The 3-Legged Stool: Payer Perspective C-E Model Using Existing Data


Our client needed to demonstrate the cost-effectiveness of their technology, a bioabsorbable hydrogel spacer designed to minimize radiation exposure in healthy tissues during prostate cancer radiotherapy, in order to make an effective case to payers to cover its use in treatment. Previous attempts by the client to generate evidence using academic partners had created an evidence base that was incomplete and unfavorable to the company, wasting years and hundreds of thousands of dollars. TTi conducted a literature review and identified and interviewed subject matter experts, pinpointing relevant complications of radiation exposure. This enabled us to design and conduct a multistage research plan to acquire and analyze relevant data from a private payer database, demonstrating cost-effectiveness. TTi obtained and analyzed real-world payer cost data for radiation induced toxicities from prostate cancer treatment, using a commercial and Medicare claims database. Cost data, with literature-based data on reduction in toxicities associated with use of the technology, was used to successfully demonstrate comparative cost-effectiveness. Our findings supported the client’s value argument to payers to support use of their technology as an adjunct to radiotherapy for prostate cancer. Additionally, a peer-reviewed manuscript was submitted to journal within 6 months of study initiation.

Prior to working with TTi we struggled to prove the cost effectiveness of our technology. In fact, several less than favorable cost-effectiveness evaluations were published. When we spoke with TTi, they reviewed existing C-E analyses; they were confident that previous study designs had biased the results and underestimated the value of our technology. It was really their confidence and their persuasive presentation of the study design flaws that convinced us to put our trust in them. Once we brought TTi on board we knew we were in the right hands. They conducted qualitative research with top clinical & academic experts prior to designing their database and cost effectiveness analysis to ensure it was robust and comprehensive. Once executed, the results firmly established our technology as well below accepted thresholds of cost-effectiveness. If we could go back in time, we would hire TTi two years ago.

VP, Global Market Access, Large Med Device Company