ROUND3
Confidential Information for HCP: Budget and QALY Adjustment for RCMD Treatment

Immediate Attention Required

Dear Healthcare Payer Team,

We have two significant updates that will impact our ongoing negotiations with the Health Technology Developer (HTD) regarding the new orphan drug for rare chronic muscle disease (RCMD).

Revised QALYs

Firstly, a recently published Cost-Utility Analysis (CUA) has revised the estimated health gains from the drug. Initially set at 0.6 Quality-Adjusted Life Years (QALYs) per patient per year, this figure has now been adjusted to 0.3 QALYs. This is due to a higher incidence of adverse events, including auto-immune responses, that were not apparent during clinical trials.

Budget Decrease

Secondly, due to unexpected financial constraints caused by a sudden influx of pandemics-related healthcare expenditures, the budget allocated for this specific treatment in Benelux is being reduced to €25,000,000 for the year.

Implications for Negotiations

These updates have significant implications for our negotiation strategy. Reduced QALYs may lower the drug’s perceived value, potentially facilitating more favourable financial arrangements. However, the reduced budget adds a layer of complexity that requires careful planning.

Immediate Actions

  1. Re-evaluate your negotiation strategy in light of these developments.
  2. Prioritize the most clinically vulnerable patient groups given the new constraints.
  3. Consider the potential for partial treatment through academic hospitals at a reduced price point, as previously discussed.

Next Steps

As you prepare for the next negotiation round, bear in mind that the HTD is likely re-strategising due to the new QALY information. Your nimbleness in these negotiations is essential, given our decreased budget and the updated health gain figures.

Your prompt attention to these matters is crucial.

Sincerely,

Financial negotiation support office