[PDB73] Analysis of factors influencing decision making on type 2 diabetes drugs in 5 HTA-agencies

[PDB73] Analysis of factors influencing decision making on type 2 diabetes drugs in 5 HTA-agencies

2009 Value in health

Adalsteinsson, J.E. | Jensen, R.C.Ã | Toumi, M. | Hemels, M. | Volume: 12, Issue: 7, Pages: A415, analysis, Decision Making,

OBJECTIVES: To map factors that influence HTA-agencies in their Health Technology
Assessments (HTA) on type 2-diabetes agents in the UK (NICE), Scotland (SMC),
The Netherlands (CVZ) Germany (IQWIG) and Sweden (TLV). METHODS: To
retrieve the HTA reports, a search was executed using the agencies websites with the
following keywords: pioglitazone, rosiglitazone, sitagliptin, vildagliptin, exenatide,
glargine, detemir, aspart, glulisine and lispro. If a report contained several drugs each
drug was counted separately although a decision could involve a class of drugs. Decision
parameters were clustered in three categories: efficacy, safety and health economics
where each assessment could contain multiple parameters. Overall recommendation
was classified in three categories: recommended restricted recommended and not
recommended in relation to indication based on marketing authorisation. RESULTS:
35 reports were identified with 49 assessments. Twelve assessments lead to recommendation
(24%), 23 to restricted recommendation (47%) and fourteen to no recommendation
(29%). Reasons for recommending a treatment contained in 83% of cases
one or more arguments related to efficacy, 33% to safety, and 66% to health economic
aspects of drugs. Reasons for restricted recommendation were 70%, 39%, and 60%,
and for not recommended were 100%, 57% and 21% respectively. Within each decision
parameter the most common reason for restricting the market authorization
indication was related to the drug not being cost-effective (57%). The most common
reason for not recommending a drug was lack of long term data on efficacy (86%).
CONCLUSIONS: Despite that large variations in results between agencies were
observed, data demonstrating efficacy of the drug appeared to be the most important
factor in getting a recommendation for type 2 diabetes treatment. A high incremental
cost-effectiveness ratio was likely to lead to restrictions in indication (NICE, SMC and
TLV) whereas lack of long term data could lead to the drug not being recommended
(IQWIG and CVZ).

https://www.doi.org/10.1016/S1098-3015(10)75051-8