STEFAN WALZER*¹, ELINE KOGELS², BJOERN SCHWANDER³, MARK NUIJTEN⁴
Corresponding author*
1. MArS Market Access & Pricing Strategy UG (h.b), Geffelbachstr. 6, 79576 Weil am Rhein, Germany
2. Kogels Consultancy Network, Stadionweg 55h, Amsterdam, The Netherlands
3. AHEAD Agency for Health Economic Assessment and Dissemination GmbH, Arndtstrasse 19, Loerrach, Germany
4. Ars Accessus Medica, Dorpstraat 75, Jisp (Amsterdam), The Netherlands

Abstract

Even though healthcare decision-makers have begun to realize that food plays an important role, the medical nutrition interventions tend to be excluded from pricing and reimbursement processes even though they (might) also have an (positive) impact on patients clinical outcomes. Medical nutritions could improve health which may contribute to the cost-effectiveness and sustainability of healthcare systems. Anyhow, to price such products according to their value is difficult. We are introducing key strategy components from the pharmaceutical world and analyse the applicability to the medical nutrition world in order to better reflect their value in the potential price setting.

INTRODUCTION

In Europe, health authorities have started to establish incentives for efficient healthcare delivery by means of decentralisation of the healthcare decision-making process and implementation of market mechanisms.
In this paper, the following working definition is used: Medical Food/Nutrition is designed to deliver proven benefits through nutritional intervention, that normal food intake can’t achieve, to improve clinical outcomes and the quality of life for patients, as an integral part of disease management.
An analogue with the reimbursement of pharmaceuticals is used for purpose of comparison and illustration as various cost containment measures have been already widely developed for pharmaceuticals, which may also be applicable to medical nutrition. The decision on reimbursement for drugs is based on value for money of a new drug, which is based on the incremental clinical benefit of the new drug compared with standard therapy. The health authorities will make a trade-off between the of the extra clinical benefit and the (premium) price new drug versus the price of the standard therapy. The judgment of the clinical bene ...