IS THE FRENCH ‘LISTE-EN-SUS’ STILL
SUPPORTING ACCESS TO INNOVATIVE
MEDICINES?
Isabelle Ortiz, Caroline Conti, Jim Furniss (GfK London,UK)
OBJECTIVE
The ‘liste-en-sus’ was implemented within the framework of the HPST law[1], which aim was to lead the French healthcare
system towards a quality-based organisation in order to address medical needs in a more efficient way.
One of the objectives of the ‘liste-en-sus’ was to ensure access to highly-priced innovative medicines in hospital settings
without distorting the Diagnostic-Related Groups (DRG). The objective of this research is to analyse the degree of innovation
of the medicines included in the ‘liste-en-sus’ as of January 2014.
METHODS
The ATIH[2] is a public agency in charge of coding, collecting,
analysing, restoring and broadcasting information on hospital
activity. Among others, they keep track of all inclusions,
delisting and tariff amendment from the ‘liste-en-sus’, and the
consolidated list is publicly downloadable from their website.
From the latter list, an initial analysis consisted of identifying
all the Health Technology Assessments (HTAs) for each product
included in the ‘liste-en-sus’, those HTAs were downloaded
from the HAS website[3]. Then, for each HTA, the following
information was collected: assessment date, SMR (medical
benefit) and ASMR (improvement in medical benefit) scores.
RESULTS (Note: numbers were rounded to the nearest one)
The ‘liste-en sus’ includes 123 medicines. 21% have no HTA
available on the HAS website. Another 19% were last evaluated
before 2004 according to the HAS website. (Figure 1)
an ASMR III, 8% an ASMR IV, 36% an ASMR V. In other terms,
amongst the medicines which have undergone an HTA in
the last 10 years, about 44% of them were deemed noninnovative (ASMR IV/V). (Figure 2)
Among the medicines which have undergone an HTA since
2004, 7% were granted an ASMR I, 27% an ASMR II, 22%
Figure 2: Most recent ASMR scores granted by HAS for products
evaluated after 2004[3]
Figure 1: Last HAS evaluation of ‘liste-en-sus’ products
21%
Before 2004
AMSR I
After 2004
AMSR II
7%
Not available
19%
44%
‘non-innovative’ products
Medicines which were granted
an ASMR IV or V mainly
consist in antihaemorrhagics
(27%), antianaemics (18%),
antineoplastics (15%)
and immune sera and
immunoglobulins (15%)[4].
Although they are not
innovative, those medicines
are only used in a proportion
of patients and are thus likely
to distort DRG. (Figure 3)
To put these results into
perspective, since 2005,
92% of evaluated medicines
were granted an ASMR IV/V:
the ‘liste-en-sus’ medicines
are more innovative than
the average medicines
evaluated[3]. (Figure 4)
AMSR IV
27%
36%
8%
60%
AMSR III
56%
22%
AMSR V
‘innovative’ products
Figure 3: ATC classification of products deemed non-innovative by HAS (ASMR IV or V[4])
3% 3%
B03: Antihaemorrhagics (e.g. factor VIII)
B03: Antianaemic preparations (e.g. epotein alfa)
6%
27%
12%
J06: Immune sera and immunoglobulins (e.g. human normal immunoglobulin)
L01: Antineoplastic agents (e.g. carmustine)
L04: Immunosuppressants (e.g. ustekinumab)
B01: Antithrombotic agents (e.g. treprostinil)
15%
18%
A16: Other alimentary tract and metabolism products (e.g. velaglucerase alfa)
B03: Other haematological agents (e.g. human C1 inhibitor)
15%
Figure 4: ASMR granted to ‘liste-en-sus’ products compared to all products evaluated since 2005[3]
ASMR I
ASMR II
ASMR III
ASMR IV
Liste-en-sus products
All products
7%
1%
27%
3%
22%
4%
8%
7%
ASMR V 36%
85%
CONCLUSIONS
Looking at the ‘liste-en-sus’ objectives, the most decisive criterion seems to be more stability of the DRG rather than access
to innovative medicines; however a higher proportion of the medicines in the ‘liste-en-sus’ are innovative.
Poster PHP27 presented at ISPOR 17th Annual European Congress, Amsterdam, The Netherlands
For additional information, please contact: [email protected], [email protected] or [email protected]
© GfK, October 2014
1. HPST: Hospital, patients, healthcare, territories; Loi n° 2009-879 du 21 juillet
2009.
2. ATIH: Technical agency responsible for hospitalisations’ information; http://
www.atih.sante.fr/unites-communes-de-dispensation-prises-en-charge-en-sus,
downloaded 25/01/2014
3. HAS: High Authority for Health; http://www.has-sante.fr
4. WHO Collaborative Centre for Drugs Statistics and Methodology, ATC Index