L'eficiència de l'atenció no presencial

The COVID-19 Pandemic and the Future of Telemedicine 

Els fets són toçuts i fan canviar comportaments quan menys t'ho esperes. I això és el que va passar durant la pandèmia. Havíem d'accedir al contacte expert amb metges i estava limitat. La telemedicina es va presentar com a solució efectiva a un problema real. Però no és que no hi fos abans, moltíssima gent es va adonar que existia "La meva salut" just en el moment de la pandèmia (1,5 milions d'altes el 2020). La infraestructura havia costat molt bastir-la però estava apunt. Algú es pot imaginar com s'haurien pogut gestionar els 9,4 milions de contactes realitzats només mitjançant TIC l'any 2020?.  Si a això afegim els 18,6 milions de contactes telefònics, tenim 28 milions de contactes no presencials, en comparació als 24,7 milions de contactes presencials. El resultat és que les tecnologies de la comunicació van ajudar a resoldre el 53% dels contactes i van contribuir moltíssim a resoldre problemes de salut durant la pandèmia. Altres països de l'OCDE van fer una proporció inferior de teleconsultes, vegeu el gràfic de l'informe de l'OCDE:

El missatge és que la tecnologia ajuda però també complica les coses si no som capaços de gestionar-la. Ens cal donar una resposta acurada amb una nova organització de les tasques. Ara que tant es parla de la càrrega burocràtica dels metges, caldria donar-hi resposta precisament mitjançant una nova organització de les tasques, on precisament la tecnologia de la informació hi té molt a dir. Posar a l'abast l'accés a les  tecnologies de la informació en medicina sense modificar l'organització és motiu de desajust assegurat. 

Més enllà de la millora en l'accés a l'assistència que aporten les TIC, i per tant una major quantitat de contactes no presencials, caldria també comprendre quin és el valor que aporten, i per tant com contribueixen a una major eficiència. Caldria doncs separar el gra de la palla, allò que realment afegeix valor a la salut en l'assistència no presencial d'allò que és superflu i ens ho podríem estalviar i alhora suposa una càrrega evitable. I d'aquesta manera aclarir quina part tenen les TIC de substitutives o si són simplement additives. D'això en sabem poca cosa, només aquí en trobareu un exemple encertat. Ara ens en falten molts més exemples en temps fora de pandèmia.

PD. Avui toca llegir FT també. Big pharma groups rejoin battle with governments on drug prices. Si no hi teniu accés me'l podeu demanar per correu electrònic.

El missatge: 

When European health authorities head to the negotiating table, they will have to come to terms with a drug industry that is no longer focused on producing daily pills to pop.

Whereas drugmakers used to make a little from each patient in a large market, increasingly they are focused on charging more to treat small subsets of patients, with rare diseases, or in oncology, with a certain mutation in their tumour.

Governments have not been giving their health systems more money to cope with this change.

Tot d'una algú s'ha adonat que no hi ha mercat en els medicaments sota patent, sino que tenim un monopsoni. Ha tardat molt, però ha arribat el dia que han conegut el monopsonista que és qui mutualitza el risc poblacional d'emmalaltir. I ara només cal veure com es desenvolupen els escenaris, o captura del regulador/monopsonista o benestar social. 

Fasten seat belts (3)

In former posts I have argued that pharmaceutical pricing is forging a new trend. The summary is in this figure (US prices):

The latest FDA approved drug is Harvoni, for hepatitis C. This new drug will compete with Sovaldi, the best drug launch ever made by the same manufacturer, 9.000 million $ in sales in 9 months.
The soaring costs of drugs is also affecting the generics market in US. Have a look at this blog.
As far as the economy is not growing at the same pace, new resources are needed and this may come from reductions on current drug benefits (price or quantity) or less expenditures in non-pharmaceutical goods. Otherwise the option is to delay access. Is this an option for cost-effective therapies?

Pharma industry regulation: extracting or creating value

 The Global Pharmaceutical Industry. The Demise and the Path to Recovery

The pharmaceutical industry has reached a tipping point. Its business growth is predicated upon fagrantly raising drug prices (especially in the U.S.), thereby increasing the inability of patients to afford medications. The clinical trials that provide the basis for pharma’s new drug development rely on biased designs to favor approvable outcomes, even as sponsors selectively publish mainly the reports that contain favorable results for their test drugs. The industry’s research process exerts a corrupting infuence on medical researchers and the channels of medical communication, while its everyday product promotions involve regular payments of financial and other inducements to prescribers that effectively constitute bribes. Even its involvement in continuing medical education poses a confict of interest and a corrupting infuence on medical practitioners.

If pharma continues operating in this manner, it cannot complain when citizens worldwide demand their governments impose onerous restrictions. Each passing week sees the emergence of additional outrages that make such controls more likely.

Any generalization doesn't fit with an objective observation of reality. However, in chapter 5, you'll find proposals for a new regulation.  

Efficiency in drug patents buyout

Panning for gold: sourcing pharmaceutical innovation

Once upon a time there were pharmaceutical firms that invested mostly in internal R+D departments. Long time ago, the door was opened to contracting out, buying patents and licensing. The most recent step is to the acquisition of firms with promising molecules.
A short article in Nature sheds some light about the efficiency of recent mergers and acquisitions. And the summary is:

Our analysis suggests that most companies have a considerable opportunity to get better at deploying capital and resources efficiently when sourcing innovation externally. In our experience, we have found that the best performers develop robust forecasts for the key assets, are fiscally disciplined, and set up their innovation-sourcing teams and transaction capabilities to ensure that the right internal expertise is brought to bear and to ensure smooth hand‑offs through the life cycle of a deal.

The success lies within, the internal expertise is crucial. Have a look at the figure and you'll notice that the most efficient (defined as the commercial impact of the products acquired relative to capital deployed in M&As) is Roche. This is not by chance.

PS. Unfortunately, the study doesn't reflects any consideration to value in health or lobbying efforts in drug prices.
PS. FT's summer books 2015 

Understanding Generic Drug Markets

Comparing Generic Drug Markets in Europe and the United States: Prices, Volumes, and Spending

The development of generic drug markets depends widely on an active regulator. This is the main reason of differences in consumption among countries. A new article highlights these differences and allows to understand better such market.

Substituting generic medicines for more expensive brand-name versions is likely among the most cost-effective interventions in health care systems.

There remain large differences in the usage and prices of generics in Europe and the United States. The barriers to market entry for generic companies vary between countries, as do pricing and reimbursement policies. Beyond such features of the market,
there are differences in whether, and to what extent, patients and health care professionals perceive generic and branded medicines to be bioequivalent.

Overvaluing expensive drugs

A research from University of York has concluded that NICE is overvaluing expensive treatments because its cost threshold - the price at which a treatment is deemed good value for the NHS - is set too high. The threshold value per quality-adjusted life year (QALY) - a measure of the health benefits of a treatment - should be lowered from £30,000 to just £18,317, their analysis found. It suggests the NHS may be wasting money on treatments that are not as good value as first thought. Professor Sculped said:

It is crucial that the cost effectiveness threshold is seen as representing health forgone as the additional costs of new technologies are imposed on the fixed budgets of local commissioners. For decisions made by NICE and many policy options considered by the NHS and DH, this is the key to establishing the value for money of new services.

This is a strong criticism against QALYs, let's see if it has some impact in the near future. Fortunately, the British have the opportunity to debate on it. Nearer here, the press is saying now that 30% of drugs requested for approval were rejected (7 out of 24). No details available, no website, no transparent process. That's alleged democracy, southern style. NTA=Nothing to add.

PS. If you don't want to read the article, have a look at this presentation. I suggest you save it, it may be useful for the future.

PS. As you can see from my blog, in one week, two officials have said different numbers of rejected drugs for public funding (2 vs 7). Does this make any sense? Is there anybody asking for an explanation in Parliament?

PS. Follow the controversy on DSM-5 at BBC News.

PS. Check here how our drug prices have converged to the european average.

PS. Must read: Uwe Reinhardt blog.

PS. Interesting article on 20 years of economic evaluations of cancer.

Book choice

Drugs, Money, and Secret Handshakes
The Unstoppable Growth of Prescription Drug Prices

El valor de les proves diagnòstiques

Can and Should Value Based Pricing Be Applied to Molecular Diagnostics?

Cal dir que la distància entre preu i valor en cada mercat és ben diferent. Penseu per un moment en una prova diagnòstica. La informació que ofereix pot capgirar el curs de la malaltia, i fins i tot assegurar la supervivència. El preu que en paguem s'acosta previsiblement més al cost que al valor que representa.
Fa poc que els de l'Office of Health Economics han publicat un article que ens ofereix una perspectiva en aquest sentit.
El resum:

Current pricing and reimbursement systems for diagnostics are not efficient. Prices for diagnostics often are driven by administrative practice and expected production cost. The purpose of this paper is to discuss how a value based pricing (VBP) framework that is being used to ensure efficient use and price of medicines also could be applied to diagnostics. Diagnostics not only facilitate health gain and cost savings, but also provide information to inform patients’ decisions on interventions and their future “behaviours”. For value assessment processes, we recommend a two-part approach. Companion diagnostics introduced at the launch of the drug should be assessed through new drug assessment processes considering a broad range of value elements and a balanced analysis of diagnostic impacts. A separate diagnostic-dedicated committee using VBP principles should review other diagnostics lying outside the companion diagnostics-and-drug “at-launch” situation.

A data d'avui em costa assenyalar quin és el mecanisme de preus òptim per a les proves de laboratori, ni sé si existeix com a tal un mercat que permeti aquesta formació de preus. En absència de mercat competitiu, aleshores cal pensar més aviat en mecanismes d'assignació adhoc, subhastes i preus de transferència interns. Per tant el que diuen a l'article cal considerar-ho com una primera aportació. Ells mateixos assenyalen que no resoldran teòricament l'aportació de valor en la combinació diagnòstic-teràpia. I per aquest motiu que cal seguir refinant l'anàlisi.

PS. Llegeixo a les comunicacions AES, frases com aquesta:  "La introducción de tests genéticos en el tratamiento de pacientes con cáncer de mama es una opción eficiente". O aquesta altra: "El extra coste del test genético se ve compensado con ahorros potenciales de la reducción de eventos coronarios en pacientes
de alto riesgo no identificados con el método estándar". I només em pregunto sobre el que significa realment,  si té sentit i res més, i aquí ho deixo.

PS. Un gran record per un dels grans emprenedors del país: Josep Maria Rubiralta. va saber situar la seva empresa entre les 10 més grans del món en diagnòstic. El seu llegat ens ensenya que la capacitat d'innovació i adaptació esdevenen la clau de l'èxit.

PS. Quan en un país hi ha un jutge que per 60.000 euros deixa anar a tres presos i no passa res, i quan en un país el president del tribunal suprem utilitza fons públics per al seu ús de cap de setmana i es considera que no hi ha intenció d'ús inapropiat, és una confirmació de la inseguretat jurídica de la que n'he parlat en diverses ocasions.

PS. A la King's Fund trobareu informació sobre com va anar l'International Integrated Care Summit.

PS. Avui és el dia que ens informen que l'any que ve també hi haurà recessió, i fins quan?

Pharma landscape

The Global Use of Medicine in 2019 and Outlook to 2023

The summary of IQVIA report:

• Global spending on medicines reached $1.2 trillion in 2018 and is set to exceed $1.5 trillion by 2023.
• Invoice spending in the United States is expected to grow at 4– 7% to $625–655 billion across all channels, but net manufacturer revenue is expected to be 35% below invoice and have growth of 3-6% as price growth slows on both an invoice and net basis.
• Net drug prices in the United States increased at an estimated 1.5% in 2018 and are expected to rise at 0–3% over the next five years.
• China reached $137 billion in medicine spending in 2018, but will see growth slow to 3-6% in the next five years as central government reforms to expand insurance access to both rural and urban residents, as well as expansions and modernizations of the hospital system and primary care services have been largely achieved and efforts shift to cost optimization and addressing corruption.
• Medicine spending in Japan totaled $86 billion in 2018, however spending on medicines is expected to decline from -3 to 0% through 2023, due to the effect of exchange rates and continued uptake of generics and offset by the uptake of new products.
• The number of new products launched is expected to increase from an average of 46 in the past five years to 54 through 2023, and the average spending in developed markets on new brands is expected to rise slightly to $45.8 billion in the next five years, but represent a smaller share of brand spending

The farce of confidential drug prices (3)

 Exploring the consequences of greater price transparency on the dynamics of pharmaceutical markets

The 2018 OECD report Pharmaceutical Innovation and Access to Medicines suggested that increased price transparency could promote public accountability, while potentially delivering efficiencies to health systems by including economic considerations in coverage, treatment decisions and budget allocation. Despite this, precisely what should be made more transparent, and how greater transparency would affect the functioning of markets, have been poorly characterised. To help frame the policy debate, the OECD undertook an exploration of the potential consequences of greater price transparency on market dynamics. The work included a roundtable and a series of semi-structured interviews, with participation by 19 experts in pharmaceutical pricing, economics of pharmaceutical markets, competition, and law. With an extensive review of the current practice and relevant literature as a preface, this report presents the key findings from those consultations.

 

A prescription for pharmaceutical expenditure, is there any one?

Pharmaceutical Expenditure And Policies

If you want to know what's going on in OECD countries on pharmaceuticals, just read this paper. The challenges are huge, and policy answers are delayed. My impression is that beyond the standard approach (the one in the paper), somebody should start talking about priorities for research and innovation according to health needs and potential benefit from recent advances in basic science. There is a need for a dialogue between firms and governments about it. Just a signaling game, saying how much are willing to pay for new innovations if they fit with health needs and potential benefit.

PS.Drug prices: Tweaking the formula excellent article in FT

Nirvis (2)

 High drug prices are not justified by industry’s spending on research and development

Les dues retòriques per justificar els preus alts dels medicaments són: cal recuperar la inversió en recerca, i cal relacionar el preu amb el valor que aporten. La primera d'aquestes dues retòriques és la que s'explica a un article de BMJ. Són dades conegudes mostrades d'una altra manera. A la meva conferència a la Reial Acadèmia de Medicina del novembre passat ja ho vaig reflectir. La segona retòrica, la del valor, també apareix d'esquitllada a l'article, però sens dubte és el tema que es vol enfatitzar en aquest moment. 

El relat dels preus alts per recuperar inversió ja sap tothom que no se sosté per enlloc, i no cal donar-hi més voltes. I quan entrem en la retòrica del valor aquí hi podem trobar de tot, regles de rescat incloses. Per tant entrem a un camp minat, terres fangoses i sense cap concreció d'on anirem a parar.

Al final donen recomanacions al govern:

• Making national patent systems more stringent to avoid rewarding chemical novelty and inventiveness independent of added therapeutic value

• Clear communication by public health authorities to lay out health needs focused research and development priorities and the strategic use of public research funding to support them

• Smarter allocation of public research funds with retention of (partial) ownership that can be leveraged to pursue public health objectives, including affordable pricing

• Raising evidence standards for market authorisation by requiring companies to conduct comparative clinical trials designed to establish added therapeutic value whenever possible, and

• Reforming pricing and reimbursement systems to reward companies that develop drugs that deliver clinical benefit and discourage me-too and evergreening strategies

Llegiu-vos l'article i guardeu-lo. S'apropen els medicaments per l'hemofília i en sentirem a parlar dels seus preus i de l'impacte pressupostari. L'argument no serà la recerca, serà el valor que pressumptament aporten. Veig nirvis per totes bandes.

Banksy

An illusionary free lunch

Some months ago I started a series of posts under the title "Fasten seat belts". The topic is well known, how new skyrocketing drug prices are distorting budgets and access. Yesterday we got the final resolution. Fasten you seat belt, this is the moment of truth: The government has decided that hepatitis C patients under specific conditions will get treatment. And once he has decided coverage, he concludes that he will not pay the bill. Somebody else will have to do it, autonomous communities governments. Free lunchs exists in Sepharad!
This is a complete mess and it is only the begining, new drugs are knocking at the door. For catalans, this foreign decision represents 470 m €, an additional deficit for the 2015 budget of 5.7%!!! (if all expenditure were charged in one year). Does this make any sense?. Of course Basque country is not included in such arrangements...
There is an objective need to disconnect, the time is getting closer. Things couldn't have been done worse.

Value creators and extractors

The Value of Everything: Making and Taking in the Global Economy

The rethorics of value is usually plagued with deliberate misunderstandings. Specially, those that quote themselves as value creators may appear on a close look as a value extractors. This is precisely what the book of Marianna Mazucatto does. It identifies the patterns to assess value creation and extraction and the private of public and private roles.Chapter 7 on Extracting Value through the Innovation Economy is specially helpful. You'll find there the patents as a value extraction process or the pharmaceutical pricing discussed in detail. Therefore, a must read.

In modern capitalism, value-extraction is rewarded more highly than value-creation: the productive process that drives a healthy economy and society. From companies driven solely to maximize shareholder value to astronomically high prices of medicines justified through big pharma's 'value pricing', we misidentify taking with making, and have lost sight of what value really means. Once a central plank of economic thought, this concept of value - what it is, why it matters to us - is simply no longer discussed.

 The logical outcome of a combination of monopoly and rigid demand is sky-high prices, and this is precisely what is happening with specialty drugs. It explains why pharmaceutical companies enjoy absurdly high profit margins: in addition to the normal profit rate, they earn huge monopoly rents.59 A value-based assessment of the kind NICE carries out can be helpful because it reduces demand for the monopolists’ drugs and prevents them from charging whatever price they choose. The downside, however, is that increased elasticity of demand for drugs comes at the cost of leaving some patients without the medicines they need, because pharmaceutical companies may not cut their prices enough to treat everyone who needs the drug if doing so would reduce profit margins by more than the companies want.

Khan el-Khalili based drug pricing

When is it too expensive? Cost-effectiveness thresholds and health care decision-making

In one week of difference, the same technology: CAR T-cells has had two different options for drug pricing. Last week, under NICE review the answer was no to Gilead, and yesterday was yes to Novartis. The first paradigm applied to Yescarta is well known: marginal effectiveness should be acceptable at an affordable cost (NICE). The second one applied to Kymriah is based on preferences and willingness to pay under confidential prices. It is also a well known system specially at bazaars like Khan el-Khalili in Cairo.
This is an example of how two systems are applied in practice and nobody cares about it. I'm concerned about transparency, and that's why I can't understand why with public money the expenditure is confidential. I would agree if somebody explain the budget impact that have been agreed, otherwise with public money Kahn el-Khalili system is not acceptable. After more than four decades, Torrance would ask himself if all this effort on cost-effectiveness analysis has had any sense to arrive at this point.
Anyway, the remaining question is: when is too expensive? This is precisely what this editorial asks. And the and the answer (?) is:

For deciding whether something is too expensive, thresholds are crucial. Depending on which perspective is taken, the word ‘threshold’ may either refer to the consumption value of health or the marginal cost-effectiveness of current spending. 

This is a standard health economics perspective that no health politician nowadays will buy. Right now they are not buying the idea, and I think that they prefer confidential prices. It allows to reflect power,  discretionality, or even worse arbitrariness. Khan el-Khalili system has won.

Health Reform Zombies

 Better Now. SIX BIG IDEAS TO IMPROVE HEALTH CARE FOR ALL CANADIANS

Morris Barer and Bob Evans first coined the term “health care zombies” in 1998. A health care zombie is a terrible idea about health care that refuses to die. No matter how many times you drive an evidence-based stake through its heart, it rises from the (un)dead to confront you in the newspapers of the nation, ruining a perfectly good morning cup of coffee.

These ideas have often been proposed as solutions to the pressures on our health care system. But they’ve all been shown, time and time again, to weaken health care quality and sustainability. They also undermine our shared values.

These words sound familiar in our context. However it comes from a canadian book.

A canadian physician reflects her views in a well written book about the health reform. It says:

When care is necessary to improve health, every Canadian deserves reasonable access to it. That means solutions to wait times that help everyone, not just people who can afford to pay for their care. And it means finally bringing medicines under medicare. Across the country, people like Ahmed the taxi driver are forced to sacrifice their long-term health because of the short-term crunch of prescription drug costs. Alongside that profound inequity lives the uncomfortable truth that we pay some of the highest prices in the world for our prescription medicines. Only our governments can take the necessary steps to establish a national pharmacare program that would ensure access, safety, and appropriate use of medicines at a cost that is affordable not just for governments, but also for citizens and for employers.

It is quite incredible that canadians don't have drugs in the benefits package. And this is the outline of the book:

THE BASICS

Dr. Martin Goes to Washington

Getting Our Facts Straight

Taking the Pulse of the System

Health Care Zombies

BIG IDEA 1 Abida: The Return to Relationships

Primary Care: When It Works, It Works

Three Relationships for Health

Rewarding What Matters

BIG IDEA 2 Ahmed: A Nation with a Drug Problem

Medicare’s Unfinished Business

The Price Is Wrong

Prescribing Smarter

BIG IDEA 3 Sam: Don’t Just Do Something, Stand There

The Compulsion to Cure

Slow Medicine

BIG IDEA 4 Susan: Doing More with Less

The Revolving Door of Health Care

What Better Looks Like

The F-Word

BIG IDEA 5 Leslie: Basic Income for Basic Health

Sick with Poverty

Curing Income Deficiency

BIG IDEA 6 Jonah: The Anatomy of Change

From Pilot Project to System Solution

Data: The Brain of the System

The Heart of the Matter

Feet to Do the Walking

CONCLUSION Worthy Action

 

Confidential drug pricing without confidential prices

Performance-based managed entry agreements for new medicines in OECD countries and EU member states: How they work and possible improvements going forward

In this blog I've explained my position against confidential prices for drugs. However, there is an option to complicate it: confidential entry agreements. This is the current trend for high cost drugs with uncertain outcome. The report of the OECD explains the current situation in different countries and helps to shed light in this important issue. Just take this short statement and you'll be convinced of the complete mess:

It is difficult to assess to what extent performance-based MEAs have so far been successful. Few countries have formally evaluated their experience. Confidentiality of agreements continues to be a barrier to independent evaluation and little evidence is public. However, information available from expert interviews and from prior studies indicates that CED agreements have so far had a poor track record of reducing uncertainty around the performance of medicines. As a result, some countries have recently reformed CED schemes and some are discontinuing CED agreements altogether in favour of alternatives. The latter include restricted or conditional coverage without a MEA, whereby coverage is initially restricted to certain indications or patient groups and only broadened if and when additional evidence becomes available. Payment-by-result agreements continue to be used quite widely, but they do not always generate evidence
on product performance because data used for triggering payments are not always  aggregated and analysed.

Sophia Al-Maria at Tate

La competència a mercats farmacèutics protegits per patent

Enhancing competition in on-patent markets 

Algú pot pensar, si un producte farmacèutic està protegit per patent doncs llavors és un monopoli, doncs no. Pot haver-hi alternatives terapèutiques dins el mateix grup que es trobin en competència. I si això és així, llavors ens hem de preguntar quin és el nivell de competència que es produeix realment. 

L'OCDE acaba de donar resposta a la pregunta, i el missatge és que l'impacte en preus és molt limitat. Fins i tot es produeixen augments de preus en contextos on el nou producte no redueix quota de mercat dels anteriors ni el preu.

Aquestes són les conclusions:

 • There is mixed empirical evidence of the existence and impact of therapeutic competition in OECD countries. A review of the literature revealed only very limited evidence of the impact of competition between patented products on prices or market share, with a few studies reporting that the impact may not be discernible until several competing products have entered the market;

• No clear evidence of price competition was observed within those therapeutic classes in our sample with fewer than five therapeutic alternatives. In fact, over the period of the analysis the countries in our sample experienced significant price increases despite the market entry of multiple therapeutic alternatives within the selected drug classes, with prices of follow-on products often higher than those of the first-in-class. Later entrants were also observed to acquire market share without any decline in sales of the first-in-class product, regardless of whether they set a price higher or lower than that of the first-in-class. 

• Policies that define coverage, pricing, prescribing and procurement practices can theoretically shape the extent to which product alternatives compete. 

• While most countries assess comparative effectiveness of alternative products within a therapeutic class, the extent to which that assessment informs policy varies widely, and the extent to which these analyses are used to promote on-patent competition is unclear. 

• While tendering is increasingly used for procurement of medicines, few countries apply it to patented products in both inpatient and outpatient sectors;

• Price competition does not appear to be the default dynamic resulting from successive market entries. Policy settings around pricing, procurement and formulary management must therefore be designed to facilitate and promote competition between patented products.

I aquestes són les quatre recomanacions:

• Ensuring alignment of pricing and procurement policies to create a pro-competitive environment. 

• Optimising the use of formulary management. Payers and health insurers in only a few countries use formulary management to foster competition as leverage in price negotiations in exchange for preferred status on formularies or in clinical algorithms. Where therapeutic alternatives exist, preferred status can be used to encourage competitive pricing as it significantly impacts market share;

• Promoting the use of tendering by class or indication for the treatment of a particular condition; and,

• Utilising evidence of comparative effectiveness to build recognition among the clinical community and competent authorities of the potential value of therapeutic alternatives in driving on-patent competition.

El suggeriment a tenir en compte per al regulador-finançador: utilitzar licitacions enlloc de preus en grups terapèutics equivalents patentats. En un context de preus confidencials, aquesta recomanació encara pren més volada. Se li ha girat feina, si en vol tenir.

 

 

 

In search for a fair price-setting in cancer drugs

Pricing of cancer medicines and its impacts

We all know that new cancer drugs represent a challenge for the whole society. Expectations from drug firms are high and public and private budgets do not increase according to such expectations. A technical report released by WHO sheds light on the issue.
Just one statement:

Overall, the analysis suggests that the costs of R&D and production may bear little or no relationship to how pharmaceutical companies set prices of cancer medicines. Pharmaceutical companies set prices according to their commercial goals, with a focus on extracting the maximum amount that a buyer is willing to pay for a medicine. This pricing approach often makes cancer medicines unaffordable, preventing the full benefit of the medicines from being realized.

You may find here former posts on the same topic.

PS. My comment on genetics in clinical practice in GCS 69, p.96

TATE MODERNEXHIBITION

THE C C LAND EXHIBITION

PIERRE BONNARD

THE COLOUR OF MEMORY

Raonable i necessari

Aquesta vegada el Journal of Economic Perspectives ve carregat de valent. Molts temes d'interès relacionats amb la salut.
Avui em referiré a l'article d'en Chandra, Jena i Skinner sobre efectivitat comparada. El text s'ha de llegir sencer i destacaria l'elevada expectativa que dispositen en l'avaluació de l'efectivitat comparada malgrat no hi hagi cost-efectivitat. Comparteixo totalment la seva perspectiva.
Aquesta és la seva posició:

We argue that comparative effectiveness research still holds promise. First, it sidesteps one problem facing cost-effectiveness analysis—the widespread political resistance to the idea of using prices in health care. Such resistance is not just from political interest groups, but also from voters, who even in lab settings often dislike rationing based on cost effectiveness (Nord, Richardson, Street, Kuhse, and Singer, 1995). Second, there is little or no evidence on comparative effectiveness for a vast array of treatments: for example, we don’t know whether proton-beam therapy, a very expensive treatment for prostate cancer (which requires building a cyclotron and a facility the size of a football fifi eld) offers any advantage over conventional approaches. Most drug studies compare new drugs to placebos, rather than “headto- head” with other drugs on the market, leaving a vacuum as to which drug works best (Nathan, 2010). Simply knowing what works and what doesn’t will improve productive effifi ciency by shedding medical practices that are unsafe at any price.

Aquí no tenim ni això encara que la llei tímidament demana avaluar utilitat terapèutica i ningú es preocupa per ara d'aplicar-la. Cal trobar un patró per mesurar aquelles prestacions que són raonables i necessàries.