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      How aligned are the perspectives of EU regulators and HTA bodies? A comparative analysis of regulatory‐HTA parallel scientific advice

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          Abstract

          Background

          In 2010, the European Medicines Agency (EMA) initiated a pilot project on parallel scientific advice with Health Technology Assessment bodies (HTABs) that allows manufacturers to receive simultaneous feedback from both the European Union (EU) regulators and HTABs on their development plans for medicines.

          Aims

          The present retrospective qualitative analysis aimed to explore how the parallel scientific advice system is working and levels of commonality between the EU regulators and HTABs, and among HTABs, when applicants obtain parallel scientific advice from both a regulatory and an HTA perspective.

          Methods

          We analysed the minutes of discussion meetings held at the EMA between 2010, when parallel advice was launched, and 1 May 2015, when the cutoff date for data extraction was set. The analysis was based on predefined criteria and conducted at two different levels of comparison: the answers of the HTABs vs. those of the regulators, and between the answers of the participating HTA agencies.

          Results

          The analysis was based on 31 procedures of parallel scientific advice. The level of full agreements was highest for questions on patient population (77%), while disagreements reached a peak for questions on the study comparator (30%). With regard to comparisons among HTABs, there was a high level of agreement for all domains.

          Conclusions

          There is evident commonality, in terms of evidence requirements between the EU regulators and participating HTABs, as well as among HTABs, on most aspects of clinical development. Indeed, regardless of the question content, the analysis showed that a high level of overall agreement was reached through the process of parallel scientific advice.

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          Most cited references7

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          Key principles for the improved conduct of health technology assessments for resource allocation decisions.

          Health technology assessment (HTA) is a dynamic, rapidly evolving process, embracing different types of assessments that inform real-world decisions about the value (i.e., benefits, risks, and costs) of new and existing technologies. Historically, most HTA agencies have focused on producing high quality assessment reports that can be used by a range of decision makers. However, increasingly organizations are undertaking or commissioning HTAs to inform a particular resource allocation decision, such as listing a drug on a national or local formulary, defining the range of coverage under insurance plans, or issuing mandatory guidance on the use of health technologies in a particular healthcare system. A set of fifteen principles that can be used in assessing existing or establishing new HTA activities is proposed, providing examples from existing HTA programs. The principal focus is on those HTA activities that are linked to, or include, a particular resource allocation decision. In these HTAs, the consideration of both costs and benefits, in an economic evaluation, is critical. It is also important to consider the link between the HTA and the decision that will follow. The principles are organized into four sections: (i) "Structure" of HTA programs; (ii) "Methods" of HTA; (iii) "Processes for Conduct" of HTA; and (iv) "Use of HTAs in Decision Making."
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            Relative efficacy of drugs: an emerging issue between regulatory agencies and third-party payers.

            Drug regulatory agencies have traditionally assessed the quality, safety and efficacy of drugs, and the current paradigm dictates that a new drug should be licensed when the benefits outweigh the risks. By contrast, third-party payers base their reimbursement decisions predominantly on the health benefits of the drug relative to existing treatment options (termed relative efficacy; RE). Over the past decade, the role of payers has become more prominent, and time-to-market no longer means time-to-licensing but time-to-reimbursement. Companies now have to satisfy the sometimes divergent needs of both regulators and payers, and to address RE during the pre-marketing stages. This article describes the current political background to the RE debate and presents the scientific and methodological challenges as they relate to RE assessment. In addition, we explain the impact of RE on drug development, and speculate on future developments and actions that are likely to be required from key players.
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              Time to market and patient access to new oncology products in Italy: a multistep pathway from European context to regional health care providers.

              The main purpose of this study was to identify each sequential phase followed by an oncology product, from European assessment until to patient access in each Italian region (IR). A panel of oncology products approved by the European Medicines Agency (EMA) in the period 2006-2008 was considered. The explored sequential phases included the times to market for: the EMA; pharmaceutical companies; the Italian Medicines Agency (Agenzia Italiana del Farmaco, AIFA); and IRs as final providers of health care. The IR's time to market was also analyzed by a Cox regression model. The overall mean time required before patients access was 2.3 years. EMA accounted for the greater proportion of time (31.8%), followed by AIFA (28.2%). However, the duration for both pharmaceutical companies and IRs was associated with the highest variability. An oncology product authorized with a risk-sharing agreement showed an early access in the IRs. On the contrary, the introduction in IRs having a compulsory formulary was delayed. Both a high forecast of economic impact and a high oncology product price can also delay the patient access. The process before patient access to an oncology product is time and cost consuming. This study identifies the main predictors that affect the missing overlap between market and patient access in Italy.
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                Author and article information

                Contributors
                giovanni.tafuri@ema.europa.eu
                Journal
                Br J Clin Pharmacol
                Br J Clin Pharmacol
                10.1111/(ISSN)1365-2125
                BCP
                British Journal of Clinical Pharmacology
                John Wiley and Sons Inc. (Hoboken )
                0306-5251
                1365-2125
                01 July 2016
                October 2016
                01 July 2016
                : 82
                : 4 ( doiID: 10.1111/bcp.v82.4 )
                : 965-973
                Affiliations
                [ 1 ]European Medicines Agency (EMA) 30 Churchill Place London E14 5EUUK
                [ 2 ]Italian Medicines Agency (AIFA) via del Tritone 181 ‐ 00187 RomeItaly
                [ 3 ]German Federal Joint Committee (G‐BA) Wegelystr. 8 D‐10623 BerlinGermany
                [ 4 ]Catalan Agency for Health Quality and Assessment (AQuAS) Carrer de Roc Boronat 81‐95 08005 BarcelonaSpain
                [ 5 ]National Institute for Health and Care Excellence (NICE) 10 Spring Gardens London SW1A 2BUUnited Kingdom
                [ 6 ]Dental and Pharmaceutical Benefits Agency (TLV) Fleminggatan 7 112 26 StockholmSweden
                [ 7 ]National Institute for Sickness and Invalidity Insurance (INAMI) Avenue de Tervueren 211 1150 BruxellesBelgium
                [ 8 ]Main Association of Austrian Social Security Institutions (HVB) Kundmanngasse 21 A‐1031 ViennaAustria
                Author notes
                [*] [* ] Correspondence

                Giovanni Tafuri, PhD, National Expert on Secondment, Scientific Advice, European Medicines Agency, 30 Churchill Place, London, E14 5EU, UK.

                Tel.: +44 (0)20 3660 8135

                E‐mail: giovanni.tafuri@ 123456ema.europa.eu

                Article
                BCP13023 MP-00235-16.R1
                10.1111/bcp.13023
                5137821
                27245362
                7075bb40-4b40-4d0e-9578-164eb13a8f0f
                © 2016 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 17 March 2016
                : 20 May 2016
                : 28 May 2016
                Page count
                Figures: 4, Tables: 3, Pages: 9, Words: 5670
                Categories
                Clinical Trials
                Clinical Trials
                Custom metadata
                2.0
                bcp13023
                October 2016
                Converter:WILEY_ML3GV2_TO_NLMPMC version:4.9.4 mode:remove_FC converted:09.09.2016

                Pharmacology & Pharmaceutical medicine
                agreement,ema,health technology assessment,parallel scientific advice,regulatory

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