After publishing The Diagnostics Reimbursement Compass: A 90-Minute Guide to Define, Demonstrate and Capture Diagnostics Value Confidently we have also created some short “explainer” videos.
Check out: #4 – What will be the likely price of a diagnostic solution?
There are four principal methods to estimate the likely price of the diagnostic solutions: health economic assessment, willingness to pay studies, analogue assessment, and reimbursement tariff analysis.
When defining the price of a diagnostic solution, the test result (service) should be the primary focus, and healthcare system perspective should be accurately applied (reimbursement tariffs, hospital budgets, out of pocket payments or innovative, alternative funding pathways).
Comprehensive economic modelling, incremental cost-effectiveness ratio (ICER) and ICER thresholds are useful tools to assess diagnostic value drivers. Willingness to pay (WTP) studies capture the customer perspective in various hypothetical and real-life purchasing scenarios, while analogue assessment uses benchmarking to collect lessons learned.
One of the most powerful methods is: reimbursement tariff assessment. It shows which solutions are reimbursed, at what price, which patients are eligible, what technology limitations apply and whether coverage applies in central laboratory and/or point-of-care settings. Reimbursement codes are generally not exclusive to brands or manufacturers; they cover technologies, methodologies, or analytes. In very specific cases (unique, complex tests with high unmet need and supporting evidence), manufacturer product-specific coverage might be possible.
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