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Table 1 Timing and Outcome of HTA appraisals in France, Italy, and Germany since 2011

From: Leveraging EUnetHTA’s conceptual framework to compare HTA decision drivers in France, Italy, and Germany from a manufacturer’s point of view

Medicine EMA Appro-val Indication France Italy Germany
Vemurafenib Feb 17th 2012 Melanoma 1st Appraisal: Oct 3rd, 2012
2nd Appraisal: Mar 22nd, 2017
Publication Price: Feb 1st, 2013
Both Appraisals:
SMR: substantial
ASMR: moderate (level III)
Publication: Jun 4th, 2013;
Class H
Payment by Result scheme and sales cap
1st appraisal: Sep 6th, 2012
2nd appraisal: Mar 6th, 2014
Both appraisals: Indication considerable benefit
Pirfenidon
(Orphan Designation)
Feb 28th, 2011 Idiopathic Pulmonary Fibrosis 1st Appraisal: Mar 14th, 2012
2nd Appraisal: Feb 18th, 2015
Publication Price: Oct 16th, 2012
SMR 1st Appraisal: Low
SMR 2nd Appraisal: Moderate
ASMR: minor (level IV)
1st Publication: Jun 14th, 2013
Class H
‘success fee’ agreement and stopping rule
2nd Publication: Jul 3st, 2015
Removal of ‘success fee’ and stopping rule due to new evidence submitted
Appraisal: Mar 15th, 2012
Additional benefit non-quantifiable
Pertuzumab
1st Indication
Metastatic
Mar 4th 2013 Her2+ metastatic Breast Cancer Appraisal: Jul 24th, 2013
Publication Price: Dec 13th, 2013
SMR: substantial
ASMR: moderate (level III)
Publication: June 23rd, 2014
Class H
‘Innovation designation’
Appraisal: Oct 1st, 2013
• Visceral Metastases: Hint Considerable benefit
• Non-visceral Metastases: no additional benefit
• Locally recurrent: no additional benefit
Pertuzumab
2nd Indication Neoadjuvant
Jul 28th 2015 Neo-adjuvant Appraisal: Jul 6th, 2016
SMR: insufficient
ASMR: not applicable
Publication: Jan 5th, 2017
No reimbursement
Appraisal: Feb 18th, 2016
No additional benefit
Vismodegib Jul 12th 2013 Locally advanced or metastatic Basal Cell Carcinoma Appraisal: Dec 18th, 2013
Publication Price: Sept 2nd, 2015
SMR: substantial
ASMR: minor (level IV)
Publication: April 9th, 2015
Class H
Cost sharing agreement
1st appraisal: Feb 6th, 2014
2nd appraisal: Aug 4th, 2016
Both appraisal:
• Metastatic BCC: no additional benefit
• Locally Advanced BCC: Hint Minor Benefit
Trastuzumab Emtansine Nov 15th, 2013 Her2+ Breast Cancer Appraisal: Mar 19th, 2014
Publication Price: Nov 14th, 2014
SMR: substantial
ASMR: substantial (level II)
Publication: Sep 26th, 2014
Class H
‘Potential Innovation’ designation
Payment by Result scheme
Appraisal: Jun 19th, 2014
• Locally Advanced: no additional benefit
• Previous therapy includes Anthracycline: Indication considerable benefit
• Previous therapy without Anthracycline: no additional benefit
Obinutu-zumab
1st indication
(Orphan Designation)
Jul 23rd 2014 Chronic Lymphocytic Leukaemia Appraisal: Feb 18th, 2015
Publication Price: Dec 24th, 2015
SMR: substantial
ASMR: moderate (level III)
1st Publication: Jan 3rd, 2015
Class C
2nd Publication: Feb 24, 2017
Class H
Reimbursed with cost sharing scheme
Appraisal: Feb 5th, 2015
Non-quantifiable additional benefit
Obinutu-zumab
2nd indication
(Orphan Designation)
Jun 13th, 2016 Follicular Lymphoma Appraisal: Mar 8th, 2017
SMR: substantial
ASMR: no (level V)
Publication: Aug 31st, 2017
Class H
Reimbursed with discount (removal of previous cost sharing agreement)
Appraisal: Dec 16th, 2016
Non-quantifiable additional benefit
Cobimetinib Nov 20th, 2015 Melanoma Appraisal: Mar 16th, 2016
Publication Price: Feb 16th; 2017
SMR: substantial
ASMR: moderate (level III)
Publication: Oct 1st, 2016
Class H
Reimbursed with Payment by Result Scheme
Appraisal: Jun 2nd, 2016
Indication Considerable benefit
Alectinib Feb 16th 2017 Non-small lung cancer Appraisal: Dec 13th, 2017
Publication Price: Pending
SMR: substantial
ASMR: minor (level IV)
Publication: Final Publication pending Appraisal: Oct 19th, 2017
• Patients eligible for DCP: Hint Minor benefit
• Patients not eligible for DCP: no additional benefit
  1. Abbreviations: ASMR Amélioration du Service Médical Rendu, CDF Cancer Drug Fund, DCP Docetaxel, or Pemetrexed, or Ceritinib, ERG Evidence Review Group, FVC Forced Vital Capacity, ICER Incremental Cost Effectiveness Ratio, QALY Quality Adjusted Life Year, SMR Service Médical Rendu
  2. * 2nd opinion was conducted as Budget Impact by Pirfenidon sales was considered significant