Introduction
Navigating the pathway to reimbursement can often feel like an uphill battle, and you’re not alone in this struggle. Market Access professionals frequently encounter challenges such as:
- Difficulty securing agreement from the Pharmaceutical Benefits Advisory Committee (PBAC) on the comparator, despite robust clinician survey support;
- Scarcity of Australian data to demonstrate the relevance of clinical trial outcomes in the real-world setting;
- Limited access to hospital service utilisation data, such as patient length of stay or concomitant treatment.
These obstacles may seem daunting, but the key to overcoming them lies in leveraging robust real-world data (RWD) for your reimbursement submissions.
Collecting and utilising local data ensures that your submission evidence successfully:
- Justifies the proposed comparator;
- Supports the applicability of trial data to the proposed Australian population;
- Estimates costs and uptake rates in the economic model and financial estimates.
In this article, we’ll explore various data sources available to sponsors for health technology assessment (HTA) activities. We’ll also offer insights on how these datasets can support your Market Access strategies, ensuring that your submissions are both robust and relevant to the Australian context.
Useful Datasets
Medicare Australia Data
Medicare is Australia’s national health insurance scheme, subsidising out-of-hospital medical and allied health services, as well as in-hospital services for private patients, whether in private or public hospitals. Notably, it excludes services for public inpatients. Medicare provides rebates for services claimed by private practitioners, who comprise of most Australian doctors.
Medicare Benefits Schedule (MBS) Data
Overview: The Medicare Benefits Schedule (MBS) provides real-time data on items and services covered under Medicare. These data can be analysed by patient gender and age group, with services and benefits reported as counts, percentages, or per capita statistics.
Use in HTA: MBS data is particularly useful for assessing the utilisation of out-of-hospital and in-hospital services for private patients. It allows for a detailed analysis of service use according to patient demographics, which can be crucial for demonstrating the real-world applicability of clinical trial data in your reimbursement submissions.
Access: aggregate data online http://medicarestatistics.humanservices.gov.au/statistics/mbs_item.jsp
Pharmaceutical Benefits Scheme (PBS) Data
Overview: The Pharmaceutical Benefits Scheme (PBS) provides data on the dispensing volumes and costs associated with medicines covered under the PBS and the Repatriation PBS (RPBS). The statistics are based on items and Anatomical Therapeutic Chemical (ATC) groups and include information on the defined daily dose, discontinuation rates, intermittent use, treatment switches, and patient demographics such as age and gender.
Use in HTA: PBS data is invaluable for understanding the utilisation patterns of new and existing drugs. It helps assess treatment adherence, potential therapy switches, and overall medication use in acute, episodic, and long-term settings. These data are crucial for building a strong case for the budget impact and cost-effectiveness of your intervention in the Australian market.
Access:
Aggregated PBS Data: http://medicarestatistics.humanservices.gov.au/statistics/pbs_item.jsp
PBS 10% Sample Dataset: Available for a fee, send email request to statistics@humanservices.gov.au.
DUSC Utilisation Analysis Reports are publicly available online: https://www.pbs.gov.au/info/industry/listing/participants/public-release-docs/dusc-utilisation-public-release-docs
Custom PBS analyses can also be requested via email to dusc@health.gov.au.
IHACPA National Hospital Cost Data Collection (NHCDC)
Overview: The Independent Health and Aged Care Pricing Authority (IHACPA) gathers detailed hospital cost and expenditure data annually from State and Territory jurisdictions. These data includes insights into costs associated with hospital separations, average length of stay, and costs per specialty or ward.
Use in HTA: NHCDC data is particularly valuable for submissions involving hospital admissions, offering crucial insights into the cost structure of hospital services. This information is critical for showing the cost-effectiveness and budget impact of new interventions compared to the current clinical pathway.
Access: NHCDC Public Sector Report Appendix Table Data (most recent 2021-22) available online
Australian Institute of Health and Welfare (AIHW)
Overview: The Australian Institute of Health and Welfare (AIHW) provides statistical data on a wide range of health and welfare topics, including health expenditure, hospital procedures, disease incidence, injury, mental health, aging, and disability.
Use in HTA: AIHW data is particularly rich and under-utilised by industry for market access and pricing activities. It offers valuable insights that can enhance the understanding of healthcare utilisation, disease prevalence, and outcomes, which are critical for building a strong submission.
Access: AIHW data is available in various formats, including reports, bulletins, and interactive data products like data cubes and Tableau visualisations.
https://www.aihw.gov.au/reports-data
For bespoke data needs, sponsors can submit a Data on Request Form through AIHW’s website. The request process typically takes between two weeks and several months, depending on the complexity of the data and whether ethics approval is required. A small fee is required. More information is available here.
https://www.aihw.gov.au/about-our-data/accessing-data-through-the-aihw/data-on-request
ABS Population Health Surveys
Overview: The Australian Bureau of Statistics (ABS) conducts a range of population health surveys that provide comprehensive data on health conditions, service usage, and risk factors across the population. These surveys include the National Health Survey, the Patient Experiences Survey, the Australian Aboriginal and Torres Strait Islander Health Survey, and the National Study of Mental Health and Wellbeing.
Use in HTA: ABS data is essential for understanding the prevalence of health conditions and the potential market size for new interventions. It also provides insights into patient demographics, healthcare experiences, and mortality, which are crucial for building a robust case for the cost-effectiveness and budget impact of new treatments.
Access: Data cubes from these surveys are publicly available through the ABS website, and researchers can create their own tables using the ABS TableBuilder tool or analyse unit record data through the MicrodataDownload and DataLab services. Access more information here.
https://www.abs.gov.au/statistics/health/health-conditions-and-risks/national-health-survey/2022
https://www.abs.gov.au/statistics/microdata-tablebuilder
Longitudinal Data
Overview: Longitudinal datasets, such as the 45 and Up Study, track health outcomes over time, providing insights into the long-term effects of interventions.
Use in HTA: Ideal for submissions involving chronic disease management and aging-related interventions.
Access: Limited; sponsors should contact the data custodians directly.
Clinical Registries
Overview: Clinical registries collect data on specific diseases or interventions, offering detailed insights into treatment regimens and clinical outcomes.
Use in HTA: Clinical registries are valuable for tracking disease incidence, treatment patterns, and long-term outcomes, critical for evaluating the long-term performance and cost-effectiveness of new interventions.
Access: Many registries publish aggregated data reports; specific data sets can be requested.
Specialised Datasets
Overview: These datasets offer niche insights crucial for specific reimbursement submissions, such as the National Disability Insurance Scheme (NDIS) data and TGA’s Database of Adverse Event Notifications (DAEN).
Use in HTA:
NDIS data can support submissions focused on interventions for people with disabilities. It provides insights into service utilisation, costs, and outcomes.
DAEN data can be used to assess the safety profiles of existing treatments, helping to build a comprehensive risk-benefit analysis.
Access: Available through respective organisation websites or by request.
https://www.ndis.gov.au/about-us/publications/quarterly-reports
https://dataresearch.ndis.gov.au/request-data
Data Sourced via Third Parties
Overview: Several organisations offer data to sponsors on a subscription or one-off request basis, including retail and compound pharmacy dispensing volume data and PBS 10% sample data.
Use in HTA: Third-party data is often used to assess the utilisation trends of treatments, aiding in budget impact models and comprehensive market access strategies.
Access: Requires engagement with the third-party provider.
Dataset Assessment Criteria
When selecting datasets for your market access activities, we recommend using the following assessment criteria:
- Relevance to your market
- Granularity of data
- Accessibility
- Data coverage and completeness
- Technical requirements
- Cost-benefit ratio
- Responsiveness and support
- Ethical and legal compliance
For access to a detailed report on data sources using these assessment criteria, please email contact@pulse-economics.com.au.
Conclusion
Navigating the complexities of reimbursement submissions can be challenging, but leveraging the right real-world data can make a significant difference. By understanding where to find these datasets, how to access them, and how to evaluate their suitability, Sponsors can strengthen their submissions and improve their chances of successful reimbursement.
Remember to keep these resources in your toolkit, and don’t hesitate to reach out to the respective data providers to discuss your specific needs. The right data can not only support your case but also demonstrate the real-world impact of your technology on patient outcomes in the Australian healthcare context.
