부산대학교 도서관

Background: There has been an increasing demand to reimburse high-cost medicines, through public health insurance schemes in Thailand. Methods: A mixed method approach was employed. First, a rapid review of select high-income countries was conducted, followed by expert consultations and an in-depth review of three countries: Australia, England and Republic of Korea to understand reimbursement mechanisms of high-cost medicines. In Thailand, current pathways for reimbursing high-cost medicines reviewed, the potential opportunity cost estimated, and stakeholder consultations were conducted to identify context specific considerations. Results: High-income countries reviewed have implemented a variety of pathways and mechanisms for reimbursing high-cost medicines under specific eligibility criteria, listing processes, varying cost-effectiveness thresholds and special funding arrangements. In Thailand, high-cost medicines that do not offer good value-for-money are excluded from the reimbursement process. A framework for reimbursing high-cost medicines that are not cost-effective at the current willingness-to-pay threshold was proposed for Thailand. Under this framework, specific criteria are proposed to determine their eligibility for reimbursement such life-saving nature, treatment of conditions with no alternative treatment options, and affordability. Conclusion: High-cost medicines may become eligible for reimbursement through alternative mechanisms based on specific criteria which depend on each context. The application of HTA methods and processes is important in guiding these decisions to support sustainable access to affordable healthcare in pursuit of Universal Health Coverage (UHC). Key message: There is a growing demand for public health insurance programmes to reimburse high-cost medicines, including those that do not represent good value-for-money. This demand is likely to inhibit financial sustainability, given the growth of new technologies and public demands for expanded access to care. This study reviewed the experience of selected countries with established health technology assessment (HTA) systems and found that almost all have initiated special programmes or alternative mechanisms to fund high-cost, cost-ineffective medicines as they progress towards Universal Health Coverage (UHC). We recommend no reimbursement for cost-ineffective medicines and reimbursement of other high-cost medicines only when they are the only life-saving option available to patients. In such cases, contextual factors may be taken into account to determine the appropriate willingness-to-pay threshold and budget limits. Monitoring and evaluation of implementation arrangements will be critical for assessing the impact of these programmes. [ABSTRACT FROM AUTHOR]