Jump to comment:

• Value-based versus real prices of four innovative devices for interventional cardiology
  Andrea Messori
  Published on: 13 January 2009

• Published on: 13 January 2009

  Value-based versus real prices of four innovative devices for interventional cardiology

  • Andrea Messori
  • Other Contributors:
    • and Sabrina Trippoli

  The guidance on drug-eluting stents by Richarson et al. (1) is a typical application of the value-based approach that NICE systematically uses to examine costs and benefits of innovative treatments.

   ...

  Show More

  The guidance on drug-eluting stents by Richarson et al. (1) is a typical application of the value-based approach that NICE systematically uses to examine costs and benefits of innovative treatments.

   

  In countries like Italy where national regulatory agencies do not use any value-based approach in their approval process, appraisals on whether or not innovative interventions are value for money are left to individual researchers or to the work of scientific societies. While the impact of such unofficial appraisals is admittedly low, one advantage is that the speed of completion of these analyses is faster.

   

  With respect to Italian costing data, Table 1 summarises the value-based data of 4 innovative treatments in the area of interventional cardiology published in the website of an Italian scientific society. The real price (RP) and the value-based price (VBP) are reported for each of these 4 devices and compared with one another. One point of strength of this analysis is the speed of availability of the information in relation to the date of publication of the original clinical data (e.g. reference 3).

   

  These comparisons of RP versus VBP show a remarkable heterogeneity that both decision-makers and clinicians are generally unaware of. Extreme situations include, on the one hand, carotideal filters (that are currently paid for much more than their value-based price) and, on the other hand, drug-eluting stents in acute myocardial infarction (that could claim, according to value-based principles, a nearly ten-fold increase in their price if their favourable impact on survival is confirmed by further studies).

   

  Regardless of whether or not individual countries have incorporated value-based analysis in their regulatory approval process, it becomes increasingly clear that all health-care professionals will have to gain more and more familiarity with these issues in the near future; many of them will probably be called to discussing value-based data and even to understanding why agreement or discrepancies are found between RP and VBP. From this perspective, the case of drug-eluting stents used for their on-label indications or acute myocardial infarction is particularly interesting.

   

  References

   

  1. Richardson J, Stevens A, Barnett D, Longson C. Drug-eluting stents for the treatment of coronary artery disease: NICE technology appraisal guidance. Heart. 2008 Sep 3. [Epub ahead of print]

   

  2. Trippoli S. Definizione del prezzo dei dispositivi medici innovativi sulla base del rapporto costo efficacia (abstract),XXIX Congresso Nazionale SIIFO, Napoli, 12 - 15 October 2008

   

  3. Mauri L, Silbaugh TS, Garg P, Wolf RE, Zelevinsky K, Lovett A, Varma MR, Zhou Z, Normand SL. Drug-eluting or bare-metal stents for acute myocardial infarction- N Engl J Med 2008;359:1330-42.

   

   

   

  Table 1. Innovative devices for interventional cardiology: value-based information published

  in the website of the Osservatorio Innovazione#.

   

  	Incremental benefit	Real price (RP)	Value-based price (VBP)	Comparison
  Drug-eluting stents for on-label indications*	Avoidance of 5.7 revascularisations for every 100 patients	EUR 1,600##	EUR 961	RP > VBP
  Left ventricular assist device (Heartmate) for end-stage heart failure	Survival gain of 9 to 16 months per patient	EUR 75,000*	EUR 45, 000 to 82,426	RP ≈ VBP
  Protective filters in carotideal stenting	Avoidance of 0.7 ipsilateral strokes for every 100 patients	EUR 1,100*	EUR 300	RP > VBP
  Drug eluting stents in acute myocardial infarction	Survival gain of 2.65 months per patient	EUR 1,412**	EUR 13,567	RP < VBP

   

   

  # All but one of these examples have been published over the past months in the website

  www.osservatorioinnovazione.org coordinated by the Italian Society of Hospital Pharmacists (file

  cards number 5, 13, and 32); the data concerning carotideal filters have been presented as an

  abstract at the national congress of the same society (2); drug-eluting stents are assessed in comparison

  with bare metal stents (RP in 2008 = EUR 500; differential in RP between the two types

  of stents = approximately EUR 1,000).

   

  ## Price paid by the Azienda Ospedaliero-Universitaria Careggi of Firenze in 2007.

   

  * Price paid by the Azienda Ospedaliero-Universitaria Careggi of Firenze in 2008.

   

  ** Price paid by the Azienda Ospedaliera S. Maria Nuova of Reggio Emilia in 2008.

   

   

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top