How Could ATMPs Demonstrate an Economic Benefit for Payers and What Are the Real-World Examples of This?

Author(s)

Taylor A1, Chirico G1, Kwong T1, Chunara F2, Craddy P2
1Remap Consulting UK Ltd, Macclesfield, CHE, UK, 2Remap Consulting GmbH, ZUG, ZG, Switzerland

OBJECTIVES: This study explores the role of economic benefit in HTA decisions across different market types: cost-effectiveness driven (UK), budget-impact driven (Italy), and clinical-differentiation driven (France). The aim is to determine whether clinical or economic factors primarily influence these decisions and how this varies across market archetypes.

METHODS: The UK, Italy, and France were chosen as representative market archetypes. ATMPs assessed by HTA bodies within these markets were identified using NICE, AIFA, and HAS databases. Two ATMPs, Yescarta and Alofisel, were selected to illustrate contrasting examples from a P&R perspective. Key payer considerations from HTA reports were categorised as positive, uncertain, or negative, and as clinical or economic. A comparative analysis was conducted between the two ATMPs across the three markets.

RESULTS: Yescarta (first indication) received positive HTA outcomes in the selected markets, often linked to conditions or facilitated by MEAs. Alofisel, however, is only reimbursed in France and only for a sub-group. Key payer considerations for both Yescarta and Alofisel mainly pertain to the clinical domain across all markets. In France and the UK, economic concerns arise from uncertainties in clinical benefit.

CONCLUSIONS: The level of clinical benefit is the key factor in HTA decisions for ATMPs. ATMPs often lack sufficient evidence to demonstrate clinical and economic benefit at launch. Alternative reimbursement schemes, like coverage with evidence development, and payment methods are used to provide access despite uncertainties. However, if clinical benefit uncertainty is too high, as with Alofisel, these schemes are not considered. This is especially true in markets where clinical benefit assessment precedes economic discussions.

Conference/Value in Health Info

2024-11, ISPOR Europe 2024, Barcelona, Spain

Value in Health, Volume 27, Issue 12, S2 (December 2024)

Code

EE420

Topic

Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

Oncology, Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)

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