This OHE Consulting Report reviews “Estimated costs of production and potential prices of medicines for the World Health Organization Essential Medicines List” (Hill et al., 2018) in which the authors argue for “greater transparency in drug pricing” and propose generating estimates of the cost of manufacturing essential medicines to inform negotiations on drug pricing.
The notion that the price of a medicine should be linked in some way to value it generates for patients and the health system is generally accepted. Yet, how can this be achieved, when increasingly medicines are being developed that derive patient benefit across many different indications? Indication-based pricing (IBP) has been proposed as a way to tackle this issue, permitting price to vary according to indication and – critically – according to value.
This seminar briefing examines (1) why the UK has not produced large biotech firms that develop drugs, similar to those in the United States (US), (2) why the UK biotech firms that do exist have not brought blockbuster drugs to the market and (3) what the implications are for industrial strategy after Brexit. These remarks are based primarily on research we completed for our recent book, Science, the State and the City (Owen and Hopkins, 2016), with some additions and specific observations about the potential effects of Brexit.
Zamora, B., Parkin, D., Feng, Y., Bateman, A., Herdman, M., and Devlin, N.
This paper reports new methods for analysing the distribution of EQ-5D observations. The Health State Density Index and Health State Density Curve are used to summarise the extent to which people’s self-reported health on the EQ-5D is concentrated on a few health states, or distributed more evenly over a wide range of health states. This information can be useful in understanding patients’ treatment needs, as well as providing a way of comparing the nature of data provided by different patients or collected using different patient-reported outcome measures.
Pearson, S., Dreitlein, B., Towse, A., Hampson, G. and Henshall, C.
OHE Research Paper 18/02: Real World Evidence (RWE) – This paper provides a framework and specific steps to help both manufacturers and payers meet the challenge of developing observational RWE through a transparent process that can be considered credible by all stakeholders.
Hampson, G., Towse, A., Dreitlein, B., Henshall, C. and Pearson, S.
OHE Research Paper 18/01: This paper sets out the potential opportunities and important challenges and limitations that must be addressed in considering options for using RWE to inform insurer coverage decisions. The primary purpose of developing the paper was to stimulate discussion at the 2017 ICER Policy Summit meeting. A separate paper is available that summarises the authors reflections and proposed ways forwards based on the discussions that were had at the meeting.
The report addresses the implications of NICE appraising treatments for very rare diseases using a cost-per-QALY gained decision rule of the type used by NICE in its Technology Appraisal Programme to appraise therapies for more common conditions.
Cole, A., O'Neill, P., Sampson, C., and Lorgelly, P.
Surgical practice has and continues to develop at a tremendous pace, reflecting the evolving technological landscape as well as the expanding skillset of the surgical workforce. Minimal access surgery (MAS) can offer improved recovery prospects for patients, but uptake in the UK is variable across both procedures and hospitals.
Low levels of mortality are important indicators of societal success. This lecture is about trends in mortality in the white non-Hispanic population in the United States of America (US), a subject which is not only interesting in itself, but also of global significance because we are all wondering whether this could happen to our own societies or to specific groups within them. The lecture was delivered by Professor Case, Sir Angus added some further reflections and then both professors engaged in a question and answer session at the end. The work discussed here, which is part of a much larger research agenda, leads to comparisons between the US and what might be happening in Europe.The authors’ most recent work on the topic of mortality rates is summarised in three papers (Case and Deaton 2015, 2017a, 2017b; there are links to these papers at https://scholar.princeton.edu/accase/publications).
This version of the text is based on a transcript of the lecture and, as such, is often less formal and more colloquial than might be expected in an academic paper.
The CRA Report has an underlying assumption that the EU is as globally competitive in generics and biosimilars as it is in innovative products. There is no evidence to support this. The correct industrial strategy for the EU may well be to focus on the development, manufacture and export of innovative products, rather than on lower value generics where EU global competitiveness appears to be weaker.