Exploring the uptake of economic evaluation in Spanish reports positioning medicines for public reimbursement

Therapeutic positioning reports (IPTs, Spanish acronym) are a crucial tool for informing funding and pricing decisions for drugs in the Spanish healthcare system. In 2020, for the first time the inclusion of economic evaluations (EEs) was explicitly set as a primary objective in a new Action Plan aimed at consolidating IPTs. This paper seeks to examine the uptake of EE into IPTs and to compare the methods and techniques employed in the EEs conducted during the two-year pilot phase following the reform, i.e., from June 2021 to July 2023. During this period, a total of 181 IPTs were published, with 19 (10.5%) incorporating an EE section. However, out of these 19 identified IPTs, six did not actually conduct a <i>de novo</i> EE, and four only performed a drug cost minimisation analysis. Six IPTs conducted EE analyses following international methodological standards. Based on this review, we observe that the percentage of IPTs incorporating EEs had remained low and exhibited significant heterogeneity. The experience of these two years must be translated into lessons that can serve to reinforce the evaluation of the efficiency of medicines in Spain in the coming years.