Patient-reported outcomes in the context of the benefit assessment in Germany

Since the 2011 Act on the Reform of the Market for Medicinal Products, benefit dossiers are submitted by pharmaceutical companies to facilitate the Health Technology Assessment (HTA) appraisals in Germany. The Institute for Quality and Efficiency in Health Care conducts the added benefit assessment following their General Methods Paper, which was updated November 5, 2020. This White Paper is dedicated to patient-reported outcomes (PRO) to highlight their importance for the added benefit assessment. We focus on methodological aspects but consider also other relevant requirements and challenges, which are demanded by G-BA and IQWiG. The following topics will be presented and discussed: 1. Role of PRO in HTA decision making exemplary to benefit assessment in Germany 2. Guidances of PRO evaluations 3. PRO Estimand framework 4. Perception and requirements for PRO within the German benefit assessment 5. Validity of instrument 6. Response thresholds for assessing clinical relevance of PRO 7. PRO endpoints / outcome measures / operationalization 8. Missing PRO data 9. PRO after treatment discontinuation This White Paper aims to provide deeper insights about new requirements concerning PRO evaluations for HTA decision making in Germany, highlight points to consider that should inform global development in terms of study planning and frame the requirements also in the context of global recommendations and guidelines. We also aim to enhance the understanding of the complexity when preparing the benefit dossier and promote further scientific discussions where appropriate.