Third-party payers routinely need, and request from R&D companies, high-quality evidence on the potential fiscal implications of funding new and emerging health technologies and services. We believe that such discussions should be based on the foundation of 'principled negotiations' put forth initially by Fisher and Ury in Getting to Yes, first published in 1981. Analyses to inform these discussions require a mutual understanding and agreement on diverse set of inputs, such as:

• How many people may be eligible for the new intervention (e.g., target population)?
• What is the likely uptake of the new intervention in the target population? How is this affected by the payers’ decisions concerning prior authorization and patient insurance status and co-payments?
• What are the likely costs of the new invention, included but not limited to considerations of the price of the intervention, cost of administration, and expected use of the intervention relative to its labeled indication(s)?

Cedar Associates LLC has extensive experience obtaining reliable information to such question and developing credible fiscal forecasts (also referred to as Budget Impact Models, see ISPOR at http://www.ispor.org/workpaper/practices_index.asp).

In addition, we realize that the findings must be conveyed in a manner that is well understood by all parties and allows them to test the assumptions that drive the findings. We have developed many highly successful tools based on the latest understanding in how to effectively communicate quantitative data visually. These tools have helped facilitate understanding among parties so that they may (1) focus on interests, not positions; (2) consider more fully options for mutual gain; and (3) assure use of objective, well-substantiated criteria for making decisions.

Recent Projects

Fiscal Implications of Recurrence Score Testing (FIRST) in Early-Stage Breast Cancer

We forecasted the financial impact of health plans adopting a novel RT-PCR genomic assay that more accurately predicts, compared with traditional markers, distant recurrence of breast cancer among women diagnosed with lymph-node negative, estrogen-receptor positive early stage breast cancer. The assay provides a prognosis (10-year recurrence rate) if the women elects not to receive adjuvant chemotherapy and predicts the response to chemotherapy.  The analyses has been shown to major public and private third-party payers, resulting in greater understanding by these stakeholder of the assay, its financial implications, and has contributed to the assay’s widespread acceptance and adoption.

Fiscal Implications of a Novel Treatment to Manage Anemia of Chronic Kidney Disease

Cedar has forecast the financial impact of erythropoietins used in the management of anemia of chronic kidney disease.  The forecasts allow third-party payers (government, employer-paid health plans) and providers to better understand how these products could be more optimally used in their settings and the potential sources of cost-savings.