Daniel Grunes Value of Medicines

8/3/2019 Daniel Grunes Value of Medicines

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The value of medicines

- an analysis of the assessment of value -

Daniel Grnes

EPH conference

June 23rd, 2011


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205/02/2012

The ever-increasing abilities of medicine raise

fundamental value questions of how society should

use these abilities and how much of them societycan afford to use

(Centre for Medical Ethics and Health Policy)


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Figure 2: health system actors and functions (Zweifel & Breuer, 2002, p.6)

PATIENT PROVIDER

PAYER

POLITICS

regulation

therapies / medicines

information asymetry

insurance premiums


reimbursement


How to define value in healthcare?


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VALUE = BENEFIT


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Two sides of the story

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Pharmaceuticals account for

-40% of the late increase in life expectancy

-17.0% of the total EU business R&D expenditure

-3.5% of total EU manufacturing value added-more than 600,000 jobs

Most relevant asset in preparing health systems to

meet current and future challenges and aprerequisite to Europes global economic

competitiveness


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They can mean an extra three months or five

months or a year - another Christmas with the

family, another season to plant a garden, anotherpassage in the life of a child.

(Washington Post)


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7Source:


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The OFT market study (2007)

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Recommendation:

Need to replace the current

price regulation scheme with a

value-based approach to pricingto ensure:

- value for money for the NHS

- better incentives to invest

- a stable, sustainable system- a credible, practical pricing

regime for the long term


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Why Britain matters

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Problem statement and questions for research?

What different indicators of value of a pharmaceutical

product exist and what criteria underlie a comprehensive

value-based approach to the pricing and reimbursement

of innovative medicines in the UK?

- What constitutes value in the current assessment of NICE?

- What are the advantages and disadvantages of this

methodology?

- In how far does the German IQWIG differ from thisapproach?

- In how far could the application of Multi Criteria Decision

Analysis support value-driven decision-making?

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NICE Reference Case

Perspective on costs NHS

Perspective on outcomes All health effects on patients

Type of economic evaluation Cost-effectiveness analysis

Measure of health effects QALY

Source of data for measure of HRQL Reported directly by patients

Source of data for preference

regarding the valuation of HRQL

Representative sample of the public

Equity weighting QALY = QALY

Decision threshold ICER = 20,000 to 30,000 per QALY


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Potential benefits from innovative medicines

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?


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What do we want as a society?


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Breakthrough vs. incremental innovation

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The Original

A me-too?


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Conclusions

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Questions

Is it possible to postpone my hand in of the draft version to

next week?

What are the expectations for the presentation on the 23rd

of June?

How do we proceed?

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The failures to adopt value as the central goal in health care

and to measure value are arguably the most serious failures of

the medical community. This has hobbled innovation, led to

slow diffusion of innovation, allowed pseudo-innovation with no

meaningful value benefits, resulted in ill-advised cost

containment, and encouraged micromanagement of physician

practices, which imposes significant costs of its own.

(Porter, 2010)

Documents

Daniel Grunes Value of Medicines