Modeling To Inform Payer Communications and Policy – Optimizing Treatment Sequences in Multiple Immunology Indications

Focus Area Immunology

Solutions Value, access & outcomes

Challenge

Health systems view low-cost therapeutic alternatives (biosimilars and generics) as opportunities to reduce their medicine spend. However, this approach focuses on costs only and not outcomes, which results in the adoption of ‘low-cost first’ blanket policies regardless of biologic class or therapy area. Consequently, patients are left to cycle through low-cost options before they can access the most effective treatments
The client sought expertise for the development of a tool that aimed to demonstrate the value of both biosimilars/generics and newer, innovative treatments. By illustrating and quantifying this point, an optimized patient pathway can be developed, where better outcomes are achieved within budget constraints and ultimately, treatment choice is based on the patient need and the outcomes as opposed to solely on costs
This tool was required internationally, to support market access discussions, as well as publishing findings to ultimately help drive the debate on the positioning of innovative treatments as well as to inform updates to clinical guidelines as the market becomes increasingly crowded
The tool needed to be easily updatable as new data and new treatments become available, whilst maintaining consistency in functionality across country adaptations

Desk research and model conceptualization, involving a comprehensive assessment of the available evidence, with a presentation of the suggested model design to an advisory board and client’s internal review committee
Initial model built in Excel with a short-list of countries invited for initial roll-out and testing, with additional validation with clinicians
Migration of model to R-Shiny web app

An online sequencing model, capturing the efficacy and costs of all possible treatment sequences across 7 different immunology indications, considering country-specific reimbursement rules and market share estimate
The model captures the potential improvements in patient outcomes from current practice, as well as the potential cost savings that could be made with efficient use of biosimilars
As a central, core model, it allows updates to be made and rolled out across all adaptations and users simultaneously, with no need for sharing of separate model versions or files
As the model is online, it also allows the user to access it anywhere with connection to the internet, requiring just their username and password
Conference publication presenting the core model methodology and efficacy results (manuscript in progress), giving further validation and academic support to the model