Amortization of gene replacement therapies: A health policy analysis exploring a mechanism for mitigating budget impact of high-cost treatments |
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| Affiliation: | 1. University of Aix-Marseille, Public Health Department, 27 Boulevard Jean Moulin, 13385 Marseille, France;2. KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, Oude Markt 13, 3000 Leuven, Belgium;3. University of Duisburg-Essen, Institute for Health Services Management, Forsthausweg 2, 47057 Duisburg, Germany;4. ApotheCom, A MEDiSTRAVA company, Holborn Gate, 26 Southampton Buildings, Holborn, London WC2A1, United Kingdom;5. University of Paris-Est Creteil, 61 Avenue du Général de Gaulle, 94000 Créteil and Creativ-Ceutical, 215 rue du Faubourg Saint-Honore, 75008 Paris, France;6. Interuniversity Center for Health Economic Research (ICHER), Department of Public Health, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium;7. Universität Hannover, Institute of Risk and Insurance, Otto-Brenner-Straße 7, 30159 Hannover, Germany;8. FHiTT, HiTT Foundation, Aragó 60 ppal 1a, 08015 Barcelona, Spain;9. University of Utah, College of Pharmacy, 30 2000 E, Salt Lake City UT 84112, United States;10. University of Washington, Department of Pharmacy, Health Sciences Building, 1959 NE Pacific St, Box 357630, Seattle, WA 98195, United States;1. Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;2. Master Program in Trans-disciplinary Long-Term Care and Management, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;3. Department of Social Insurance, Ministry of Health and Welfare, Taiwan;1. Centre for Healthcare Education Research Innovation (CHERI), School of Medicine, Medical Sciences & Nutrition, Polwarth Building, Foresterhill, University of Aberdeen, AB25 2ZD, UK;2. Health Economics Research Unit (HERU), School of Medicine, Medical Sciences & Nutrition, Polwarth Building, Foresterhill, University of Aberdeen, AB25 2ZD, UK;3. Lee Kong Chian School of Medicine (LKCMedicine), Nanyang Technological University Singapore, 308232, Singapore;4. School of Health Sciences, University Road, University of Southampton, SO17 1BJ, UK;1. Walsall Manor Hospital, Walsall Healthcare NHS trust;2. University Hospitals Coventry and Warwickshire;3. Edge Hill University, UK;4. Dudley Group of Hospitals NHS Trust;1. Departamento Políticas Públicas e Historia Económica, Universidad Del País Vasco (UPV/EHU), Avenida Lehendakari Aguirre 83. 48015, Bilbao, SPAIN;2. Departamento Políticas Públicas e Historia Económica, Universidad Del País Vasco (UPV/EHU), Avenida Lehendakari Aguirre 83. 48015, Bilbao, SPAIN |
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| Abstract: | With gene replacement therapies (GRTs) increasingly and rapidly reaching the healthcare marketplace, the vast potential for improving patient health is matched by the potential budgetary impact for healthcare payers. GRTs are highly valuable given their potential life-extending or even curative benefits and may provide significant cost-offsets compared with standard of care. Current healthcare systems are, however, struggling to fund such valuable but costly therapies. Some payers have already implemented specific financing models to account for the new treatment paradigms, but these do not address the budget impact in the year of acquisition or administration of these costly technologies. This health policy analysis aimed to assess the rationale and feasibility of amortization, within the context of financing healthcare technologies, and specifically GRTs. Amortization is an accounting concept applied to intangible assets that allows for spreading the cost an intangible asset over time, allowing for repayment to occur via interest and principal payments sufficient to repay the intangible asset in full by its maturity. Our systematic scoping review on the amortization of healthcare technologies found a very small literature base with even that being unclear and inconsistent in its understanding of the issues. Where amortization was proposed as a solution for funding costly, but highly valuable GRTs, the concept was not fully investigated in detail, nor was the feasibility of the approach fully challenged. However, by providing clear definitions of relevant concepts along with an example of amortization models applied to some example GRTs, we propose that amortization can offer a promising method for funding of extraordinarily high-value healthcare technologies, thereby increasing market and patient access for these technologies. Nonetheless, healthcare accounting principles and financing guidelines must evolve to apply amortization to the rapidly developing GRTs. |
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