(Content sponsored by Johnson & Johnson Innovative Medicine)
Authors
Arthur Attema, Associate Professor of health Economics and Utility Theory, Erasmus School of Health Policy & Management
Avril Daly, president of EURORDIS-Rare Diseases europe and CEO of Retina international
Andries Hof, Center for Environmental Quality, national Institute for Public health and the Environment (RIVM)
Maarten J. Postma, Professor of Global Health Economics, University of Groningen
Martin Price, Vice President of Health Economics, Market Access and Reimbursement, EMEA Johnson & Johnson Innovative Medicine
Michael Spackman, Visiting Senior Lecturer, Department of Geography and Environment, London School of Economics and Political Science
Lotte Steuten, Deputy Director General of the Office for Health Economics
Evaluation of preventive interventions in sexually transmitted diseases: the impact of topical practices
The practice of discounting
Frequently enough the costs and benefits of an intervention – whether in the field of healthcare, the environment or other areas of public policy – are not only experienced in the present, but are realized in the future.
In traditional economic evaluations, discounting is a practice that allows costs and benefits too be compared over long periods by adjusting their values to current equivalents. Discounting is based on the idea that individuals prefer to consume sooner rather than later.
But governments are increasingly faced with interventions whose benefits accumulate over many decades, especially in the health and environmental sectors. In these cases, the discount is used in cost-effectiveness and cost-benefit analyzes to inform decision-making about public spending.
Recent advances in preventive health technologies, such as new vaccines, advanced therapy drugs (ATMs) and gene therapies, are challenging traditional health technology assessment (HTA) frameworks, which struggle to adequately capture long-term benefits high initial costs. And this practice raises the question of whether we are creating a barrier for citizens to access these transformative interventions.
How health technology assessment evaluates future benefits
Major health benefits from human papillomavirus (HPV) vaccination, for exmaple, will begin to appear approximately 30 years after the initial vaccination, leading up to the prevention of cervical cancer associated with morbidity and mortality. But studies have shown that the current assessment of the health benefits of HPV vaccination varies considerably when different discount rates and approaches are used.
A similar situation occurs with MTAs. These treatments involve high initial costs – often in the form of a one-off payment for a one-off therapy – but also offer the possibility of obtaining notable benefits throughout the patient’s life, from the interception of the disease to his eventual recovery. <a target="_blank" href="https://www.ohe.org/insight/cost-effectiveness-analysis-of-gene-therapies-for-inherited-eye-disease-are-current-discounting-approaches-too-short-sighted/" data-wpel-link="
Most countries apply the same discount rate to healthcare costs and benefits.The problem is that there is often little or no evidence to support this approach.
To make matters worse, current value assessment methodologies do not necessarily reflect the wide range of social benefits that both offer vaccines AS the MTAs: productivity of patients and healthcare workers, such as, or savings in social care.
Therefore, preventive interventions, such as new vaccines and MTA, may be at a disadvantage in STDs due to the combined challenges of discounting, uncertainty in long-term outcomes, and limited appreciation of elements of value beyond primary healthcare.
Approaches to STDs also differ by area. Some countries,such as Germany and Switzerland,currently do not use discounts in the evaluation of drugs for sexually transmitted diseases,focusing mainly on clinical aspects. This diversity of methods could perpetuate inequalities in the EU and represent a potential barrier to patient access in countries where cost-effectiveness drives reimbursement decisions.
In environmental policy,traditional discounting practices would weigh public decision-making over climate change prevention measures.
Economists now accept an alternative approach to discounting,which uses a rather decreasing discount rateand apply it in environmental contexts. This reflects the idea that people favor doing more for the future when there is uncertainty in consumption growth and economic and ecological risks are positively correlated.
For health economics, lessons can be learned from this evolution in the environmental economics approach.
Given the large impact that discounting has on profits, the standards used in the ETS must be fully transparent.At a minimum, sensitivity analyzes shoudl show policy makers how different discounting scenarios affect the overall outcome.
We should also explore non-traditional discounting approaches. one of they This is differential discounting, where a lower rate is used for health effects than costs, because quality of life increases in value as income grows over time. This approach is currently applied in Belgium, Poland and the Netherlands. Other countries apply time-varying discounts, where a lower discount rate is used for effects that occur after a certain number of years: France, for example, after 30 years, or Denmark
and alternative payment models could be a complementary way to address the issue of uncertainty (due to lack of outcomes and long-term data) with interventions such as MTAs: outcomes-based payment models, for example.There is no doubt that these solutions should better leverage the use of real-world data (DMR) to make them work for both manufacturers and payers.
Adopt a future perspective in decision making
To ensure that patients across Europe have timely access to transformative treatments, we need fit-for-purpose value assessment methodologies.
Policy makers and HTA agencies should take a long-term perspective and broaden their view of what constitutes value in cost-effectiveness analyses. They should also consider a broader range of benefits, beyond health outcomes themselves.
With the pace of innovation,changes in social preferences,and a growing focus on the sustainability and resilience of healthcare systems,it is indeed time for policymakers and all healthcare stakeholders to collaborate on this vision.
STD procedures must give due importance to long-term interventions. Currently, alternative discounting methods remain underutilized, despite being well established in several countries and industries. We need to advance methodologies that allow us to better capture the value of innovative and preventative healthcare technologies and ultimately ensure patient access.
What is the role of health technology assessment (HTA) in evaluating the value of preventive interventions like vaccines?
Interview between Time.news Editor and Martin Price, Vice President of Health Economics, Market Access and Reimbursement, EMEA Johnson & Johnson Innovative Medicine
Time.news Editor: Good afternoon,martin! Thank you for joining us today too discuss the complex interplay between health economics and the evaluation of preventive interventions in the context of sexually transmitted diseases (STDs).
Martin Price: Good afternoon! Thank you for having me. It’s a crucial topic, especially as we see tremendous changes in health technology.
Time.news Editor: Absolutely! Your recent article highlights the practice of discounting in health technology assessment (HTA). Can you explain why discounting is used and how it impacts the evaluation of long-term health interventions?
Martin Price: Certainly! discounting is a method used to compare costs and benefits over different time periods. Essentially, it reflects the preference for immediate benefits over future benefits. In economic evaluations, this poses unique challenges, especially for preventive health interventions like vaccines and advanced therapies that yield benefits many years down the road.
Time.news Editor: It sounds like a double-edged sword. On one hand, it helps with evaluations, but on the other, it risks underestimating the true value of long-term interventions. How do you see this affecting access to transformative therapies?
Martin Price: That’s a key concern. With many preventive measures, particularly vaccines, the full benefits—like decreased incidence of diseases and enhanced quality of life—may only be realized decades later. This delay can result in substantial discounting during HTA evaluations, influencing reimbursement decisions.Hence, we might inadvertently create barriers for patients seeking access to these life-saving interventions.
Time.news Editor: Speaking of vaccines, the article mentions the long-term benefits of HPV vaccination specifically. Can you elaborate on how current HTA practices may misjudge its value?
martin Price: Of course. HPV vaccination can prevent cervical cancer and other HPV-related diseases, but as you mentioned, the significant health benefits may not manifest until 30 years post-vaccination. Current HTA frameworks often use a single discount rate for costs and benefits, which in the case of HPV vaccines, could undervalue the vast long-term savings in terms of healthcare costs and improved quality of life.
Time.news Editor: It seems like differing approaches to discounting among countries could widen inequalities. How do different countries’ evaluation methods impact patient access to preventive treatments for STDs?
Martin Price: Exactly! Different countries, like Germany and Switzerland, refrain from discounting for certain interventions, focusing instead on clinical outcomes. This divergence can perpetuate inequalities within the EU. If countries with stringent HTA processes undervalue future benefits, they may restrict access to critical treatments, while others may facilitate broader patient access based on different evaluation criteria.
Time.news Editor: That raises a critical point about the need for a more consistent approach to health economics across Europe.What recommendations would you suggest to improve the evaluation of preventive interventions?
Martin Price: we need to embrace a more nuanced framework that acknowledges the long-term social value of health interventions. This means adapting HTA methodologies to reflect the broader impacts of vaccines and treatments—such as increased productivity, reduced healthcare costs in the long run, and enhanced overall community well-being. Collaboration between governments, health authorities, and stakeholders, including pharmaceutical companies, is essential here.
Time.news Editor: It’s clear that creating equitable access to healthcare requires a thorough rethink of evaluation methods. Before we wrap up, what do you believe is the biggest challenge ahead in overcoming these barriers?
Martin Price: I think the primary challenge lies in shifting perceptions. We must facilitate understanding among policymakers about the long-term social and economic benefits of preventive health interventions. As we gather more data on these interventions’ impacts over time, I hope we can transition towards a more favorable HTA landscape that recognizes and rewards future benefits.
Time.news Editor: Thank you for such insightful discussion,martin! Addressing these issues will be pivotal in ensuring that patients have adequate access to innovative therapies. We appreciate your expertise and look forward to seeing these changes take shape in health policy.
Martin Price: Thank you for having me. I’m optimistic about the future of health economics and the potential for impactful change!
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This engaging dialog illustrates the complexities of health economics and the importance of reevaluating assessments to ensure equitable access to preventive health interventions.