How well do price regulations of pharmaceuticals help to achieve the desired social objectives? Such as improved health, rapid access to new therapies, sustainable health spending or securing investment in research?

Dominik J Wettstein, Stefan Boes

Overview

The aim of this review is to assess the current state of empirical research regarding the effectiveness of national pricing regulations of the patent-protected market for prescription pharmaceuticals. A systematic review of the published literature on pricing regulations in OECD countries was performed. We found evidence that therapeutic reference pricing may reduce pharmaceutical prices and expenditures in the short term and may lead to substitution effects towards lower-priced drugs in the short term. Apart from the above, the existing research does not provide credible evidence that the current policies have an impact on healthcare utilisation, patient access, health outcomes or R&D investments.

Summary

There is a strong need for evidence generation regarding effective pricing policies, particularly for value-based pricing policies and for non-financial outcomes.

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Author Comments

Dominik J Wettstein
Dominik J Wettstein
Department of Health Sciences and Medicine, University of Lucerne
Health Economist
Zurich | Switzerland
Policy makers should systematically define the assessment of policy effectiveness during the policy formulation process. In addition, experimental research on the topic could augment the scarce amount of available evidence, especially for value-based pricing policies.Dominik J Wettstein

Resources

Publication
https://doi.org/10.1007/s40258-018-0437-z

Effectiveness of National Pricing Policies for Patent-Protected Pharmaceuticals in the OECD: A Systematic Literature Review.

Authors:
Dominik J Wettstein
Dominik J Wettstein
Department of Health Sciences and Medicine, University of Lucerne
Health Economist
Zurich | Switzerland

Appl Health Econ Health Policy 2019 04;17(2):143-162

Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland.

Objectives: The aim of this review is to assess the current state of empirical research regarding the effectiveness of national pricing regulations of the patent-protected market for prescription pharmaceuticals. Effectiveness is understood to be the capacity of policies to have a desired impact on outcomes, such as health status, patient access, healthcare expenditure, and research investments, among others.

Methods: A systematic review of the published literature on pricing regulations in OECD countries was performed. The PubMed, MEDLINE, Scopus, Web of Science, Cochrane Library and the OECD iLibrary databases were searched in September 2016 and December 2017, with an update in August 2018. Interrupted time series studies and additional empirical studies were included, as well as systematic reviews if appropriate methods were applied. The risk of bias was assessed based on the recommendations of the BMJ guidelines, Cochrane EPOC criteria, QHES instrument, HTA good practice guidelines, CRD's guidance and the CHEC criteria. The quality of evidence was evaluated using the suggestions from EPOC and GRADE.

Results: Thirty-one publications met the inclusion criteria. Most of the assessed empirical research included therapeutic (TRP) and/or external reference pricing (ERP), with a clear majority focusing on TRP. The main outcomes that were analysed were drug prices, expenditures and drug use. For value-based pricing (VBP), only limited empirical data were found.

Conclusions: We found evidence that TRP may reduce pharmaceutical prices and expenditures in the short term. Furthermore, TRP may lead to substitution effects towards lower-priced pharmaceuticals. The effects of TRP on patient access, healthcare utilisation and R&D investments were found to be uncertain. No conclusions were drawn for ERP and VBP. No evidence was found for the effects on health outcomes for any of the analysed policies. There is a strong need for evidence generation regarding effective pricing policies, particularly for VBP, managed entry agreements and non-financial outcomes.

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Source
http://dx.doi.org/10.1007/s40258-018-0437-zDOI Listing
April 2019
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