Review of studies reporting actual prices for medicines

Mardetko, N; Kos, Mitja; Vogler, Sabine

doi:10.1080/14737167.2019.1552137

Cited by 17 publications

(15 citation statements)

References 39 publications

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“…First, when publicly available information about list prices for drugs do not reflect actual prices, the comparison of drug prices across countries becomes more difficult and less relevant. 39 , 40 Another ethical concern is that confidential pricing reduces transparency and legitimacy in the health care system. This lack of procedural fairness makes it difficult for the public to assess whether the criteria are adhered to in practice and to what degree access to new treatments is equitable and fair.…”

Section: Discussionmentioning

confidence: 99%

Appraising Drugs Based on Cost-effectiveness and Severity of Disease in Norwegian Drug Coverage Decisions

et al. 2022

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IMPORTANCE Rising health care costs are a major health policy challenge globally. Norway has implemented a priority-setting system intended to balance cost-effectiveness and concerns for fair distribution, but little is known about this strategy and whether it works in practice. OBJECTIVETo present and evaluate a systematic drug appraisal method that uses the severity of disease to account for a fair distribution of health in cost-effectiveness analysis, forming the basis for price negotiations and coverage decisions. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study uses confidential drug price information and publicly available data from health technology assessments and logistic and linear regression analyses to evaluate drug coverage decisions for the Norwegian specialized health care sector from 2014 to 2019. MAIN OUTCOMES AND MEASURES Drug coverage decisions by Norwegian authorities andincremental cost-effectiveness and severity of disease measured as absolute shortfall of quality adjusted life years. RESULTSBetween 2014 and 2019, a total of 188 drugs were appraised, of which 113 were cancer drugs. The overall coverage rate was 73% (138 of 188). The number of annual appraisals increased during the observation period. Based on 83 chosen decisions, regression analysis showed that incremental cost-effectiveness ratios (ICER) based on negotiated drug prices, adjusted for severitydifferentiated cost-effectiveness thresholds, was the variable that best projected drug approvals

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Section: Discussionmentioning

confidence: 99%

Appraising Drugs Based on Cost-effectiveness and Severity of Disease in Norwegian Drug Coverage Decisions

et al. 2022

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“…Withholding agreed prices because of commercial confidentiality is an understandable consequence of price negotiation between the State and manufacturers. This confidentiality is valuable to manufacturers for their negotiations in other markets [ 31 ]. Offering confidentiality to manufacturers may help decision makers secure savings for the State and is common practice in many countries [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness evidence on approved cancer drugs in Ireland: the limits of data availability and implications for public accountability

et al. 2021

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Background We surveyed evidence published by Ireland’s National Centre for Pharmacoeconomics (NCPE) on the cost-effectiveness of cancer drugs approved for funding within the Irish public healthcare system. The purpose is threefold: to assess the completeness and clarity of publicly available cost-effectiveness data of such therapies; to provide summary estimates of that data; to consider the implications of constraints on data availability for accountability regarding healthcare resource allocation. Methods The National Cancer Control Programme lists 91 drug-indication pairs approved between June 2012 and July 2020. Records were retrieved from the NCPE website for each drug-indication pair, including, where available, health technology assessment (HTA) summary reports. We assessed what cost-effectiveness data regarding approved interventions is available, aggregated it and considered the consequences of reporting constraints. Results Among the 91 drug-indication pairs 61 were reimbursed following full HTA, 22 after a rapid review process and 8 have no corresponding NCPE record. Of the 61 where an HTA report was available, 41 presented costs and quality-adjusted life-year (QALY) estimates of the interventions compared. Cost estimates and corresponding incremental cost-effectiveness ratios (ICERs) are based on prices on application for reimbursement. Reimbursed prices are not published. Aggregating over the drug-indication pairs for which data is available, we find a mean incremental health gain of 0.85 QALY and an aggregate ICER of €100,295/QALY, which exceeds Ireland’s cost-effectiveness threshold of €45,000/QALY. Conclusion Reimbursement applications by pharmaceutical manufacturers for cancer drugs typically exceed Ireland’s cost-effectiveness threshold, often by a considerable margin. On aggregate, the additional total net cost of new drugs relative to current treatments needs to be more than halved for the prices sought on application to be justified for reimbursement. Commercial confidentiality regarding prices and cost-effectiveness upon reimbursement compromises accountability regarding the fair and efficient allocation of scarce healthcare resources.

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“…It has been highlighted in literature [28,[35][36][37] and in policy debate that the cost-containment capacity of EPR is strongly impaired by referencing to 'fake prices' Table 2 Parameters of the EPR methodology in the studied EPR-applying countries, 2015…”

Section: Discussionmentioning

confidence: 99%

“…It has been highlighted in literature [ 28 , 35 – 37 ] and in policy debate that the cost-containment capacity of EPR is strongly impaired by referencing to ‘fake prices’ [ 38 ] since the real prices are not known due to the confidential character of discounts and managed-entry agreements. Both scenarios of this study that considered discounts confirmed the loss of savings opportunities given the non-consideration of discounted prices in other countries.…”

Section: Discussionmentioning

confidence: 99%

Impact of changes in the methodology of external price referencing on medicine prices: discrete-event simulation

Vogler

Schneider

Lepuschütz

2020

Cost Eff Resour Alloc

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Background Several governments apply the policy of external price referencing (EPR), which considers the prices of a medicine in one or more other countries for the purpose of setting the price in the own country. Different methodological choices can be taken to design EPR. The study aimed to analyse whether, or not, and how changes in the methodology of EPR can impact medicine prices. Methods The real-life EPR methodology as of Q1/2015 was surveyed in all European Union Member States (where applicable), Iceland, Norway and Switzerland through a questionnaire responded by national pricing authorities. Different scenarios were developed related to the parameters of the EPR methodology. Discrete-event simulations of fictitious prices in the 28 countries of the study that had EPR were run over 10 years. The continuation of the real-life EPR methodology in the countries as surveyed in 2015, without any change, served as base case. Results In most scenarios, after 10 years, medicine prices in all or most surveyed countries were—sometimes considerably—lower than in the base case scenario. But in a few scenarios medicine prices increased in some countries. Consideration of discounts (an assumed 20% discount in five large economies and the mandatory discount in Germany, Greece and Ireland) and determining the reference price based on the lowest price in the country basket would result in higher price reductions (on average − 47.2% and − 34.2% compared to the base case). An adjustment of medicine price data of the reference countries by purchasing power parities would lead to higher prices in some more affluent countries (e.g. Switzerland, Norway) and lower prices in lower-income economies (Bulgaria, Romania, Hungary, Poland). Regular price revisions and changes in the basket of reference countries would also impact medicine prices, however to a lesser extent. Conclusions EPR has some potential for cost-containment. Medicine prices could be decreased if certain parameters of the EPR methodology were changed. If public payers aim to apply EPR to keep medicine prices at more affordable levels, they are encouraged to explore the cost-containment potential of this policy by taking appropriate methodological choices in the EPR design.

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Review of studies reporting actual prices for medicines

Cited by 17 publications

References 39 publications

Appraising Drugs Based on Cost-effectiveness and Severity of Disease in Norwegian Drug Coverage Decisions

Appraising Drugs Based on Cost-effectiveness and Severity of Disease in Norwegian Drug Coverage Decisions

Cost-effectiveness evidence on approved cancer drugs in Ireland: the limits of data availability and implications for public accountability

Impact of changes in the methodology of external price referencing on medicine prices: discrete-event simulation

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