|
Matching Managed Entry Agreement strategies with high-cost drugs to maximize drug cost saving |
|---|---|
| รหัสดีโอไอ | |
| Title | Matching Managed Entry Agreement strategies with high-cost drugs to maximize drug cost saving |
| Creator | Piyapat Owat |
| Contributor | Cha-oncin Sookriwong, Advisor |
| Publisher | Thammasat University |
| Publication Year | 2568 |
| Keyword | Access, Budget, Cost saving, Expenditure, High-cost drug, Innovative drug, Managed Entry Agreement, Pharmaceutical policy, Procurement, การเข้าถึงยา, งบประมาณ, การประหยัดต้นทุน, ค่าใช้จ่ายด้านยา, ยาราคาแพง, ยานวัตกรรม, ข้อตกลงการเข้าถึงยาแบบมีการจัดการ, นโยบายเภสัชกรรม, การจัดซื้อยา |
| Abstract | Background: The procurement of high-cost drugs presents considerable fiscal challenges to healthcare systems globally. Managed Entry Agreements (MEAs) have emerged as policy instruments designed to facilitate patient access to innovative therapies while maintaining financial sustainability and addressing clinical uncertainty. Nevertheless, empirical evidence regarding the practical implementation and economic implications of MEA strategies within the Thai healthcare context remains scarce. This study sought to develop evidence-based recommendations for policymakers to inform drug procurement decisions through appropriate MEA selection that ensures long-term budgetary sustainability.Methods: This study utilized an analytic cohort design incorporating real-world data obtained from Thammasat University Hospital (TUH) spanning the period from 2010 to 2025. Six high-cost oncology medications—pertuzumab, osimertinib, afatinib, ceritinib, palbociclib, and ribociclib—were examined under five distinct MEA modalities: price discount, free initiation treatment, conditional treatment continuation, utilization cap, and pay-by-result arrangements. Drug procurement expenditures were calculated from the payer perspective. Each MEA scenario was subsequently compared against a reference case without MEA implementation to determine the most economically advantageous technique.Results: The findings demonstrate that MEA implementation yielded substantial reductions in drug procurement expenditures. The free initiation treatment modality generated the most pronounced cost savings, achieving total cost reductions ranging from 59.87% to 79.75% relative to conventional procurement without MEA. The conditional treatment continuation technique similarly demonstrated considerable cost containment effects, followed by the price discount strategy, which provided moderate savings while offering enhanced feasibility for implementation. Conversely, utilization cap and pay-by-result modalities resulted in comparatively modest cost reductions.Conclusions: This investigation establishes that MEA techniques, particularly free initiation treatment and conditional treatment continuation, can effectively mitigate the financial burden associated with high-cost drug procurement. For practical application within the Thai healthcare system, a minimum price discount of 40% is recommended as a sustainable negotiation baseline. Future research should incorporate data from diverse healthcare settings to validate these findings and inform the development of comprehensive national MEA policies. |
