Reimbursement of pharmaceuticals: reference pricing versus health technology assessment

Eur J Health Econ. 2011 Jun;12(3):263-71. doi: 10.1007/s10198-010-0274-y. Epub 2010 Aug 28.

Abstract

Reference pricing and health technology assessment are policies commonly applied in order to obtain more value for money from pharmaceuticals. This study focussed on decisions about the initial price and reimbursement status of innovative drugs and discussed the consequences for market access and cost. Four countries were studied: Germany, The Netherlands, Sweden and the United Kingdom. These countries have operated one, or both, of the two policies at certain points in time, sometimes in parallel. Drugs in four groups were considered: cholesterol-lowering agents, insulin analogues, biologic drugs for rheumatoid arthritis and "atypical" drugs for schizophrenia. Compared with HTA, reference pricing is a relatively blunt instrument for obtaining value for money from pharmaceuticals. Thus, its role in making reimbursement decisions should be limited to drugs which are therapeutically equivalent. HTA is a superior strategy for obtaining value for money because it addresses not only price but also the appropriate indications for the use of the drug and the relation between additional value and additional costs. However, given the relatively higher costs of conducting HTAs, the most efficient approach might be a combination of both policies.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anticholesteremic Agents / economics
  • Anticholesteremic Agents / therapeutic use
  • Antipsychotic Agents / economics
  • Antipsychotic Agents / therapeutic use
  • Antirheumatic Agents / economics
  • Antirheumatic Agents / therapeutic use
  • Cost Control / methods
  • Costs and Cost Analysis
  • Europe
  • Health Policy
  • Humans
  • Insulin / economics
  • Insulin / therapeutic use
  • Insurance, Health, Reimbursement*
  • Prescription Drugs / economics*
  • Reference Values
  • Technology Assessment, Biomedical / methods*

Substances

  • Anticholesteremic Agents
  • Antipsychotic Agents
  • Antirheumatic Agents
  • Insulin
  • Prescription Drugs