National Centre for Pharmacoeconomics

National Centre for
Pharmacoeconomics

NCPE Ireland

NCPE Recommendations

Queries on the reimbursement process and next steps once a recommendation has been issued should be directed
to the CPU at cpu@hse.ie .

Interpreting NCPE Recommendations

The NCPE evaluates new medicines to check their:

  • clinical effectiveness (how well they treat a patient’s condition compared with other ways to manage the condition);
  • cost effectiveness (value for money); and
  • effect on the HSE budget (budget impact).

We send our recommendations to the HSE to help them decide whether or not to provide a medicine.

We carry out two types of assessments:

Rapid Review

This assessment is done on all new medicines to see if a medicine needs a more in-depth evaluation (that is, a
Health Technology Assessment). A Rapid Review takes about four weeks to complete.

Health Technology Assessment (HTA)

This assessment gives us a comprehensive overview of how a new medicine might affect the health service. We will
do a HTA if there is a question about the clinical effectiveness and/or the cost effectiveness of the medicine. We carry
out a HTA on all new medicines with a high cost compared with existing treatments and/or a high impact on the drugs
budget, or if there is uncertainty related to the cost. HTAs can take several months to complete.

We publish the outcomes of Rapid Reviews and Health Technology Assessments on our website (www.ncpe.ie) under
the ‘Pharmacoeconomic Evaluations’ tab.

Below, we explain possible recommendations first for Rapid Reviews and then for Health Technology Assessments.

Rapid Review Recommendations – 5 possible recommendations
A full HTA is recommended to assess the clinical effectiveness and cost effectiveness of [Medicine] compared with the current standard of care.
We have completed a Rapid Review for this medicine. We believe that a more detailed assessment (a full health technology assessment) is needed. This will allow us to recommend to the HSE whether or not to provide this medicine. A more detailed assessment is needed because it is not clear that the medicine works as well or better than other ways to manage this condition, or it is not clear that the medicine is value for money.

The HSE considers a number of factors along with our recommendation when deciding whether to provide this medicine. These factors are listed in the Health (Pricing and Supply of Medical Goods) Act 2013.

A full HTA is recommended to assess the clinical effectiveness and cost effectiveness of [Medicine] compared with the current standard of care, on the basis of the proposed price relative to currently available therapies.
We have completed a Rapid Review for this medicine. We believe that a more detailed assessment (a full health technology assessment) is needed. This will allow us to recommend to the HSE whether or not to provide this medicine. We believe that the medicine works as well or better than other ways to manage this condition.

The price of the medicine is higher than other treatments used for this condition, and it is not clear that the medicine is value for money. A full health technology assessment may not be needed if the HSE can agree a suitable price reduction with the pharmaceutical company.

The HSE considers a number of factors along with our recommendation when deciding whether to provide this medicine. These factors are listed in the Health (Pricing and Supply of Medical Goods) Act 2013.

A full HTA is not recommended. The NCPE recommends that [Medicine] be considered for reimbursement.*

*This recommendation should be considered while also having regard to the criteria specified in the Health (Pricing and Supply of Medical Goods) Act 2013

We have completed a Rapid Review for this medicine. We recommend that the HSE consider providing this medicine. We believe the medicine works as well or better than other ways to manage this condition, and we believe the medicine is value for money. We believe enough information was provided in the Rapid Review. Therefore, a more detailed assessment (a full health technology assessment) is not needed.

The HSE considers a number of factors along with our recommendation when deciding whether to provide this medicine. These factors are listed in the Health (Pricing and Supply of Medical Goods) Act 2013.

A full HTA is not recommended. The NCPE recommends that [Medicine] not be considered for reimbursement at the submitted price*.

*This recommendation should be considered while also having regard to the criteria specified in the Health (Pricing and Supply of Medical Goods) Act 2013.

We have completed a Rapid Review for this medicine. We recommend that the HSE consider not providing this medicine unless the HSE can agree a suitable price reduction with the pharmaceutical company. The price of the medicine is higher than other ways to manage this condition, and we believe that the medicine is not value for money. We believe enough information was provided in the Rapid Review. Therefore, a more detailed assessment (a full health technology assessment) is not needed.

The HSE considers a number of factors along with our recommendation when deciding whether to provide this medicine. These factors are listed in the Health (Pricing and Supply of Medical Goods) Act 2013.

A full HTA is not recommended until additional efficacy and/or safety data is submitted. On the basis of current evidence, the NCPE recommends that [Medicine] not be considered for reimbursement*.

*This recommendation should be considered while also having regard to the criteria specified in the Health (Pricing and Supply of Medical Goods) Act 2013.

We have completed a Rapid Review for this medicine. We believe that a more detailed assessment (a full health technology assessment) should not be done at this time because there is not enough information on how well the medicine works. We recommend that the HSE consider not providing this medicine. We will assess this medicine again when we get more information from the pharmaceutical company.

The HSE considers a number of factors along with our recommendation when deciding whether to provide this medicine. These factors are listed in the Health (Pricing and Supply of Medical Goods) Act 2013.

 

 

 

Full HTA Recommendations – 4 possible recommendations
The NCPE recommends that [Medicine] be considered for reimbursement*.

*This recommendation should be considered while also having regard to the criteria specified in the Health (Pricing and Supply of Medical Goods) Act 2013.

We have completed a full health technology assessment of this medicine. We recommend that the HSE consider providing this medicine. We believe the medicine works as well or better than other ways to manage this condition, and we believe the medicine is value for money.

The HSE considers a number of factors along with our recommendation when deciding whether to provide this medicine. These factors are listed in the Health (Pricing and Supply of Medical Goods) Act 2013.

The NCPE recommends that [Medicine] be considered for reimbursement if cost-effectiveness can be improved relative to existing treatments*.

*This recommendation should be considered while also having regard to the criteria specified in the Health (Pricing and Supply of Medical Goods) Act 2013.

We have completed a full health technology assessment for this medicine. We recommend that the HSE consider providing this medicine if the HSE can agree a suitable price reduction with the pharmaceutical company. We believe the medicine works as well or better than other ways to manage this condition. However, the price of the medicine is too high compared with other ways to manage this condition, and we believe that the medicine is not value for money.

The HSE considers a number of factors along with our recommendation when deciding whether to provide this medicine. These factors are listed in the Health (Pricing and Supply of Medical Goods) Act 2013.

The NCPE recommends that [Medicine] not be considered for reimbursement unless cost effectiveness can be improved relative to existing treatments*.

*This recommendation should be considered while also having regard to the criteria specified in the Health (Pricing and Supply of Medical Goods) Act 2013.

We have completed a full health technology assessment for this medicine. We recommend that the HSE consider not providing this medicine unless the HSE can agree a suitable price reduction with the pharmaceutical company. This is because we believe the medicine works as well or better than other ways to manage this condition. However, the price of the medicine too high compared with other ways to manage this condition, and we believe that the medicine is very poor value for money.

or

we believe it is not clear that the medicine works as well or better than other ways to manage  this condition. The price of the medicine is too high compared with other ways to manage this condition, and we believe that the medicine is very poor value for money.

The HSE considers a number of factors along with our recommendation when deciding whether to provide this medicine. These factors are listed in the Health (Pricing and Supply of Medical Goods) Act 2013.

The NCPE recommends that [Medicine] not be considered for reimbursement*.

*This recommendation should be considered while also having regard to the criteria specified in the Health (Pricing and Supply of Medical Goods) Act 2013.

We have completed a full health technology assessment for this medicine. We recommend that the HSE consider not providing this medicine. This is because we did not receive enough information to clearly assess how well the medicine works compared with other ways of managing this condition or whether the medicine is value for money.

The HSE considers a number of factors along with our recommendation when deciding whether to provide this medicine. These factors are listed in the Health (Pricing and Supply of Medical Goods) Act 2013.