【Central Social Insurance Medical Council】Many committees disagree with the prematurity of evaluation cost and expansion of the scope

2020年10月30日 (金)

At a general meeting held online on the 28th, the Central Social Insurance Medical Council (Chuikyo) discussed the cost-effectiveness evaluation system for pharmaceutical products, which started operation from April last year. The expansion of the scope and scale of the cost-effectiveness evaluation addressed in the Medical Insurance Committee in September has been in operation for about one and a half years. Many committee members commented that “The impact has not been verified and the issues have not been identified, so it should not be implemented now.”

The cost-effectiveness evaluation system’s target are products with large sales and very high unit price. It is said that price adjustments will be made on the cost-effectiveness evaluation results which have undergone comprehensive evaluation by company and public analysis.

As of the 1st of this month, 12 products have been selected as cost-effective items and are being analyzed. Such as “TRELEGY” for and “KYMRIAH” for leukemia. A comprehensive evaluation of multiple items is expected to be deliberated by Chuikyo by the end of this fiscal year.

At the general meeting on the day, the Ministry of Health, Labor and Welfare focused on expanding the scope and scale of implementation toward the utilization of cost-effectiveness evaluation results, including the propriety of insurance listing, based on the contents of a discussion at the Medical Insurance Committee. However, many committee members commented “It is premature.” for the implementation.

Yoshiro Matsumoto, a committee member from the medical side (Executive Director of the Japan Medical Association), stated that principle of the cost-effectiveness evaluation should be used only for price adjustment without using it for the judgement of insurance. However, he indicated “Because the system operation just began, we should continue to verify and identify issues.“

Kenji Arisawa (Managing Director of the Japan Pharmaceutical Association) also called for a careful discussion, with saying “We consider that the evaluation implementation system has not been established yet, and so we should not expand the scope and scale of the evaluation more than necessary.”

Toshikazu Yoshimori (Director of Japan Health Insurance Association) from the reimbursement side, indicated “Although it is necessary to verify the impact on the premise that will be used to decide the propriety of reimbursing in the future, it is important at first to take prompt action for the accumulation and analysis of case studies in Japan.”

However, shortening the evaluation period, which takes one and a half years maximum from insurance listing to price adjustment, and expanding the items subject to cost-effectiveness evaluation are “essential issues”. He requested the expansion of the evaluation system saying “If you think that the number of target items such as high-priced drugs will increase in the future, I would like to ask for a concrete process chart showing that the evaluation system will be done by when and whom.”

Shoji Kono (Director of the Federation of Health Insurance Associations) pointed out that “It is necessary to verify the validity of the current system.” on the premise that cases of cost-effectiveness evaluation will be accumulated in Japan. In addition to the validity of the evaluation process and the period from insurance listing to price adjustment, he said, “We must also verify the ideal way of price adjustment that targets only the additional portion and operating income.”

Regarding the use of cost-effectiveness evaluation for insurance listing, he said, “I think it will be discussed in the future as the next step after examining the current system.

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