Kosteneffiziente medikamentöse Therapie der Hepatitis C durch neue Vergütungsmodelle – pay for cure

Zusammenfassung

Neue direkt-antiviral wirkende Substanzen zur Therapie der chronischen Hepatitis C erreichen sehr hohe Heilungsquoten von bis zu 100 %. Gleichzeitig ist ihr Einsatz mit hohen Arzneimittelkosten verbunden. Die Behandlung aller Hepatitis-C-Virusträger in Deutschland würde je nach eingesetztem Präparat schätzungsweise zwischen 19 und 37 Mrd. EUR kosten. Hiervon wären die Arzneimittelkosten der erfolglos behandelten Patienten als vergeblich aufgewendete Gesundheitsausgaben zu bewerten – diese liegen je nach Behandlungsregime zwischen 0,9 und 2,15 Mrd. EUR. In schwierig zu behandelnden Patientenkollektiven, gekennzeichnet durch Leberzirrhose oder Vortherapie, können sich die Arzneimittelkosten aufgrund längerer Behandlungsdauer erhöhen. Gleichzeitig liegen die Heilungsquoten in diesen Patientengruppen teilweise deutlich niedriger, sodass die verlorenen Therapiekosten besonders hoch sind. Qualitätsorientierte Vergütungsmodelle sind im Gesundheitswesen als Maßnahmen zur Qualitätssteigerung und Kostenbegrenzung anerkannt. In Deutschland werden sie bislang im Hinblick auf die Erbringung von Gesundheitsdienstleistungen angewendet (Disease-Management-Programme). Dagegen erfolgt die Vergütung der pharmazeutischen Industrie weiterhin nach abgegebener Medikamentenpackung (pay for pill). Die Verknüpfung der Vergütung des Arzneimittelherstellers mit dem Heilungserfolg durch die eingesetzte medikamentöse Therapie (pay for cure) stellt einen neuartigen Ansatz dar, der im Allgemeinen und bei den neuen Hepatitis-C-Therapeutika im Besonderen den erfolgreichen Einsatz eines Arzneimittels belohnt, verlorene Arzneimittelausgaben zu begrenzen hilft und im Sinne des „shared risk“ alle Beteiligten involviert. Unter den Annahmen, dass jährlich 20 000 Hepatitis-C-Virusträger behandelt und durchschnittliche Heilungsquoten gemäß der aktuellen Studienlage von 95,4 % erreicht werden, ergeben sich abhängig von den in der Population eingesetzten Therapieregimen Einsparpotenziale zwischen 45 und 107 Mio. EUR pro Jahr. Insbesondere in schwierig zu behandelnden Patientenkollektiven werden so ökonomische Fehlanreize, die zum Nachteil der Patienten wären, reduziert.

Abstract

Direct acting antivirals (DAAs) have increased cure rates for chronic hepatitis C infection up to nearly 100 %. At the same time treatment costs have risen significantly. Treating all HCV infected patients in Germany with DAAs would generate medication costs ranging between 19 and 37 billion EUR depending on the drug regimen used. Expenses in patients who fail to respond to treatment would amount to approximately 0.9 to 2.15 billion EUR. In difficult to treat patient populations that are characterized by prior failure to treatment or advanced liver disease, lost drug expenses are particularly high due to lower cure rates and longer treatment duration. Outcome-based reimbursement schemes are used to improve the quality of care and to reduce costs in the health care system. In Germany, disease management programs have been implemented for defined chronic diseases. However, drug reimbursement is still based on packages sold (pay for pill). In this context, it would be appealing to link reimbursement and treatment success (pay for cure) in order to reward successful treatment, limit lost drug spending and develop a shared risk environment that would involve all concerned parties. Under the assumption that 20 000 patients with HCV are treated each year in Germany and that cure rates are 95.4 %, the saved treatment costs would amount up to 45 and 107 million EUR per year. By this approach, economic incentives to withhold therapy from difficult to treat patients could be avoided.

Schlüsselwörter

Hepatitis C - Leberzirrhose - Antivirale Therapie - Kosteneffizienz - Vergütungsmodelle - pay for performance

Key words

hepatitis C - liver cirrhosis - antiviral agents - cost effectiveness - reimbursement mechanisms - pay for performance

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