocal motor neuropathy (MMN) compared with best supportive care. Methods A Markov model was used to estimate costs and quality-adjusted life-years (QALYs). Input sources included randomised controlled trials, single-arm studies, the Australian clinical criteria for MMN, clinical guidelines, previous Medical Services Advisory Committee (MSAC) reports and inputs from clinical experts. Sensitivity analyses were conducted to assess the uncertainty and robustness of the CE results. Results The cost per patient of treating MMN with immunoglobulin was AU$275,853 versus AU$26,191when no treatment was provided, with accrued QALYs of 6.83 versus 6.04, respectively. The latter translated into a high incremental cost-effectiveness ratio (ICER) of AU$317,552/QALY. The ICER was most sensitive to the utility weights and the price of immunoglobulins. MSAC advised to continue funding of immunoglobulins on the grounds of efficacy, despite the high and uncertain ICER. Conclusions Beyond the ICER framework, other factors were acknowledged, including the high clinical need in a patient population for which there are no other active treatments available. This case study highlights the challenges of conducting HTA for already funded interventions, and the efficiency trade-offs required to fund effective high-cost therapies in rare conditions.

Suggested Citation

  • Constanza Vargas & Rebecca Addo & Milena Lewandowska & Philip Haywood & Richard Abreu Lourenco & Stephen Goodall, 2024. "Use of Health Technology Assessment for the Continued Funding of Health Technologies: The Case of Immunoglobulins for the Management of Multifocal Motor Neuropathy," Applied Health Economics and Health Policy, Springer, vol. 22(1), pages 73-84, January.
    • Handle: RePEc:spr:aphecp:v:22:y:2024:i:1:d:10.1007_s40258-023-00853-1
    DOI: 10.1007/s40258-023-00853-1
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    References listed on IDEAS

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    1. Anthony H. Harris & Suzanne R. Hill & Geoffrey Chin & Jing Jing Li & Emily Walkom, 2008. "The Role of Value for Money in Public Insurance Coverage Decisions for Drugs in Australia: A Retrospective Analysis 1994-2004," Medical Decision Making, , vol. 28(5), pages 713-722, September.
    2. Martin Wenzl & Suzannah Chapman, 2019. "Performance-based managed entry agreements for new medicines in OECD countries and EU member states: How they work and possible improvements going forward," OECD Health Working Papers 115, OECD Publishing.
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