Services

Reimbursement Decision Support Analysis

Reimbursement Decision Support Analysis (RDSA) is a fully substantively justified response to strategic questions relating to the application or maintenance of public funding.

The main purpose of this analysis is to support managerial decision in choosing the optimal price/population/funding conditions for the medicinal product, by reducing uncertainty and limit the range of options to choose from. Therefore, the Client receives evidence-based support to develop and maintain a negotiating strategy with the Payer.

Reimbursement Decision Support Analysis on Price

Provides answers to the following questions:

• At what level should the Client set the official price of the product applied for reimbursement?
• How are the Client's chances for a positive reimbursement decision for financing in the registered population change with a change of price?
• For a centrally fixed range of product prices, what are the chances of obtaining public funding without restrictions (for the registered population)?

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Reimbursement Decision Support Analysis on Population

Provides answers to the following questions:

• Should the Client at the application stage reduce the population covered by financing?
• What is the probability of a positive reimbursement decision when introducing additional reimbursement limits on the registered population?

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Reimbursement Decision Support Analysis on Funding

Provides an answer to the following question:

• What conditions of public funding should be applied for to get the most acceptable relationship of the refund of revenues and risks of a negative decision?

All three versions of the RDSA are prepared under following assumptions.

Estimated probability is based on a full SWOT analysis of the considered circumstance, then in pairs individual variations are assessed in two dimensions:

1. The probability of a positive reimbursement decision,
2. Revenues from public funding conditions specified in the analyzed option.

The final stage of the process is to identify the optimal variables based on analysis of marginal options or based on optimizing the utility using a Cobb-Douglas function.

While preparing a RDSA a Common Evidence & Appraisal Basis (CAEB) is developed throught a systematic search of available databases and other sources for secondary studies in the field of clinical and economic recommendations, guidelines and clinical opinions and recommendations, and finally reimbursement decisions with justifications.

The scope of CEAB includes not only the drug or medical technology, but also competitive medical technologies. It is possible to prepare the analysis based only on the materials provided by the Client.

The CEAB may be used as a basis for other advisory products (eg, Reimbursement Argumentation).

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