Are We Ready for a New Approach to Comparing Coverage and Reimbursement Policies for Medical Nutrition in Key Markets: An ISPOR Special Interest Group Report


Perugini M., Johnson T. J., Beume T. M., Dong O. M., Guerino J., Hu H., ...Daha Fazla

VALUE IN HEALTH, cilt.25, sa.5, ss.677-684, 2022 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 25 Sayı: 5
  • Basım Tarihi: 2022
  • Doi Numarası: 10.1016/j.jval.2022.01.011
  • Dergi Adı: VALUE IN HEALTH
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI), Scopus, Academic Search Premier, ASSIA, PASCAL, CINAHL, EMBASE, International Pharmaceutical Abstracts, MEDLINE, Psycinfo, Public Affairs Index
  • Sayfa Sayıları: ss.677-684
  • Anahtar Kelimeler: coverage, food for special medical purposes, malnutrition, medical food, medical nutrition, regional differences, reimbursement, ENTERAL NUTRITION, ESPEN GUIDELINES, MALNUTRITION, IMPACT, ADULTS, COST, SUPPLEMENTATION, READMISSION, MORTALITY, DIAGNOSIS
  • İstanbul Teknik Üniversitesi Adresli: Evet

Özet

Objectives: Healthcare policy makers should ensure optimal patient access to medical nutrition (MN) as part of the management of nutrition-related disorders and conditions. Questions remain whether current healthcare policies reflect the clinical and economic benefits of MN. The objective of this article is to characterize coverage and reimbursement of MN, defined as food for special medical purposes/medical food for a diverse set of countries, including Australia, Belgium, Brazil, Canada, China, France, Germany, Hong Kong, Italy, Japan, The Netherlands, Singapore, Spain, United Kingdom, and United States. Methods: Data sources included published literature and online sources. ISPOR's Nutrition Economics Special Interest Group developed a data collection form to guide data extraction that included reimbursement coverage, years that reimbursement policies were established, and presence of a formal health technology assessment (HTA) for MN technologies. Results: Reimbursement coverage of MN technologies varied across the countries that were reviewed. All but 3 countries limited coverage to specific formulations of products, regardless of demonstrated clinical benefit. The year that reimbursement policies were established varied across countries (ranging from 1984 to 2017), and only 4 countries regularly update policies. France and Brazil are the only countries with a formal HTA process for MN technologies. Conclusions: Most countries have limited MN reimbursement, have not updated reimbursement policies, and lack HTA for MN technologies. These limitations may lead to suboptimal access to MN technologies where they are indicated to manage nutrition-related disorders and conditions, with the potential of negatively affecting patient and healthcare system outcomes.