Role of Economic Evaluations on Pricing of Medicines Reimbursed by the Italian National Health Service

Objective The main objective of this study was to explore the extent to which the incremental cost-effectiveness ratio (ICER), alongside other factors, predicts the final outcome of medicine price negotiation in Italy. The second objective was to depict the mean ICER of medicines obtained after negotiation. Methods Data were extracted from company dossiers submitted to the Italian Medicines Agency (AIFA) from October 2016 to January 2021 and AIFA's internal database. Beta-based regression analyses were used to test the effect of ICER and other variables on the outcome of price negotiation (Delta P), defined as the percentage difference between the list price requested by manufacturers and the final price paid by the Italian National Health Service (INHS). Results In our dataset of 48 pricing and reimbursement procedures, the ICER before negotiation was one of the variables with a major impact on the outcome of negotiation when >= 40,000euro/QALY. As resulting from multiple regression analyses, the effect of the ICER on Delta P seemed driven by medicines for non-onco-immunological and non-rare diseases. Overall, the negotiation process granted mean incremental costs of euro64,688 and mean incremental QALYs of 1.96, yielding an average ICER of euro33,004/QALY. Conclusions This study provides support on the influence of cost-effectiveness analysis on price negotiation in the Italian context, providing an estimate of the mean ICER of reimbursed medicines, calculated using net confidential prices charged by the INHS. The role and use of economic evaluations in medicines pricing should be further improved to get the best value for money.

Automated summary

The study aims to explore the predictive role of ICER in medicine price negotiation in Italy, and depict the mean ICER after negotiation. The results show that the ICER has a significant impact on the negotiation outcome, especially for non-onco-immunological and non-rare diseases. Overall, the negotiation process resulted in additional costs and QALYs, yielding an average ICER.