The use of health economic analysis in OECD countries' pharmaceutical reimbursement systems and its contribution to decision-making

Developed countries' publicly funded health care systems all share the similar task of deciding which pharmaceuticals should be reimbursed. DECD countries' pharmaceutical reimbursement systems achieve this task through a number of institutions some of which use Health Technology Assessment (HTA) including health economic analysis to inform decision-making. The reimbursement decisions influence the health outcomes of patients, produce signals of the demand curve to manufacturers and may have political consequences. The overall aim of this thesis is to examine the use of health economic analysis in DECD countries' reimbursement systems and the contribution of health economic analysis and other factors to decision-making. Chapter 2 provides a literature review of previous quantitative and qualitative studies examining the factors contributing to reimbursement decision-making in DECD countries. The review identified limited evidence for comparisons across DECD countries and outlined the methodological limitations of identifying influence. Chapters 3 and 4 categorise DECD reimbursement systems using a published framework. Application of the framework identified that Health Economic analysis is used by agencies operating in heterogeneous reimbursement systems with respect to the objectives, other institutions, processes, guidelines, interpretation and other factors considered alongside health economic analysis. Chapter 5 uses regression analysis to examine decisions by those agencies that similarly use clinical evidence and health economic analysis, and identifies common factors across four countries. Chapter 6 uses a qualitative methodology to match decisions for an agency using health economic analysis in comparison to one not and found evidence of the influence of health economic analysis alongside other evidence and process factors. Finally, chapter 7 concludes by outlining the differential contribution of health economic analysis depending on how it is used by the systems. The limitations are discussed and recommendations provided for further research.