In 2018, the NHS turns 70. This OHE Consulting Report demonstrates the contribution and impact of medicines to the health economy in the UK throughout the history of the NHS. Through interviews with experts we identified a shortlist of the most important medicines to have been brought to market, and from a review of the literature and evidence base we attempt to quantify the benefits of these key medicines in terms of health and economic outcomes.
Hernandez-Villafuerte, K., Zamora, B. and Towse, A.
This OHE Research paper by Karla Hernandez-Villafuerte, (German Cancer Research Center, DKFZ), Bernarda Zamora (OHE) and Adrian Towse (OHE) sets out a research agenda proposing new approaches in three areas to improve understanding of supply side opportunity costs for the English NHS. A subsequent paper will set out the authors research findings.
Berdud, M., Garau, M., Neri, M., O'Neill, P., Sampson, C. and Towse, A.
Using a multidisciplinary methodological approach combining a theoretical economic framework with uptake/market share analyses by country and interviews, this OHE research concludes that: (i) IP incentives for R&D may have encouraged a high degree of in-class competition of DAAs close to the first entrant launch; (ii) in-class competition had a positive impact on uptake and adoption of DAAs in the top-5 European countries and; (iii) although in-class competition is a necessary condition for early adoption and fast uptake of innovative medicines, it is not sufficient as there are other factors related to the performance of the new technology, characteristics of the healthcare system and political factors which can have an effect.
The high cost of drugs for rare diseases (‘orphan drugs’) has generated considerable debate. While there is debate in the economic literature over whether a premium should be paid for ‘rarity’, these drugs are reimbursed with high prices in many countries. The question then arises as to what should be a reasonable price for an orphan drug?
Cole, A., Towse, A., Lorgelly, P., and Sullivan, R.
The current system of a single price per medicine means that, for multi-indication medicines, the relationship between price and “value” can vary substantially. In this OHE Research paper, we consider: What are the economic implications of an alternative to single-price payments for pharmaceuticals? In particular, what are the implications for: payer budgets, patient access, and the incentives for innovation?
Cubi-Molla, P., Mott, D., Shah, K., Herdman, M., Summers, Y. and Devlin, N.
Cancer survival rates have improved dramatically in recent decades due in part to pharmaceutical advances, with a growing range of increasingly effective and targeted medicines being developed, such as immunotherapies. In the economic modelling of such treatments, the question arises of which utilities should be assigned to patients who show a long-term, durable response.
In recent critiques of economic models in this area by the National Institute for Health and Care Excellence (NICE), the idea that long-term cancer survivors (LTCS) who have received such treatments could report quality of life (QoL) scores which are similar to, or higher than, those of equivalent general population samples has not been viewed as credible. This literature review examines whether there is evidence to support the assumption that the QoL of LTCS can be similar to that of age/sex-matched population samples.
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.