Solutions

Models

- Aim: To understand the impact on payers, providers, and patients of introducing a new product
- Cost-effectiveness, cost-utility, cost-benefit, and cost-consequence models, e.g., suitable for reimbursement submissions, or to communicate value in hospital settings
- Budget-impact and return on investment models
- Conjoint models to measure sales message impact
- Assess product profile for key drivers
- All models are developed de-novo in lie with any relevant local or international guidelines
- Informs: Messaging and interactions with healthcare providers and payers, patient segmentation, and product development
- See our work: Impact of product X on procedure Y: model example

What is a budget impact analysis or budget-impact model?

Budget-impact analysis (BIA) or budget-impact model (BIM) is an essential part of any health-economic assessment. In many jurisdictions, BIA is required to gain reimbursement. Even when not mandated, many healthcare providers will not add new products to their formulary without a comprehensive BIA. The purpose of a BIA is to quantify (with an estimate of uncertainty) the financial consequences of adopting a new healthcare product within a specified healthcare setting. Specifically, the BIA predicts how a change in the product used or the product mix in use to treat a condition will impact overall spending on that condition. The BIA considers both the efficacy and safety of the products, and is generally focused on the short- to mid-term horizon of 1 to 5 years. A BIA is often complemented by a cost-effectiveness analysis (CEA). These sometimes cover a longer time horizon, up to patient lifetimes, and can include consideration of patient quality of life. A BIA is used mostly for private payer interactions, whereas a CEA is of more broader interest to physicians, national payers, and patients—and can be published in academic, peer-reviewed journals.

What is a cost-effectiveness analysis or cost-effectiveness model?

The cost of healthcare is always an important aspect, but most decisions on product coverage and reimbursement are not made oblivious to patient outcomes. Clinical data is almost always required, and a key question is the balance between costs and beneficial outcomes. A cost-effectiveness analysis (CEA) or cost-effectiveness model (CEM) estimates the cost of healthcare provision and the potential patient outcomes, both positive and negative (e.g. adverse events), and quantifies the cost-benefit ratio between them. This can be in terms of the cost per health outcome (e.g. hospitalization) avoided or cost per patient life year gained. For healthcare providers, these are commonly presented as an incremental cost-effectiveness ratio (ICER). The ICER is the difference in cost between the two interventions divided by the difference in health outcomes between the two interventions.