Study types

We have built health economic models for nearly all pharmaceutical companies. Key achievements by iMTA are the development of the friction cost method, acceptability curves for cost-effectiveness ratios, equity weighting in HTA, proportionate shortfall methodologies, estimation of the Dutch EQ5D-5L tariff, development of the CarerQoL for assessing informal care burden, estimation of indirect medical costs and theoretical foundations for the societal perspective.

Early HTA is often a pre-clinical, pre-market access assessment of the cost and benefit of new medical intervention. It can be used to assist go/no-go decision in product development, pricing strategies through headroom analyses or to help design the best upcoming clinical trial. With early-HTA, we get the most out of limited data.

For nearly all disease areas, iMTA validates, adapts and submits health economic dossiers to reimbursement agencies in several European countries. If iMTA did not develop the global model but receives it from the manufacturer, we check its validity and perform quality assurance and subsequently adapt the model to meet local circumstances and guidelines. Of course, we also program the societal perspective into the model if it is not yet in place.

Real world data and late-phase studies require innovative solutions to data issues such as patient and treatment heterogeneity. At iMTA, we daily deal with these issues and apply several novel statistical solutions, from patient-level models to combined decision-trees and Markov Models.

Patient registries can highlight slow uptake of innovative medicines and be used for real-world cost-effectiveness studies. At this moment, patient registries are considered one of the most important development in improving cancer care in The Netherlands.

iMTA faced and solved many issues in analytic decision-making. We work with top econometricians, mathematicians, epidemiologists and clinicians to build the best models and employ have an internal quality control system for model quality. We have built models to identify the optimal sequencing strategy in oncology, as well as the cost-saving potential of a range of diagnostic instruments in oncology, COPD and cardiovascular diseases.

Systematic reviews are part of our daily work, as we populate health economic models with parameters based on systematic reviews. We also use reviews to provide clients with state of the art knowledge on a broad range of subjects.

The probability of making the wrong decision and the magnitude of loss when a wrong decision is made are brought together in a value of information analysis. The first step in a VoI analysis is the estimation of the expected value of perfect information (EVPI). The next step is to calculate the expected value of partial perfect information (EVPPI), after which priorities may be set for further research.

In health care decision making, costs per QALY, burden of disease, rarity of the condition, age of the patient and the availability of alternative treatment play a role in reimbursement decisions. However, these decisions are often not transparent. MCDA can be applied to make these decisions transparent. iMTA has experience in conducting MCDA studies, from simple ranking tasks to complex mathematical modelling of preferences.

iMTA does not only analyse reimbursement policy, in many instances we have developed the policy ourselves. In The Netherlands, for example, iMTA developed the iMTA-model for cost-effectiveness in which the threshold for cost-per QALY depends on burden of disease. We are also a known advisor for NICE, national governments and the European Commission.

Decision makers want to select interventions for collective reimbursement which have the most value for money. The key question is: how do we determine value? iMTA has a long history in developing preference-based measures, such as condition-specific measures for multiple sclerosis (MSIS-PBM) and cancer (QLQ-C30), the Dutch EQ5D-5L tariff, discrete choice experiments to assess treatment preferences for equity as well as patient preferences for treatments and the development of the CarerQoL instrument.

iMTA has provided cost-effectiveness studies for reimbursement dossiers for many countries and developed novel methodologies to deal with difficult late phase data analysis.

iMTA has played an important role the past years in estimating the cost price of diagnostic related groups (DRGs) for nearly all costs, most notably complex oncology cases, integrated care and stroke. iMTA is also the lead author of the Dutch costing manual, obliged for reference prices in all economic evaluations for reimbursement dossiers in The Netherlands.