HTA in Germany: very special and specific

Abstract

This is a special issue of the European Journal of Health Economics in various ways. First, it contains solely health economic evaluations which have been submitted during the last year. We will continue this policy of publishing topical issues from time to time in which we bundle a couple of accepted papers dealing with the same topic or methodological approach. Second, it is the first issue of 2010, the year in which we change from four to six issues per annum. This is necessary to enable publication of more of the outstanding high-quality papers which have been submitted to the EJHE. It reflects the increasing number of outstanding submissions in recent years. The editors are very grateful to the authors, the reviewers, and the publisher who made this success happen. Third, a citation index will be published for the EJHE for the first time in 2010. Germany will attract the attention of health economists around the world in 2010. The IQWIG (German Institute for Quality and Efficiency in Health Care) will turn into a full HTA agency assessing not only the benefits but also the costs of drugs and therapies. IQWiG will definitely start with a number of cost–benefit assessments in 2010 to support decision making on reimbursement of drugs for the German sickness funds. This will show how the methods for cost–benefit analysis published by the IQWiG will be employed in practice. The reader of the EJHE will recall the controversies about the IQWiG’s efficiency frontier to derive maximum reimbursement prices for innovative drugs. The German pharmaceutical market is regulated by numerous instruments: negative lists for drugs which are not reimbursed, reference prices, and maximum prices for innovative drugs (§ 139 German Social Code Book V). To implement those regulations information about cost and benefits are needed. This is a change of emphasis for the German health care market. In the past reimbursement decisions were made solely on the basis of need and efficiency, which has been considered as the absence of wastefulness but not as a criterion to balance cost and benefit, especially of innovative and costly therapies. In December 2009 IQWiG was commissioned by Germany’s central reimbursement institution, the Federal Joint Commission (Gemeinsamer Bundesausschuss, GBA), with the first cost–benefit assessments. The first commission will be assessment of the cost and benefits of four antidepressive drugs (venlafaxin, duloxetin, bupropion, and mirtazapin) in comparison with other drugs currently reimbursed by the sickness finds. The second commission is an assessment of clopidogrel in combination with acetylsalicylic acid (ASA) for treatment of coronary heart disease (CHD) (and clopidogrel in monotherapy in peripheral arterial occlusive disease) in comparison to ASA monotherapy. IQWiG’s cost–benefit assessments can be used by the German sickness funds to cut reimbursement for drugs declared to be ineffective. But IQWiG’s responsibilities are more than that. The institute was founded by the Federal Joint Committee in June 2004. The IQWiG’s obligation is to analyse the benefits of new technologies (for example innovative drugs) and drugs with high significance to the W. Greiner (&) Department for Health Economics, School of Public Health, University of Bielefeld, Postfach 10 01 31, Bielefeld, Germany e-mail: wolfgang.greiner@uni-bielefeld.de