The 3-Legged Stool: Payer Perspective C-E Model Using Existing Data
[Augmenix]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.