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USING CLAIMS DATA FOR EVIDENCE GENERATION IN MANAGED ENTRY AGREEMENTS

Part of: Special Collection - Methods

Published online by Cambridge University Press:  15 March 2016

Alina Brandes ,
Larissa Schwarzkopf  and
Wolf H. Rogowski
Alina Brandes
Affiliation:
Helmholtz Zentrum München; German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management
Larissa Schwarzkopf
Affiliation:
Helmholtz Zentrum München; German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management
Wolf H. Rogowski
Affiliation:
Department of Health Care Management, Institute of Public Health and Nursing Research, Health Sciences, University of Bremen, Germany; Helmholtz Zentrum München; German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care [email protected]
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Abstract

Objectives: This study assesses the use of routinely collected claims data for managed entry agreements (MEA) in the illustrative context of German statutory health insurance (SHI) funds.

Methods: Based on a nonsystematic literature review, the data needs of different MEA were identified. A value-based typology to classify MEA on the basis of these data needs was developed. The typology is oriented toward health outcomes and utilization and costs, key components of a new technology's value. For each MEA type, the suitability of claims data in establishing evidence of the novel technology's value in routine care was systematically assessed. Assessment criteria were data availability, completeness, timeliness, confidentiality, reliability, and validity.

Results: Claims data are better suited to MEA addressing uncertainty regarding the utilization and costs of a novel technology in routine care. In schemes where safety aspects or clinical effectiveness are assessed, the role of claims data is limited because clinical information is not included in sufficient detail.

Conclusions: The suitability of claims data depends on the source of uncertainty and, in consequence, the outcome measures chosen in the agreements. In all schemes, the validity of claims data should be judged with caution as data are collected for billing purposes. This framework may support manufacturers and payers in selecting the most suitable contract type and agreeing on contract conditions. More research is necessary to validate these results and to address remaining medical, economic, legal, and ethical questions of using claims data for MEA.

Keywords

Technological innovationDecision makingInsurancehealthreimbursementRisk sharingfinancial/economicsData collection/methods
Type
Methods
Information
International Journal of Technology Assessment in Health Care , Volume 32 , Issue 1-2 , 2016 , pp. 69 - 77
Copyright
Copyright © Cambridge University Press 2016 

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