title: A comparison of pharmaceutical reimbursement agencies' processes and methods in France and Scotland.
abstract: OBJECTIVE
  Pharmaceutical reimbursement agencies' processes and methods of appraisal vary across countries. The objective of this study was to examine the contribution of formal health economic analysis in a process using such analysis in Scotland in comparison to a process not routinely using such analysis in France.
  
  
  METHODS
  A framework for classifying reimbursement systems was used to analyze the two systems. A typology of recommendation was defined and a qualitative analysis of decisions on a sample of medicines appraised by both reimbursement agencies was conducted. Reasons for differences in recommendations were analyzed and case studies selected to illustrate the common reasons.
  
  
  RESULTS
  Thirty-nine common medicines appraised by both agencies were identified between 2005 and 2010, treating a variety of diseases for which the Scottish Medicines Consortium tended to provide more restrictive, or did not recommend, listing. Similarities in clinical evidence submitted to the respective reimbursement committees were observed. Differences in recommendation can be explained by a combination of the manufacturer's freedom to set price and the incentives provided by the consideration of health economic analysis and quality of life, alongside differences in relevant comparators, relevant outcomes, treatment guidelines, and the propensity to use network meta-analysis, in decision making.
  
  
  CONCLUSIONS
  This study provides some explanations and hypotheses for the differences observed in recommendations for a selected sample of medicines with regards to differences in appraisal processes and methods adopted. Further research using larger datasets may allow stakeholders to assess the impact of such differences on the efficient use of health resources.
authors.affiliation: York Health Economics ConsortiumUniversity of York, York, United Kingdom. matthew.bending@york.ac.uk
authors.forename: Matthew
authors.initials: M
authors.lastname: Bending
authors.forename: John
authors.initials: J
authors.lastname: Hutton
authors.forename: Clare
authors.initials: C
authors.lastname: McGrath
mesh_terms: D003657:Decision Making; D005602:France; D033161:Government Regulation; D006291:Health Policy / Q000191:economics*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics / Q000706:statistics & numerical data*; D007356:Insurance, Pharmaceutical Services / Q000191:economics / Q000706:statistics & numerical data*; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data*; D055553:Prescription Drugs / Q000191:economics*; D011634:Public Health; D012606:Scotland
chemical_list: D055553:Prescription Drugs