This year’s OHE lecture addresses the question: how should the world pay for a COVID-19 vaccine? Adrian Towse, Emeritus Director of OHE and Senior Research Fellow presents the challenges that we face in developing a COVID-19 vaccine,and suggests a mechanism for buying the vaccine on a global scale. This paper was published alongside the lecture but contains additional analysis, extensive footnotes and references. Comments and feedback are welcome.
This paper presents a supply and demand model of pharmaceutical markets to analyse the relationship between the value of the Cost-Effectiveness Threshold (CET) and the distribution of the health and economic value of new medicines between consumers (payers) and developers (life science industry). As a novelty, the model incorporates a bargaining process and bargaining power distributed between the payer and the developers, which has an impact on the distribution of the health and economic value of new medicines between the two parties.
The National Institute of Health and Care Excellence (NICE) makes recommendations for the use of interventions including medicines in the National Health Service in England based on their clinical and cost-effectiveness. Over the last 20 years 82% of technology appraisal recommendations have been ‘positive’. However, around one third of these are ‘optimised’ recommendations. In this report we quantify the patient access associated with NICE ‘optimised’ recommendations.
In the 2017 Industrial Strategy, the Government committed to increasing investment in UK Research and Development to the OECD-average of 2.4% of Gross Domestic Product (GDP) by 2027, with a longer-term goal of reaching 3% to put the UK in the upper quartile. Whilst there is universal agreement that increasing R&D investment in the UK is a worthy goal, there is an ongoing discussion over how best to achieve it.
OHE presents an overview on the use of cost-effectiveness thresholds (CETs) in a number of selected countries in their decision-making process for health technology assessments. In addition to the different levels of CETs in these countries, this review examines whether an explicit or implicit CET is used, and the additional considerations (here termed ‘modifiers’) that are incorporated when funding and reimbursement decisions are made.
Personalised medicine, also known as ‘precision’ or ‘stratified’ medicine, targets treatment by using genetics and/or biomarkers to identify patients or subgroups of patients who have distinct mechanisms of disease or who may respond to treatment in a particular way. The goal is to provide more effective care, which potentially not only benefits the patient but also improves the efficiency of the healthcare system.
Although the science underlying drug development has evolved, there has been little change in how we pay for them. As more and more medicines come to market with multiple indications (or even more importantly the unrealised potentialto treat multiple indications), the way we pay for those medicines becomes critical in making sure we can benefit from them. “Indication-based pricing” (IBP) permits price to vary according to indication and has been proposed to tackle this issue.
The World Health Organisation (WHO) has become quite skilled at promoting what changes are desirable in health care systems, and why, but has largely left how to implement those changes to individual countries. Although certainly no one solution will fit all countries, some evidence-informed guidelines and insights about how to implement change successfully may help ensure progress in large-scale health system transformation.
The ‘opioid epidemic’ in the US is the most recent drug-abuse challenge from the misuse of prescription medicines or the use of illicit drugs. It is a particularly difficult challenge because thousands of patients benefit from the prescription pain killers that originally fuelled the crisis. Ceasing production and use of such medications, then, is not the right answer. But the crisis has recently entered a more lethal phase, one that involves the use of illicit synthetic opioids which are both more addictive and more deadly.
Hernandez-Villafuerte, K., Shah, K., Herdman, M., and Lorgelly, P.
Meningococcal disease is a life-threatening infection and can result in severe sequelae. Recent scientific and technical advances have led to the discovery and implementation of novel meningococcal vaccines which have resulted in a substantial reduction in the burden of disease worldwide, representing a major public health achievement (Crum-Cianflone and Sullivan, 2016).