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Are We Ready for a New Approach to Comparing Coverage and Reimbursement Policies for Medical Nutrition in Key Markets: An ISPOR Special Interest Group Report
Perugini, Moreno1; Johnson, Tricia J.2; Beume, Tania Maria3; Dong, Olivia M.4; Guerino, John5; Hu, Hao6; Kerr, Kirk7; Kindilien, Shannon8; Nuijten, Mark9; Ofili, Theresa U.10; Taylor, Matthew11; Wong, Alvin12; Freijer, Karen13
2022-01-24
Source PublicationVALUE IN HEALTH
ISSN1098-3015
Volume25Issue:5Pages:677-684
Abstract

OBJECTIVES: Healthcare policy makers should ensure optimal patient access to medical nutrition (MN) as part of the management of nutrition-related disorders and conditions. Questions remain whether current healthcare policies reflect the clinical and economic benefits of MN. The objective of this article is to characterize coverage and reimbursement of MN, defined as food for special medical purposes/medical food for a diverse set of countries, including Australia, Belgium, Brazil, Canada, China, France, Germany, Hong Kong, Italy, Japan, The Netherlands, Singapore, Spain, United Kingdom, and United States. METHODS: Data sources included published literature and online sources. ISPOR's Nutrition Economics Special Interest Group developed a data collection form to guide data extraction that included reimbursement coverage, years that reimbursement policies were established, and presence of a formal health technology assessment (HTA) for MN technologies. RESULTS: Reimbursement coverage of MN technologies varied across the countries that were reviewed. All but 3 countries limited coverage to specific formulations of products, regardless of demonstrated clinical benefit. The year that reimbursement policies were established varied across countries (ranging from 1984 to 2017), and only 4 countries regularly update policies. France and Brazil are the only countries with a formal HTA process for MN technologies. CONCLUSIONS: Most countries have limited MN reimbursement, have not updated reimbursement policies, and lack HTA for MN technologies. These limitations may lead to suboptimal access to MN technologies where they are indicated to manage nutrition-related disorders and conditions, with the potential of negatively affecting patient and healthcare system outcomes.

KeywordCoverage Food For Special Medical Purposes Malnutrition Medical Food Medical Nutrition Regional Differences Reimbursement
DOI10.1016/j.jval.2022.01.011
URLView the original
Indexed BySCIE ; SSCI
Language英語English
WOS Research AreaBusiness & Economics ; Health Care Sciences & Services
WOS SubjectEconomics ; Health Care Sciences & Services ; Health Policy & Services
WOS IDWOS:000806214900001
Scopus ID2-s2.0-85129399901
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Document TypeJournal article
CollectionInstitute of Chinese Medical Sciences
Corresponding AuthorPerugini, Moreno
Affiliation1.Nestle Health Science, Bridgewater, United States
2.Rush University, Chicago, United States
3.Instituto Nacional de Câncer, Petrópolis, Brazil
4.Duke Center for Applied Genomics & Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC;
5.Durham VA Health Care System, Durham, NC, USA
6.ISPOR, Lawrenceville, NJ, USA (Guerino)
7.University of Macau, Taipa, Macau
8.Abbott, Columbus, OH, USA
9.University of New Mexico, NM, Albuquerque, United States
10.Istanbul Technical University, Turkey
11.Texas A&M University, TX, College Station, United States
12.York Health Economics Consortium, York, United Kingdom
13.Changi General Hospital, Singapore
14.Erasmus University Rotterdam, Rotterdam, Netherlands
Recommended Citation
GB/T 7714
Perugini, Moreno,Johnson, Tricia J.,Beume, Tania Maria,et al. Are We Ready for a New Approach to Comparing Coverage and Reimbursement Policies for Medical Nutrition in Key Markets: An ISPOR Special Interest Group Report[J]. VALUE IN HEALTH, 2022, 25(5), 677-684.
APA Perugini, Moreno., Johnson, Tricia J.., Beume, Tania Maria., Dong, Olivia M.., Guerino, John., Hu, Hao., Kerr, Kirk., Kindilien, Shannon., Nuijten, Mark., Ofili, Theresa U.., Taylor, Matthew., Wong, Alvin., & Freijer, Karen (2022). Are We Ready for a New Approach to Comparing Coverage and Reimbursement Policies for Medical Nutrition in Key Markets: An ISPOR Special Interest Group Report. VALUE IN HEALTH, 25(5), 677-684.
MLA Perugini, Moreno,et al."Are We Ready for a New Approach to Comparing Coverage and Reimbursement Policies for Medical Nutrition in Key Markets: An ISPOR Special Interest Group Report".VALUE IN HEALTH 25.5(2022):677-684.
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