These are vital components of many countries’ purchasing strategies, regardless of income. So given the technical challenges of using health technology assessment, focussing solely on VBP also has the potential to undermine existing and effective systems of competitive tendering and price-volume agreements. Thus, an essential medicine might offer a large health benefit or high value (determined, for example, through cost-effectiveness analysis), but still might not be affordable (because of limited resources, high prices, or both)…”. As the Lancet Commission on Essential Medicines pointed out, affordability is “distinct from the value of a product or service. Globally, the risks of using value-based assessments as the sole basis for pricing are that it does not take into account need, prevalence and affordability. For example, should ‘innovation’ attract a premium regardless of the actual therapeutic benefits? Industry has argued for this approach to ensure continued innovation, but determining how much innovation is worth is as difficult as determining ‘value’ particularly when the research and development costs are not transparent. But what we have learnt is that using cost-effectiveness ratios as the sole basis of either decision making or price setting is fraught with difficulties. Is it the ‘shadow price’ or does it represent ‘willingness to pay’? As Neyt correctly says, the cost-effectiveness ratio should only be the first consideration of many in making decisions about what to reimburse. But we have to emphasise that WHO has not recommended three times gross domestic product (GDP)/capita as ‘relatively cost effective’, which highlights that even in high-income countries controversy and confusion reigns over what the cost-effectiveness threshold represents. As Neyt also points out, there have been many debates about using ‘cost-effectiveness thresholds’. Indeed, health technology assessment and cost-effectiveness evaluation have been used by high-income countries for over 20 years, notwithstanding the well-documented limitations of economic evaluations. However, in practice this has proved more complicated, particularly when establishing what metrics should be included in ‘value’ assessments.Īs noted by Neyt, assessments of the clinical and economic value of pharmaceuticals are a key component in many countries for decisions as to whether specific pharmaceuticals should be provided by health care systems. On the face of it the theory is very simple health systems should pay similar amounts for products with the same therapeutic effect or ‘value’. It is generally defined as the use of any policy or strategy designed to link the price and/or approval of a pharmaceutical or health product to the perceived value of the product. But in the context of pharmaceuticals there is no widely accepted definition of VBP. The basic idea behind this approach is that the price of goods should reflect the value to the buyer rather than the actual costs of production plus a margin. VBP is a well-established pricing strategy for commodities. So what has gone wrong with so-called value-based pricing (VBP)? , was completely unaffordable for countries to use to treat all eligible patients. The price being asked on the basis of cost-effectiveness evaluations might be considered to be ‘value based’, but as described in Iyengar et al. In high income countries this debate has been focused primarily on medicines for cancer and orphan diseases, but in 2014 the pricing of sofosbuvir expanded the issue much more broadly: here was a ‘cost-effective’ treatment for hepatitis C that was unaffordable to countries of any income. Affordability of products, both to individual patients and to health systems, is one of the main barriers to accessing many effective medicines. It has been high on the World Health Organization (WHO) agenda for a number of years. Concern over pricing of pharmaceuticals and other health technologies in both high- and low-income countries is not new.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |