Saudi Gastroenterology Association · Open course

Scenario simulator

Interactive scenarios with illustrative GI numbers: change the levers, read the verdict, then discuss why it moved.

Appraisal committee: advanced therapy for moderate-to-severe UC

Set the price and assumptions, then read the committee’s likely verdict.

A hospital committee is deciding whether to fund a new advanced therapy against the comparator it uses today. The gain is modelled as extra months in remission per treated patient per year, valued at a utility difference of 0.25 between remission and active disease (illustrative). Move the levers and see how value and affordability separate.

Linked module: Economic evaluation: costs, QALYs and the ICER

New therapy: annual price per patientSAR

Comparator: annual cost per patientSAR

Extra months in remission per patient-year

Downstream savings per patient-yearSAR

Horizonyears

Willingness-to-pay per QALYSAR

Eligible patients

Uptake at steady state%

Annual budget ceiling for this therapySAR million

QALYs gained per patient

0.26

Incremental cost per patient

SAR 70,000

ICER per QALY

SAR 268,800

Annual budget impact

SAR 3.4 M

Threshold price (ICER = λ)

SAR 53,813

Affordable, but poor value

Do not recommend at this price. A price near SAR 53,813 per year would bring the ICER to the threshold under these assumptions.

What to notice

Lower the price until the ICER crosses the threshold. Value and affordability are two separate tests.
Raise uptake and watch the budget impact grow while the ICER stays the same.
Set months in remission low. A weak benefit estimate makes the threshold price fall quickly.

Pay-for-response agreement

See how a rebate for non-responders shifts risk between payer and manufacturer.

A manufacturer offers a high-priced therapy with uncertain real-world response. The payer proposes refunding a share of the price for patients who do not respond at one year. Your task: find terms that bring the cost per responder to the payer’s ceiling.

Linked module: Managed entry, real-world evidence and reassessment

List price per patient-yearSAR

Response rate at one year%

Refund for non-responders (share of price)%

Payer’s ceiling for cost per responderSAR

Patients treated

Expected net price per patient

SAR 50,750

Cost per responder (with agreement)

SAR 112,778

Cost per responder (no agreement)

SAR 155,556

Annual refunds from manufacturer

SAR 5,775,000

Above the payer’s ceiling

Raise the rebate, lower the list price, or tighten the responder definition. Also ask whether the response can be measured reliably.

What to notice

Drop the response rate to 30%. Cost per responder rises from about SAR 113,000 to about SAR 152,000 even with the rebate, because fewer patients benefit. The rebate softens the rise but does not remove it, and the manufacturer’s refunds grow.
Who carries more risk when the rebate is high? Who has the incentive to define response generously?
Administrative cost of verifying response is not in this calculation. Add it mentally.