Use Case: Informing Strategic Decisions with the Market Access Platform

Smart data on drug development and market access improves the process of valuing drug therapies and empowers companies to achieve optimal reimbursement for their innovation. The Context Matters Market Access Platform (MAP) delivers structured, linked data—what we call smart data—making comparative analysis and contextual views possible to drive decision-making.

See how it’s done with this Use Case. 

Situation

A UK country manager at a midsize pharmaceutical company needs to determine whether to seek approval for reimbursement in the UK from the National Institute for Health and Care Excellence (NICE) for a new hepatitis C treatment. The treatment has proven to be as clinically effective as similar drugs, with a similar adverse events profile. The drug has been launched in other markets with mixed results. The treatment is not the first of its kind and established brands are already on the market in the UK and elsewhere. Based on these factors, the reimbursement decision will be extremely price-sensitive and the predicted  incremental cost-effectiveness ratio (ICER) will serve as a major determining factor.

Initial Requirements

  • Investigate drug approvals for hepatitis C in the UK
  • Examine current landscape of approved drugs and associated ICERs

Decision Criteria

  • Extremely price-sensitive due to drug background
  • Predicted ICER will serve as major determining factor

Search and Decision Process

  • Use the Context Matters MAP with the Economic Strategy module to aggregate, visualize, and comprehend data-derived insights

  • Rely primarily on the application's charting capabilities to create a snapshot of current market conditions in the UK

Drug Valuation/Reimbursement Challenge

  • Decide whether to seek approval for reimbursement from NICE for a new treatment for hepatitis C

  • Find a quick and easy way to make the right drug pricing and reimbursement decision

Drug Background

  • Product launched by company in other markets with mixed results

  • Treatment proven to be as clinically effective as similar drugs, with similar adverse events profile

  • Treatment not the first of its kind

  • Established brands already on the market in the UK and other countries


Step 1 – Define Search

Figure 1: Context Matters Home Page and Quick Search Navigation Box

  • From the home page, view all reimbursement reviews across all agencies included in the standard MAP

  • Run a preliminary search of current market status of hepatitis C medications for adults


Step 2 – Review Analysis 

Figure 2: Market Access Table for Hepatitis C Reviews by Reimbursement Decision

  • Search produced a Market Access Table for hepatitis C for all agencies
  • Widgets provided more nuanced view of results by selecting “Agency” under “Group” and “Reimbursement decision” under “Measure”
  • Context Matters smart data
    • Hovering over stacked bar sections popped up more detailed data, e.g., number of reviews in each category
      • NICE reviewed hepatitis C drugs 21 times, far less than most other agencies
      • Reimbursement decisions for NICE in most reviews either “Recommend” (9 reviews) or “Recommend with restrictions” (8 reviews)

Step 3 – Mine Data

Figure 3: NICE Reimbursement Decisions for Hepatitis C

  • Zoomed in to get more specific details on reimbursement decisions by selecting “Agency” under “Group” and clicking on the NICE stacked bar
  •  Action transformed chart into more focused view of reimbursement landscape for NICE only
  • Table examined details of specific reimbursement decisions by clicking on various elements
  • “Compare” option provided ability to find trends across reimbursement decisions and explore different variables for each review

Step 4 – Dive Deeper

Figure 4: NICE Range of Most Plausible ICERs by Reimbursement Decision for Hepatitis C

 

  • Selected “Most plausible ICER (NICE)” with results organized by reimbursement decision
  • Reviews displayed in ranges of most plausible ICER determined by NICE
  • Table provided more details by ICER category, range, and reimbursement decision
  • Explored data in greater detail by clicking on category or specific review
  • Illustrated that all “Do not recommend” decisions were awarded to reviews with higher ICER ranges (£20,000 – £39,999) or where the ICER was determined to be “not cost effective”
  • Determined that ICER range associated with positive reimbursement outcomes is <£20,000 in this market segment .


Context Matters Outcomes

To make an informed decision, the UK country manager used the MAP information to continue to explore:

  • Variables offered, including reimbursement outcomes in relation to availability of a Patient Access Scheme (PAS)
  • Specific disease genotype in the indication
  • Comparators used in the clinical trials
  • Scope of the indication considered for approval

To determine the likelihood of a positive reimbursement, the UK country manager was able to make a more informed decision about whether to move forward through the reimbursement process for this new product by using the Context Matters Market Access Platform. 

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