Generating comparative evidence on new drugs and devices before approval
Huseyin Naci
(1)
,
Maximilian Salcher-Konrad
(1)
,
Aaron Kesselheim
(2)
,
Beate Wieseler
(3)
,
Lise Rochaix
(4, 5, 6)
,
Rita Redberg
(7)
,
Georgia Salanti
(8)
,
Emily Jackson
(1)
,
Sarah Garner
(9)
,
T Scott Stroup
(10)
,
Andrea Cipriani
(11)
1
LSE -
London School of Economics and Political Science
2 HMS - Harvard Medical School [Boston]
3 Institute for Quality and Efficiency in Health Care
4 Hospinomics
5 PSE - Paris School of Economics
6 PJSE - Paris Jourdan Sciences Economiques
7 UCLA - University of California [Los Angeles]
8 UNIBE - Universität Bern / University of Bern
9 University of Manchester [Manchester]
10 Columbia University [New York]
11 University of Oxford
2 HMS - Harvard Medical School [Boston]
3 Institute for Quality and Efficiency in Health Care
4 Hospinomics
5 PSE - Paris School of Economics
6 PJSE - Paris Jourdan Sciences Economiques
7 UCLA - University of California [Los Angeles]
8 UNIBE - Universität Bern / University of Bern
9 University of Manchester [Manchester]
10 Columbia University [New York]
11 University of Oxford
Lise Rochaix
- Fonction : Auteur
- PersonId : 1356826
- IdHAL : lise-rochaix
- ORCID : 0009-0005-2822-7439
Andrea Cipriani
- Fonction : Auteur
- PersonId : 773591
- ORCID : 0000-0001-5179-8321
Résumé
Fewer than half of new drugs have data on their comparative benefits and harms against existing treatment options at the time of regulatory approval in Europe and the USA. Even when active-comparator trials exist, they might not produce meaningful data to inform decisions in clinical practice and health policy. The uncertainty associated with the paucity of well designed active-comparator trials has been compounded by legal and regulatory changes in Europe and the USA that have created a complex mix of expedited programmes aimed at facilitating faster access to new drugs. Comparative evidence generation is even sparser for medical devices. Some have argued that the current process for regulatory approval needs to generate more evidence that is useful for patients, clinicians, and payers in health-care systems. We propose a set of five key principles relevant to the European Medicines Agency, European medical device regulatory agencies, US Food and Drug Administration, as well as payers, that we believe will provide the necessary incentives for pharmaceutical and device companies to generate comparative data on drugs and devices and assure timely availability of evidence that is useful for decision making. First, labelling should routinely inform patients and clinicians whether comparative data exist on new products. Second, regulators should be more selective in their use of programmes that facilitate drug and device approvals on the basis of incomplete benefit and harm data. Third, regulators should encourage the conduct of randomised trials with active comparators. Fourth, regulators should use prospectively designed network meta-analyses based on existing and future randomised trials. Last, payers should use their policy levers and negotiating power to incentivise the generation of comparative evidence on new and existing drugs and devices, for example, by explicitly considering proven added benefit in pricing and payment decisions.
Domaines
Economies et financesFormat du dépôt | Notice |
---|---|
Type de dépôt | Article dans une revue |
Titre |
en
Generating comparative evidence on new drugs and devices before approval
|
Résumé |
en
Fewer than half of new drugs have data on their comparative benefits and harms against existing treatment options at the time of regulatory approval in Europe and the USA. Even when active-comparator trials exist, they might not produce meaningful data to inform decisions in clinical practice and health policy. The uncertainty associated with the paucity of well designed active-comparator trials has been compounded by legal and regulatory changes in Europe and the USA that have created a complex mix of expedited programmes aimed at facilitating faster access to new drugs. Comparative evidence generation is even sparser for medical devices. Some have argued that the current process for regulatory approval needs to generate more evidence that is useful for patients, clinicians, and payers in health-care systems. We propose a set of five key principles relevant to the European Medicines Agency, European medical device regulatory agencies, US Food and Drug Administration, as well as payers, that we believe will provide the necessary incentives for pharmaceutical and device companies to generate comparative data on drugs and devices and assure timely availability of evidence that is useful for decision making. First, labelling should routinely inform patients and clinicians whether comparative data exist on new products. Second, regulators should be more selective in their use of programmes that facilitate drug and device approvals on the basis of incomplete benefit and harm data. Third, regulators should encourage the conduct of randomised trials with active comparators. Fourth, regulators should use prospectively designed network meta-analyses based on existing and future randomised trials. Last, payers should use their policy levers and negotiating power to incentivise the generation of comparative evidence on new and existing drugs and devices, for example, by explicitly considering proven added benefit in pricing and payment decisions.
|
Auteur(s) |
Huseyin Naci
1
, Maximilian Salcher-Konrad
1
, Aaron Kesselheim
2
, Beate Wieseler
3
, Lise Rochaix
4, 5, 6
, Rita Redberg
7
, Georgia Salanti
8
, Emily Jackson
1
, Sarah Garner
9
, T Scott Stroup
10
, Andrea Cipriani
11
1
LSE -
London School of Economics and Political Science
( 328453 )
- Houghton Street, London WC2A 2AE
- Royaume-Uni
2
HMS -
Harvard Medical School [Boston]
( 130467 )
- 25 Shattuck Street Boston, MA 02115
- États-Unis
3
Institute for Quality and Efficiency in Health Care
( 1041691 )
- Allemagne
4
Hospinomics
( 476518 )
- France
5
PSE -
Paris School of Economics
( 301309 )
- 48 boulevard Jourdan 75014 Paris
- France
6
PJSE -
Paris Jourdan Sciences Economiques
( 578027 )
- 48 boulevard Jourdan 75014 Paris
- France
7
UCLA -
University of California [Los Angeles]
( 72398 )
- Los Angeles, Californie 90095
- États-Unis
8
UNIBE -
Universität Bern / University of Bern
( 236940 )
- Hochschulstrasse 4 - CH-3012 Bern
- Suisse
9
University of Manchester [Manchester]
( 121172 )
- Oxford Rd, Manchester M13 9PL
- Royaume-Uni
10
Columbia University [New York]
( 75524 )
- Columbia University in the City of New York, 2960 Broadway, New York, NY 10027-6902
- États-Unis
11
University of Oxford
( 302612 )
- Wellington Square, Oxford OX1 2JD
- Royaume-Uni
|
Public visé |
Scientifique
|
Langue du document |
Anglais
|
Nom de la revue |
|
Vulgarisation |
Non
|
Comité de lecture |
Oui
|
Audience |
Internationale
|
Date de publication |
2020-03
|
Volume |
395
|
Numéro |
10228
|
Page/Identifiant |
986-997
|
Domaine(s) |
|
DOI | 10.1016/S0140-6736(19)33178-2 |
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