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Health economics is about improving the health of the population through efficient use of existing resources. The introduction of health economic evaluation in the public decision-making process aims to ensure equal access to care by promoting efficiency and financial sustainability of the health care system. It is premised on the requirement for transparency in the allocation of collective resources.
Methods for health economic evaluation
To address scientific and operational concerns in this area, the HAS published "Choices in methods for economic evaluation" which outlines a transparent and methodological framework, in accordance with HAS principles. This document is a working tool that serves to clarify the rules HAS sets for itself with regards to its scope of action, while providing guidance for manufacturer submission.
The most common metric for interpreting a cost-effectiveness analysis is based on the incremental cost-effectiveness ratio (ICER). It is defined by the difference in cost between two possible technologies, divided by the difference in their effect. It represents the average incremental cost associated with one additional unit of the measure of effect.
When a technology is more effective and less expensive than a chosen comparator, it dominates the alternative and the interpretation is clear. However, when the technology is more effective and more expensive, it is said to be “cost-effective” if the marginal cost of the health outcome produced versus a chosen comparator is below the highest price society is willing to pay.
In France, this willingness-to-pay is not specified. Therefore, it is possible to determine the cost of the health gain provided by a new technology, but it is difficult to say whether this cost is acceptable to the society.
Efficiency opinions
In addition to safety and efficacy/effectiveness data required for reimbursement purposes, cost-effectiveness analyses should also be submitted (since October 2013) by the manufacturers for drugs and medical devices deemed to be innovative and likely to have a significant impact on the statutory national health insurance expenditures. Innovative products are defined as those for which the manufacturers claim a moderate to major improvement of the clinical benefit compared to that provided by existing treatments (i.e. “ASMR” of level I through III). A significant impact on the health expenditure as been defined as
- an expected € 20 million (VAT included) or greater annual sales revenue during the second full year of marketing across all indications;
or - an impact on the organisation of care, professional practices or patient care conditions.
The cost-effectiveness analysis submitted by the manufacturer, to the HAS, is reviewed by the Division of Economic and Public Health (SEESP) which then leads to an “efficiency opinion” issued by the CEESP.
Public health & organisation of care provisions
Evaluation of public health interventions entails the critical appraisal of the available evidence of the effects of the intervention at the population level, including its harms and benefits; it usually includes an economic and organisational evaluation. It aims at informing decision-making about the initiation or modification of health programmes. The public recommendations developed are based on these evaluations and primarily intended for policymakers.
Evaluation of health care organisation includes: analysis of health care provider coordination (at the ambulatory and hospital level), and analysis of financing, pricing, and incentives to increase the efficiency of the health care system.
