The simultaneous existence of low-value health care and underutilization of high-value care are global problems. Health technology reassessment (HTR) aims to optimize the value for money of technologies already in use within health care. Identifying candidate interventions for HTR remains challenging. Therefore, we tested a novel method to identify candidate outpatient prescription drugs for HTR through practice variation.

We used administrative data for all publicly funded outpatient prescriptions dispensed to persons aged 65 or older in Alberta in 2023. Through quantitative comparison of funnel plots for Anatomic Therapeutic Chemical (ATC) classes at the fourth level stratified by prescriber specialty, variation in prescription dispensation rates between prescribers was used to estimate three outcomes: the number of prescribers affected, the number of patients affected, and the potential budgetary impact. We ranked combinations of ATC class and prescriber specialty in descending order for each outcome, with use above and below the mean considered separately.

We analyzed data on 17.5 million dispensations, encompassing more than 8,000 prescribers and approximately 600,000 patients. The top ATC class–prescriber specialty combinations for each outcome showed high similarity above and below control limits while exhibiting minimal overlap between outcomes.

Our method successfully identified ATC class–prescriber specialty combinations with marked variation in use, for potential advancement through the HTR process. Depending on the perspective of those undertaking HTR of prescription drugs, different outcomes may be useful in technology prioritization. To make the ATC class–prescriber specialty combinations actionable, future efforts should focus on exploring the patients affected.

This study’s primary objective was to test the feasibility of using the online personal utility function (OPUF) approach and develop a preliminary utility tariff for the EQ-5D-5L based on a South African community sample.

The need for an ethnically and socioeconomically diverse sample was seen as essential. This led to the need for interviewer assistance during completion of the survey instrument and translation of the instrument into multiple languages. English, Zulu, Tswana, and Afrikaans were chosen to allow the vast majority of a community sample people to participate. A sample size of sixty respondents was based on a previous OPUF pilot valuation study for the EQ-5D-5L, and a pilot study of twenty respondents was undertaken using the English language version of OPUF.

There were sixty-one respondents in the main study with most respondent characteristics being well matched with national figures, except for language. Personal utility functions could be calculated for sixty respondents, with the mean tariff showing monotonically declining utility decrements within each dimension. An examination of individual functions showed two contrasting sets of preferences that were driven by the respondents’ rating of death. A separate subgroup analysis also showed preference heterogeneity based on the home language of the respondents.

Our study showed that the application of the OPUF approach is possible in a socioeconomically diverse population in South Africa. The examination of individual personal utility functions shows marked heterogeneity of preferences that needs to be explored further so that the source of this can be established.

Since 2019 the Dutch National Healthcare Institute has operated a coverage with evidence development (CED) program for specific products with insufficient evidence of their clinical benefit: orphan medicinal products (OMPs), medicines with conditional marketing authorization (CMA), and medicines with marketing authorization under exceptional circumstances (AEC). The objective of this study is to give an overview of this program and reflect on learnings, challenges, and opportunities.

This study is a narrative policy review of the Dutch CED program and describes the different phases and stakeholder involvement. Additionally, an overview of the medicines included in the CED program is presented and put in an international perspective.

The CED program consists of four phases: candidate prescreening, research protocol drafting, signing of process agreement and financial agreement, and controlled access. Stakeholders are involved intensively throughout the process. Since 2019, six medicines have entered the program. The program is used to fill different evidence gaps for various types of medicines and indications. In other countries, these medicines are often included in restricted reimbursement programs.

The CED program is gathering clinical effectiveness data while providing patient access to OMPs, CMA, and AEC products. Important facilitating factors for the program were identified, including the involvement of all stakeholders, the only-in-research approach of data gathering, and the case-by-case evidence generation requirements and duration. Continuous evaluation is needed as the program does not yet include the expected number of medicines, and no conclusion can be drawn so far on the usefulness of the data collection.