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IQWiG presents a method for evaluating the relation between cost and benefit
Date:11/30/2009

erapy alternatives using evidence-based medicine (EBM) methods. Only when an additional benefit is identified in this benefit assessment, should a health economic evaluation be carried out.

In the second stage, the scientists ascertain the costs and compare the major benefit and cost aspects. Efficiency frontiers can be derived from the relation between cost and benefit and presented in easy-to-read diagrams, which enable efficient interventions to be identified.

IQWiG provides recommendations for appropriate maximum reimbursable prices

Ultimately, the Institute uses the efficiency frontier to formulate a recommendation as to the appropriate price of a drug. However, it is the GKV-Spitzenverband which is responsible for setting the actual maximum reimbursable price. In doing so, it must also take into consideration the manufacturer's research and development costs. In addition, it can include other aspects such as the severity or frequency of the disease.

According to legislation, the purpose of the health economic evaluation is to set a maximum reimbursable price for certain drugs that is "appropriate" to the increase in benefit. IQWiG assumes that it is appropriate if the new therapy is at least as efficient as the existing therapies for the disease in question.

Impact on total expenditure of health insurance funds estimated

Even if the price for a new health technology is "appropriate", this does not mean that it can be paid by the SHI community and thus be considered reasonable. Consequently, IQWiG will also carry out a budget impact analysis to estimate the impact that a given maximum reimbursable price might have on the total expenditure of the SHI community.

Here the costs are generally described from the perspective of the SHI community. However, depending on the disease, other costs can be included, such as nursing care from the perspective of the social insurance scheme or productivity losses f
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Contact: Dr. Anna-Sabine Ernst
info@iqwig.de
49-022-135-6850
Institute for Quality and Efficiency in Health Care
Source:Eurekalert

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