PDG33 Awareness and Consideration of Confidential Listing Agreements in Cost-Effectiveness Evaluation By Health Technology Assessment (HTA) Bodies

Abstract

Use of confidential listing agreements is growing in Québec (Canada). This reality creates an additional challenge during medicine cost-effectiveness assessment by HTA bodies. The objectives are to briefly describe the nature of listing agreements and identify if other HTA organizations around the world are aware of such agreements and how they take it into consideration. A literature review was conducted to assess the nature of confidential negotiated agreements. Then, HTA bodies’ websites were consulted. HTA organizations were selected if their respective jurisdiction was deemed similar to the ‘consumer protection priorities and economic wealth' of Canada (previously identified by the Patented Medicine Prices Review Board, PMPRB). Additionally, a short questionnaire was sent to members of the International Network of Agencies for Health Technology Assessment (INAHTA) regarding confidential agreements. Discount rate agreements, average ranging from 20 to 29%, are the most common form of listing agreement reported in the literature. Eighteen countries or provinces were included in the analysis (either via the PMPRB criterion or via an answer to the INAHTA questionnaire). Two did not have confidential listing agreements. Eight of the remaining 16 HTA organizations (50%) were aware of the content of the agreement and redacted information in their public reporting of cost-effectiveness analysis. For the 8 organizations that didn't have access to the content, including INESSS, different strategies have been adopted to deal with this uncertainty. While some don't take it into consideration at all, most use sensitivity analysis or, based on an average discount, estimate a discounted price. Access to confidential listing agreements by HTA bodies would be ideal to increase the accuracy of cost-effectiveness analysis and optimize the interpretation of results by decision makers. If impossible, HTA organizations should explore different approaches to illustrate the impact of confidential agreements.