“Doing Double Duty” Collecting Data for FDA and CMS in the Same Study
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Transcript of “Doing Double Duty” Collecting Data for FDA and CMS in the Same Study
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“Doing Double Duty”Collecting Data for FDA and CMS in the Same Study
Medical Device Regulatory & Compliance Congress
March 30, 2006
Donald P. Conway, MD, MBADirector Healthcare Initiatives
Tuck School of Business at Dartmouth
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VIEW FROM 30,000 FEET
• Increase Utilization of Healthcare Services/Products
• Constrained Budgets
• Increased Scrutiny of Healthcare Costs
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DIFFERENCES IN PERSPECTIVE
• FDA – Safety, Efficacy
• CMS – Efficiency, Cost Effectiveness
• Manufacturers – Timely Coverage and Adequate Reimbursement
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Goal: To secure coverage and adequate reimbursement in a timely manner
ASAP
PERSPECTIVE: MANUFACTURERS
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Having the right dataIn the right subpopulationWith appropriate power At the right time.
BUSINESS CASE “For Doing Double Duty”
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COST OF NOT OBTAINING COVERAGE
• Additional Trial required
• Opportunity Cost-lost sales
• Competition even more entrenched
• Practice patterns established
• Never realizing true sales potential
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$
Time
DEMONSTRATING VALUE
Peak Sales Potential
Actual SalesOpportunityCost
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WHAT MANUFACTURERS CAN DO
• Model Reimbursement landscape
• Incorporate economic “Value Proposition” in the Target Product Profile.
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Reimbursement systems are complex mechanisms.
“Understanding reimbursement is absolutely critical. It is one of the key factors we evaluate in every market opportunity.
If precedent for reimbursement exists we look at the level of reimbursement and determine what can be done to upgrade it.
Creating a new reimbursement scheme is a significant undertaking. Reimbursement battles can go on for years post-approval. They can be the major obstacle to ramping up sales.
It is essential that we understand a product’s reimbursement mechanism up front”.
Ross Jaffee, MD, MBAVersant Ventures
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WHAT Manufacturers CAN DO
• Anticipate CMS and Private Payers views
• Dialogue early and often
• Anticipate which competitive technologies will be disrupted
• Anticipate competitions response
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WHAT Manufacturers CAN DO
• Ensure pivotal trials include an adequate representation of Medicare eligible patients
• Capture economic endpoints in pivotal trials both Direct and Indirect Costs
• Model global economic impact from these endpoints
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WHAT Manufacturers CAN DO
• Ongoing collection of patient level data via open label follow-up
• Establish a Patient Registry to obtain patient level data – economic and patient reported outcomes
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• CMS sets precedent – Not Always
• Demand effectiveness data/NIH
• Comparative clinical effectiveness
• Pay for Performance
• Demand Cost/Effectiveness data
• Increasingly Important role AHRQ
PAYER COMMUNITY (CMS AND PRIVATE)
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PAYER COMMUNITY
• An Eye to Other Healthcare Systems
• National Institute of Clinical Excellence (NICE) www.nice.org.uk
• PBAC - Australia
• Provincial authorities - Canada
• County councils – Sweden
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Questions / Answers
Questions / Answers