The Right Price: A Value-Based Prescription for Drug Costs
Paperback, 272 pages, ISBN: 9780197512876, published 12 October 2021
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All signs point to this book having been written for researchers, or at least for policy wonks; the publisher, the authors, that cover design, the fact it has a DOI, that the authors so kindly sent a copy to me. Once I decided to read and review the book, I had two questions: would it be an enjoyable read, and is it likely to tell readers anything they don’t already know? (TL;DR: mostly, and yes!)
The book’s purpose is clear: to describe the challenges associated with drug pricing and propose a means of aligning the price of drugs with the value they create. This means taking a deep dive into the key players determining drug prices and the tools for measuring value; familiar territory for many readers of this blog.
If you’re from outside the US, you’ll probably know that almost anything published by Americans lacks the suffix “in the United States”. That applies here. The authors aren’t ignorant to what’s going on in the rest of the world – NICE gets plenty of mentions – but the focus is very much on the US.
It came as a surprise that this characteristic provided the most significant value to me. I like to think I know a bit about US health care, but, really, it boggles my mind. I suspect many European health economists, sheltered from the harsh winds of American health policy, feel similarly. The Right Price serves as an outstanding primer on the chaos of drug pricing policy in the US. The authors share a dizzying number of examples of policy developments and independent initiatives from the past few decades. Some of these are entertaining and illuminating tales, such as the Institute for Clinical and Economic Review’s run-ins with various companies. This is why I’ll be keeping the book on my shelf; I’ll be returning to it for references. The average number of references per chapter is about 75. No stone is left unturned.
In turning every stone, the book does lose focus in places. The authors are seasoned writers with a knack for making complicated – and occasionally tedious – topics flow on the page in an accessible way. For the most part, this book is an exhibition of their skills. But, in their ambition to cover absolutely everything in detail, and with an accuracy to satisfy peer reviewers, some passages become convoluted. And then there are the ‘boxes’. These are technical interludes that take up one or more pages and extinguish the book’s flow.
Despite these minor shortcomings, and given that there is so little logic or purpose in the direction and chronology of US pharmaceutical pricing policy, the authors do an admirable job of constructing an intuitive flow. The book starts with a discussion of the characteristics of the market, moves to an overview of the key players and institutions, and then brings it all together to outline how – and involving whom – the US might align value and price.
My most significant regret for the book is that the authors are not more forceful. On the one hand, I respect their balanced perspective; few researchers are even-handed in recognising the need to rein in drug prices without stifling innovation. But when it comes to their defence of QALYs and of technology appraisal processes in general, they are almost apologetic. This may be good diplomatic sense, but a clear and forceful message would have made for a more enjoyable read and potentially attracted a wider audience.
So, I would recommend this book to a variety of people. It will be a worthwhile investment for non-American health economists and enjoyable to those who aren’t turned off by the scholarly writing style. Who else? Well, I think researchers working at the tangents of health economics could gain a lot from the book. This might include economists who dabble in health care and health policy. Economic concepts are described in simple terms, so The Right Price would be similarly valuable to non-economists interested in health policy (American or otherwise).