Abstract
Healthcare systems are increasingly under pressure to provide funding for innovative technologies. These technologies tend to be characterized by their potential to make valued contributions to patient health in areas of relative unmet need, and have high acquisition costs and uncertainty within the evidence base on their actual impact on health. Decision makers are increasingly interested in linking reimbursement strategies to the degree of uncertainty in the evidence base and, as a result, reimbursement for innovative technologies is frequently linked to some form of patient access or risk-sharing scheme. As the dominant methods of economic evaluation report final outcomes only at the time horizon of the analysis, they present only aggregated information. This omits much of the information available on how net benefit is distributed within the time horizon. In this article, we introduce the Net Benefit Probability Map (NBPM), which maps net health benefit versus time to identify how certain decision makers can be about the benefit of technologies at multiple time points. Using an illustrative example, we show how the NBPM can inform decision makers about how long it will take for innovative technologies to ‘pay off’, how methodological choices on discount rates affect results and how alternative payment mechanisms can reduce the risk for decision makers facing innovative technologies.
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Acknowledgements
The research reported in this article was unfunded. All individuals who made substantive contributions to the ideas presented in this article are included as authors. The initial concepts for this article were proposed by Christopher McCabe. Richard Edlin was responsible for the first realisations of the NBPM. Peter Hall undertook the modelling work to provide the examples. All authors contributed towards the arguments towards the application of the probability map. We would also like to acknowledge the constructive contribution of several anonymous referees to improving this article.
Conflicts of interest
The research reported in this article is unfunded research. The focus of the article is methodological and we do not believe it has implications for any specific technology.
Christopher McCabe has no conflicts of interest.
Richard Edlin has no conflicts of interest.
Peter Hall has no conflicts of interest.
Statement on Research Ethics
The research reported in this article is methodological and has not required the use of individual data, either identifiable or anonymous. It has not required approval by a research ethics committee.
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McCabe, C., Edlin, R. & Hall, P. Navigating Time and Uncertainty in Health Technology Appraisal: Would a Map Help?. PharmacoEconomics 31, 731–737 (2013). https://doi.org/10.1007/s40273-013-0077-y
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DOI: https://doi.org/10.1007/s40273-013-0077-y