Transferability of results of cost utility analyses for biologicals in inflammatory conditions for Central and Eastern European countries.
BACKGROUND
Several Central and Eastern European (CEE) countries require cost-utility analyses (CUAs) to support reimbursement formulary listing. However, CUAs informed by local evidence are often unavailable, and the cost-effectiveness of the several currently reimbursed biologicals is unclear.


OBJECTIVE
To estimate the cost-effectiveness as multiples of per capita GDP/quality adjusted life years (QALY) of four biologicals (infliximab, etanercept, adalimumab, golimumab) currently reimbursed in six CEE countries in six inflammatory rheumatoid and bowel disease conditions.


METHODS
Systematic literature review of published cost-utility analyses in the selected conditions, using the United Kingdom (UK) as reference country and with study selection criteria set to optimize the transfer of results to the CEEs. Prices in each CEE country were pro-rated against UK prices using purchasing power parity (PPP)-adjusted per capita GDP, and local GDP per capita/QALY ratios estimated.


RESULTS
Central and Eastern European countries list prices were 144-333% higher than pro rata prices. Out of 85 CUAs identified by previous systematic literature reviews, 15 were selected as a convenience sample for estimating the cost-effectiveness of biologicals in the CEE countries in terms of per capita GDP/QALY. Per capita GDP/QALY values varied from 0.42 to 6.4 across countries and conditions (Bulgaria: 0.97-6.38; Czech Republic: 0.42-2.76; Hungary: 0.54-3.54; Poland: 0.59-3.90; Romania: 0.77-5.07; Slovakia: 0.55-3.61).


CONCLUSIONS
While results must be interpreted with caution, calculating pro rata (cost-effective) prices and per capita GDP/QALY ratios based on CUAs can aid reimbursement decision-making in the absence of analyses using local data.
Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary, laszlo.gulacsi@uni-corvinus.hu.
László
L
Gulácsi
Fanni
F
Rencz
Márta
M
Péntek
Valentin
V
Brodszky
Ruth
R
Lopert
Noémi V
NV
Hevér
Petra
P
Baji
D000068879:Adalimumab; D000893:Anti-Inflammatory Agents / Q000191:economics*; D000911:Antibodies, Monoclonal / Q000191:economics; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics; D001688:Biological Products / Q000191:economics*; D003362:Cost-Benefit Analysis; D000068800:Etanercept; D005060:Europe; D006801:Humans; D007074:Immunoglobulin G / Q000191:economics; D000069285:Infliximab; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D018124:Receptors, Tumor Necrosis Factor; D012051:Reimbursement Mechanisms / Q000458:organization & administration
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D001688:Biological Products; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; C529000:golimumab; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept