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Economic evaluations of healthcare interventions routinely focus on population level cost-effectiveness analyses to support reimbursement decisions; the so-called ‘Fourth Hurdle’. Yet what is informative at the policy level does not always translate meaningfully to the local population or individual patient level. Population level analyses consider the ‘average patient’, while local payers and prescribers work with a group of individual patients with specific characteristics and health challenges.

 Translating the findings of policy level analyses to individual patients requires a full understanding of drivers of economic value and consequent affordability. Demonstrating value to payers and prescribers is increasingly recognised as the ‘Fifth Hurdle’.

 Across a number of disease areas, we have developed tools to facilitate an improved understanding of what defines and drives value within a particular disease area. Only then is it possible to fully establish the net benefits of a technology or service intervention.

 This information is disseminated through workshops, training sessions, symposiums and peer-reviewed publications.

 As an example, in diabetes we have developed tools to facilitate understanding of drivers of cost-effectiveness in patient management and therapeutic choice, including the relationship between glycemic control, hypoglycemia and weight change (1-3), enabling informed decisions around the relative importance of model inputs, risk equations and assumptions on the health economic profile of interventions [4-6].


[1] McEwan P, Bennett H, Fellows J, Priaulx J, Bergenheim K. The Health Economic Value of Changes in Glycaemic Control, Weight and Rates of Hypoglycaemia in Type 1 Diabetes Mellitus. PLoS One. 2016 Sep 15;11(9):e0162441. doi: 10.1371/journal.pone.0162441

 [2] McEwan P, Evans M, Bergenheim K. A population model evaluating the costs and benefits associated with different oral treatment strategies in people with type 2 diabetes. Diabetes Obes Metab. 2010 Jul;12(7):623-30

 [3] McEwan P, Evans M, Kan H, Bergenheim K. Understanding the inter-relationship between improved glycaemic control, hypoglycaemia and weight change within a long-term economic model. Diabetes Obes Metab. 2010 May;12(5):431-6.

 [4] McEwan P, Gordon J, Evans M, Ward T, Bennett H, Bergenheim K. Estimating Cost-Effectiveness in Type 2 Diabetes: The Impact of Treatment Guidelines and Therapy Duration. Med Decis Making. 2015 Jul;35(5):660-70.

 [5] Gordon J, McEwan P, Evans M, Puelles J, Sinclair A. Managing glycaemia in older people with type 2 diabetes: A retrospective, primary care-based cohort study, with economic assessment of patient outcomes. Diabetes Obes Metab. 2017;19(5):644-653.

 [6] Gordon J, Evans M, McEwan P, Bain S, Vora J. Evaluation of insulin use and value for money in type 2 diabetes in the United kingdom. Diabetes Ther. 2013;4(1):51-66.

Market Access and Reimbursement

Chronic hepatitis C virus (HCV) infection is associated with significant morbidity and mortality. The global prevalence of HCV infection has been estimated at 1.6% (1.3–2.1%), equivalent to 115 (92–149) million individuals. Whereas rates of infection are decreasing in the developed world, HCV related liver disease is expected to increase due to the latent nature of early infection and the significant number of undiagnosed cases.

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