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      Advanced therapy medicinal products and health technology assessment principles and practices for value-based and sustainable healthcare

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          Abstract

          Background

          Advanced therapy medicinal products (ATMPs) are beginning to reach European markets, and questions are being asked about their value for patients and how healthcare systems should pay for them.

          Objectives

          To identify and discuss potential challenges of ATMPs in view of current health technology assessment (HTA) methodology—specifically economic evaluation methods—in Europe as it relates to ATMPs, and to suggest potential solutions to these challenges.

          Methods

          An Expert Panel reviewed current HTA principles and practices in relation to the specific characteristics of ATMPs.

          Results

          Three key topics were identified and prioritised for discussion—uncertainty, discounting, and health outcomes and value. The panel discussed that evidence challenges linked to increased uncertainty may be mitigated by collection of follow-on data, use of value of information analysis, and/or outcomes-based contracts. For discount rates, an international, multi-disciplinary forum should be established to consider the economic, social and ethical implications of the choice of rate. Finally, consideration of the feasibility of assessing the value of ATMPs beyond health gain may also be key for decision-making.

          Conclusions

          ATMPs face a challenge in demonstrating their value within current HTA frameworks. Consideration of current HTA principles and practices with regards to the specific characteristics of ATMPs and continued dialogue will be key to ensuring appropriate market access.

          Classification code

          I.

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          Most cited references60

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          Toward a More General Theory of Regulation

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            Spanish recommendations on economic evaluation of health technologies.

            The economic evaluation of health technologies has become a major tool in health policy in Europe for prioritizing the allocation of health resources and the approval of new technologies. The objective of this proposal was to develop guidelines for the economic evaluation of health technologies in Spain. A group of researchers specialized in economic evaluation of health technologies developed the document reported here, following the initiative of other countries in this framework, to provide recommendations for the standardization of methodology applicable to economic evaluation of health technologies in Spain. Recommendations appear under 17 headings or sections. In each case, the recommended requirements to be satisfied by economic evaluation of health technologies are provided. Each recommendation is followed by a commentary providing justification and compares and contrasts the proposals with other available alternatives. The economic evaluation of health technologies should have a role in assessing health technologies, providing useful information for decision making regarding their adoption, and they should be transparent and based on scientific evidence.
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              A rational framework for decision making by the National Institute For Clinical Excellence (NICE).

              Regulatory and reimbursement authorities face uncertain choices when considering the adoption of health-care technologies. In this Viewpoint, we present an analytic framework that separates the issue of whether a technology should be adopted on the basis of existing evidence from whether more research should be demanded to support future decisions. We show the application of this framework to the assessment of heath-care technologies using a published analysis of a new drug treatment for Alzheimer's disease. The results of the analysis show that the amount and type of evidence required to support the adoption of a health technology will differ substantially between technologies with different characteristics. Additionally, the analysis can be used to aid the efficient design of research. We discuss the implications of adoption of this new framework for regulatory and reimbursement decisions.
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                Author and article information

                Contributors
                +4687369000 , Bengt.Jonsson@hhs.se
                Journal
                Eur J Health Econ
                Eur J Health Econ
                The European Journal of Health Economics
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1618-7598
                1618-7601
                18 September 2018
                18 September 2018
                2019
                : 20
                : 3
                : 427-438
                Affiliations
                [1 ]ISNI 0000 0001 1214 1861, GRID grid.419684.6, Department of Economics, , Stockholm School of Economics, ; Stockholm, Sweden
                [2 ]ISNI 0000 0004 0629 613X, GRID grid.482825.1, Office of Health Economics, ; London, UK
                [3 ]ISNI 0000 0004 1936 9262, GRID grid.11835.3e, University of Sheffield, ; Sheffield, UK
                [4 ]ISNI 0000 0004 0629 613X, GRID grid.482825.1, Office of Health Economics, ; London, UK
                [5 ]ISNI 0000 0001 2163 2777, GRID grid.9122.8, Leibniz University Hannover, ; Hannover, Germany
                [6 ]Medi-Qualite Omega, Paris, France
                Author information
                http://orcid.org/0000-0002-0051-7785
                http://orcid.org/0000-0002-2019-1268
                http://orcid.org/0000-0002-3422-7102
                http://orcid.org/0000-0002-5322-9453
                http://orcid.org/0000-0002-7344-7837
                Article
                1007
                10.1007/s10198-018-1007-x
                6438935
                30229376
                ce4551d7-e064-4cb0-ba46-f5ffadff1efc
                © The Author(s) 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 4 March 2018
                : 11 September 2018
                Funding
                Funded by: Kite Pharma, a Gilead company
                Categories
                Original Paper
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2019

                Economics of health & social care
                advanced therapy medicinal products,regenerative medicine,cell therapy,gene therapy,health technology assessment,value

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