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Budget Impact
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:
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How many people may be eligible for the new intervention (e.g., target population)?
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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?
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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.
Current and
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.
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