title: Reimbursement-Based Economics--What Is It and How Can We Use It to Inform Drug Policy Reform?
abstract: BACKGROUND
  In Ontario, approximately $3.8 billion is spent annually on publicly funded drug programs. The annual growth in Ontario Public Drug Program (OPDP) expenditure has been limited to 1.2% over the course of 3 years. Concurrently, the Ontario Drug Policy Research Network (ODPRN) was appointed to conduct drug class review research relating to formulary modernization within the OPDP. Drug class reviews by ODPRN incorporate a novel methodological technique called reimbursement-based economics, which focuses on reimbursement strategies and may be particularly relevant for policy-makers.
  
  
  OBJECTIVE
  To describe the reimbursement-based economics approach.
  
  
  METHODS
  Reimbursement-based economics aims to identify the optimal reimbursement strategy for drug classes by incorporating a review of economic literature, comprehensive budget impact analyses, and consideration of cost-effectiveness. This 3-step approach is novel in its focus on the economic impact of alternate reimbursement strategies rather than individual therapies.
  
  
  RESULTS
  The methods involved within the reimbursement-based approach are detailed. To facilitate the description, summary methods and findings from a recent application to formulary modernization with respect to the drug class tryptamine-based selective serotonin receptor agonists (triptans) used to treat migraine headaches are presented.
  
  
  CONCLUSIONS
  The application of reimbursement-based economics in drug policy reforms allows policy-makers to consider the cost-effectiveness and budget impact of different reimbursement strategies allowing consideration of the trade-off between potential cost savings vs increased access to cost-effective treatments.
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Doug
authors.initials: D
authors.lastname: Coyle
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.|Canadian Agency for Drugs and Technologies in Health, Ottawa, ON, Canada.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Lee
authors.affiliation: Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.|Institute of Health Policy, Management and Evaluation and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.|Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Mamdani
authors.affiliation: Canadian Agency for Drugs and Technologies in Health, Ottawa, ON, Canada.
authors.forename: Kelley-Anne
authors.initials: KA
authors.lastname: Sabarre
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.|Canadian Agency for Drugs and Technologies in Health, Ottawa, ON, Canada.
authors.forename: Kylie
authors.initials: K
authors.lastname: Tingley
mesh_terms: D016527:Drug Costs; D006291:Health Policy / Q000191:economics* / Q000331:legislation & jurisprudence; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D009864:Ontario / Q000453:epidemiology; D012051:Reimbursement Mechanisms / Q000191:economics* / Q000331:legislation & jurisprudence; D014363:Tryptamines / Q000191:economics / Q000627:therapeutic use
chemical_list: D014363:Tryptamines
keywords: cost-effectiveness; drug reimbursement; triptan