Multicriteria decision analysis in the reimbursement of new medical technologies: real world experiences from Hungary.
We read with great interest the excellent article of Sussex et al. [1] on a pilot study of multicriteria decision analysis (MCDA) for valuing orphan medicines. MCDA seems to be more important in the past years, and many countries have tried to use it for evaluating new medical technologies [2,3] We would like to give a short overview on the application of MCDA in Hungary. Hungary can be considered an upper middle income country [4] We run a solidarity based health insurance system with a single payer, where the National Health Insurance Fund Administration (in Hungarian: Orszagos Egeszsegbiztositasi Penztar [OEP] is the only health care financing agency [5,6] All the hospitals with the exception of church hospitals are owned by the central government. On behalf of the central government, a governmental public agency, the National Institute for Qualityand Organizational Development in Healthcare and Medicines (in Hungarian: Gyogyszereszeti es Egeszsegugyi Minoseges Szervezetfejlesztesi Intezet [GYEMSZI] is responsible for the supervision of Hungarian hospitals [7] The Hungarian health technology assessment (HTA) Office was established in 2004, and it also belongs to GYEMSZI [8,9] Hungary adopted the directive 89/105/EEC of the Council of the European Communities on transparency for the evaluation of new drugs (2004) and medical devices (2007) applying for health insurance reimbursement [10] We also have a formal guideline for conducting economic evaluation of health care interventions in Hungary [11] More detailed description of the Hungarian health care system can be found elsewhere [12 17] MDCA was introduced in Hungary by a ministerial decree in 2010 for the evaluation of new hospital medical technologies applied in hospital care [18] In this term, medical technologies do include neither drugs nor medical devices. As a part of the application dossier, one must submit a formal HTA report (including a health economics analysis) clinical evaluation, clinical expert opinion, and detailed cost calculation. Detailed cost calculation should demonstrate how the new hospital medical technology complies with the special financing methods of the Hungarian hospital care. It means that beyond the cost of new technology, its additional costs (e.g. implantation surgery, hospital stay, and nursing care) must be calculated according to the diagnosis related groups such as hospital care financing [19,20] The key players of the decision making process are the health care financing agency (OEP) HTA office (within GYMESZI) Hungarian Medical College, and Scientific Council in Health Care.
Value in health the journal of the International Society for Pharmacoeconomics and Outcomes Research