Study Analyzes Health Technology Assessment Decisions for Pain Therapies

In 2016, approximately 34 million people used opioids and 19 million people used opiates. With an estimated 27 million suffering from opioid-use disorders, the increased use and misuse of pain management therapies has created a global epidemic. Kimberly Gittings, PharmD, MS and colleagues sought to evaluate health technology assessment (HTA) decisions and their rationales for pain therapies in an effort to identify trends in different countries.

“Several prescription opioids have come onto the market over the last decade, including many abuse-deterrent formulations (ADFs) developed to prevent the diversion, abuse, and misuse of prescription opioids,” explained Dr Gittings and colleagues.

The study consisted of surveying HTA decisions in several countries including: Australia, Canada, France, Germany, the United Kingdom, and the United States from 2012 to 2018.

“The HTAs for pain therapies were evaluated by indication, drug class, decision, and rationale for the decision. Products were included if they were reported by the HTA body as indicated or utilized for pain,” said the Dr Gittings and colleagues via a poster presented at ISPOR’s 2019 Annual Meeting.

HTA decisions were categorized into one of the following:

• Favorable (defined as a decision that advances the product toward coverage or reimbursement);
• Unfavorable (a decision that blocks/hinders coverage or reimbursement); or
• Neutral (defined as a decision that is neither favorable nor unfavorable).

Across all country’s HTA bodies assessed, 41 HTA decisions for pain therapies (ie, oxycodone, paracetamol, etc) published between 2012 and 2018. “The majority of HTAs were conducted for opioid treatment options, with the most frequently evaluated therapies being oxycodone formulations (24.4%) and fentanyl formulations (22%),” per the study results. The study also found that the majority of HTA decisions were performed in 2017 and 2019

“The majority of HTA decisions were made within the last 2 years, suggesting a heavier focus on pain management therapies, perhaps driven by an increasing number of therapies coming to market and significance of the worldwide opioid epidemic,” continued Dr Gittings and colleagues. “Less than half of the HTA decisions were favorable, indicating that HTA agencies do not consider the benefit of most new pain therapies to be significantly greater than alternatives already on the market.”

The Institute for Clinical and Economic Review, the US HTA body, found that all but 1of the 9 reviewed therapies in its assessment, provided promising but inconclusive evidence to support use. Dr Gittings and colleagues added, “The economic model found that, compared to non-abuse-deterrent formulations opioids, ADFs prevented approximately 2300 new cases of abuse but cost the health system $533 million per 100,000 patients over 5 years.”

The researchers noted that pain therapies continue to be rejected for insufficient clinical evidence, there is significant need for further studies to demonstrate the benefits of said therapies.

—Edan Stanley

Reference:
Gittings K, Riggs K, Campbell D, et al. Health Technology Assessment Decisions for Pain Therapies: Results, Rationales, and Trends. Poster presented at: ISPOR; May 18-22, 2019; New Orleans, LA.