PNS76 A PAN-EUROPEAN HTA, A SINGLE US PAYER?

Abstract

Pressure to cut drug prices in the US is mounting on both sides of the political spectrum. With an election looming and multiple challengers promoting Medicare for All, a route towards consolidating the diverse US payer landscape into a single-payer system is emerging. Across the Atlantic, European national HTA bodies have spent 20 years developing divergent methods of assessment; however, moves towards consolidating divergent national HTAs into a pan-European HTA are ongoing. EUnetHTA was established in 2005 to create an effective and sustainable network for Health Technology Assessment (HTA) across Europe. EUnetHTA Joint Assessments (JAs) are HTAs produced together by at least four different national European HTA bodies. This research aims to evaluate whether the joint production of EUnetHTA JAs resulted in an alignment of national reimbursement decisions and what lessons this may hold for the US. Publicly available information on EUnetHTA JAs for individual drugs were identified along with the associated national appraisal by NICE, SMC,G-BA, TLV, HAS, AIFA, SMC, NCPE, ZIN, Medicinradet, AOTM and NOMA (to 31/12/2019). Twelve EUnetHTA JAs were identified, of these 8 were single technology appraisals, 5/8 for oncology indications and 2/8 were orphan drugs. Forty-seven corresponding national HTA appraisals were identified. Despite the presence of a EUnetHTA JA, national HTA decisions were non-uniform across all products Alecensa (7 positive/3 negative), Stivarga (3 positive/4 negative), Rydapt (6 positive/1 negative), Invokana (6 positive/3 negative), Nexavar (2 positive/3 negative), Cyramza (2 positive/6 negative), Zontivity (0 positive/1 negative), Zynquista (0 positive/0 negative). Drugs appraised under EUnetHTA JAs are not associated with unanimous reimbursement decisions at the national level. Despite political pressure at the European level there seems little appetite to harmonize HTA nationally. The lack of historical HTA across the US payer landscape is one less hurdle for proponents of a single payer system in the US.