Abstract
Funding innovation under budget constraints is a trade-off between savings and reimbursement at sustainable prices. For innovations with multiple-indications like immunotherapies, one of the ways is to move from volume-based to value-based pricing models. That is what the PRM (Personalized Reimbursement Models) project sought to do by providing a pricing-model based on patients’ real-life benefit of atezolizumab in lung cancer, thanks to a better knowledge of hospital drugs’ usage. The PRM data collection is based on IT systems of the French hospitals (Electronic Pharmacy Record). Data related to demographics, disease description and drug usage are collected in the EPR and partner hospitals share their data 2-3 times a year. PRM data collection is compliant with privacy requirements. Data are controlled and centralized in an anonymous and secure way through a hosting provider. Data management is validated by a scientific committee. PRM started in 2014. More than 135 hospitals/clinics are currently taking part, covering 33% and 45% of patients with lung and breast cancers respectively and ensuring the representativeness of patient care at the national level. The database includes 26,500 breast cancer and almost 3,000 lung cancer patients. A first PRM-price agreement was signed in February 2019 between Roche and the French economic committee, based on real-life usage data of atezolizumab in lung cancer. Roche is committed to reimburse to national health insurance all treatment cycles of patients who do not fully benefit from the drug. For this therapy, the benefit is correlated with the treatment duration since a short duration means a toxicity issue or a lack of treatment efficacy. By developing a robust and representative real-world database, Roche-France was able to sign the first price agreement based on PRM data. Other pricing models might follow per indication, treatment combinations or any other usage conditions of drugs in breast/lung cancer.
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