Rapid Reviews with Health-Technology Assessments in Reimbursement Systems – an Examination of Ireland as a Case Study

Abstract

Introduction As the pace of health-technology innovations increases, greater pressure is placed on health-technology assessment (HTA) agencies to review and make recommendations promptly. One response to this pressure is the use of rapid reviews (RRs). Since 2009 all new drugs in Ireland are first subject to a RR. The RR process refers costly drugs and those with uncertainty surrounding their cost effectiveness for a full HTA. The objective of this study is to explore differences between drugs that were subject to RR only and a full HTA, compare the number of HTAs in Ireland to those in other jurisdictions and examine what factors determine the outcome of an RR, i.e. if a full HTA is recommended or not. Methods Data on drug evaluations from 2009 to July 2015 were extracted from the NCPE, SMC and NICE websites to support the univariate and comparative analysis. A logit regression was employed to determine the factors influencing the outcome of the RR, i.e. the recommendation for a full HTA. Also, propensity score matching was employed to determine if there was an expected difference in achieving a positive reimbursement between drugs recommended and not recommended for full HTAs. Results Between 2009 and July 2015 a total of 199 drugs were evaluated in Ireland: 53% of them were recommended for a full HTA (n = 105) returning a 76% reimbursement rate. This compares to 120 and 355 HTAs and reimbursement rates of 68% and 80% in Scotland and England and Wales, respectively. Results of the logit reveal that first in class drugs and those indicated for cancer and musculoskeletal disorders were more likely to require a full HTA in Ireland. The matching technique revealed there was an expected difference in achieving a positive reimbursement between drugs recommended and not recommended for full HTAs. Conclusions RRs support decision making in Ireland by reserving full scientific rigor (without comprising outcomes) for technologies that put most pressure on health budgets.