OHE at ISPOR Italy Chapter – Rome: Are Wider Societal Effects Considered in Healthcare Decision-making?

Martina Garau presented at the last ISPOR Italy Chapter – Rome conference on the topic of economic gains produced by health interventions.

On 12th April 2016, OHE’s Martina Garau  presented at the ISPOR Italy Chapter – Rome conference on the topic of the inclusion of wider societal effects in public investment decision making in Italy.

A key example of a wider societal impact is indirect costs, which can arise from reductions in productivity at work or increases in sickness absence, non-employment or early retirement.

Based on evidence from a recently published paper, Martina showed that the inclusion of wider effects in Health Technology Assessment (HTA) decision making processes is still controversial and infrequent.

She concluded that HTA agencies should signal a willingness to consider wider effects systematically, or should initiate pilots to test the appropriateness of selected methods for estimating those effects and the feasibility of incorporating them in decision making. These actions would encourage manufacturers to invest in generating the evidence required to demonstrate the existence and the magnitude of wider effects of specific treatments.

There were three further presentations at the conference given by:

• Professor Francesco Saverio Mennini, President of the ISPOR Italy Chapter – Rome;
• Pierluigi Russo, Director of the HTA Office at the Italian Medicine Agency (AIFA);
• Giovanna Scroccaro, representative of a regional payer and member of the AIFA Committee.

Professor Francesco Saverio Mennini presented evidence showing the magnitude of indirect costs in some disease areas. For example, in Italy, indirect costs of Hepatitis C, including loss of productivity, total around 600 million of euros (accounting for 60% of the disease total costs); indirect costs of diabetes, including absenteeism and early retirement are estimated to be around 11 billion of euros (accounting for 54% of the disease total costs).

Professor Mennini concluded that this evidence reinforces the need for taking indirect costs into account when allocating resources. In particular, he emphasised the need to identify innovative approaches to tackle the issue of budget silos and to plan resources allocation in an integrated fashion. Money transfers across government departments based on estimated or actual cost savings are a potential way forward.

Pierluigi Russo explained that the AIFA is developing a new guide for manuafactuers, which includes a section on indirect costs. However, the extent to which those costs will be taken into account when making pricing and reimbursement decisions remains to be seen.

Giovanna Scroccaro highlighted that there is a lack of consensus on the most appropriate method(s) of measuring indirect costs. This hinders widespread consideration of such costs in resource allocation decisions. This is also the case for some direct costs, such as hospital admissions, where actual cost savings can be hard to measure and are sometimes overestimated.

For further information please contact Martina Garau  at OHE.

Related work:

Garau, M., Shah, K.K., Sharma, P. and Towse, A., 2016. Is the Link Between Health and Wealth Considered in Decision Making? Results from a Qualitative Study.  International Journal of Technology Assessment in Health Care, 31(6), pp.449-456.

Johannesson, M., Jonsson, B., Jonsson, L., Kobelt, G. and Zethraeus, N., 2009. Why Should Economic Evaluations of Medical Innovations Have a Societal Perspective?  OHE Briefing. London: Office of Health Economics.