Paying for Cures Masterclass: Unlocking the true value of every treatment to improve outcomes for everyone

Want to know how you can help increase access to cutting-edge therapies – and fuel greater innovation? Join us on 4 July at a Central London venue for the second instalment of our Masterclass series, ‘Paying for Cures’, to get essential answers to urgent questions.

Breakthrough medical research is delivering new curative therapies that once seemed out of reach. But despite these significant steps forward, the therapeutic benefits remain unattainable for far too many patients. That’s capping both pharmaceutical revenues and the potential of future research & development.

The advent of cures is raising important questions about affordability and the long-term sustainability of health systems. Simply put, healthcare systems are not set up to pay for cures where the benefits may accrue over many decades.

So how can you help improve outcomes – for patients and industry alike?

Join us on 4 July for the next OHE Masterclass, ‘Paying for Cures’, to discuss:

• How value assessment can be adapted to recognise the full value of a cure
• How innovative financing mechanisms can help ensure that patients benefit from every exciting step forward
• What solutions are acceptable and beneficial to both industry and payers
• What lessons we’ve learned from recent experience in the UK and the rest of the world
• Get access to exciting in-progress research. Put your questions to a panel of OHE and industry experts. And help us move the industry’s pricing frameworks forward – to improve the lives of patients everywhere.

This is a full day masterclass followed by a networking drinks reception until 19:00.

Sam Watson’s journal round-up for 25th February 2019

Every Monday our authors provide a round-up of some of the most recently published peer reviewed articles from the field. We don’t cover everything, or even what’s most important – just a few papers that have interested the author. Visit our Resources page for links to more journals or follow the HealthEconBot. If you’d like to write one of our weekly journal round-ups, get in touch.

Democracy does cause growth. Journal of Political Economy [RePEc] Published January 2019

Citizens of a country with a democratic system of government are able to affect change in its governors and influence policy. This threat of voting out the poorly performing from power provides an incentive for the government to legislate in a way that benefits the population. However, democracy is certainly no guarantee of good governance, economic growth, or population health as many events in the last ten years will testify. Similarly, non-democracies can also enact policy that benefits the people. A benevolent dictator is not faced with the same need to satisfy voters and can enact politically challenging but beneficial policies. People often point to China as a key example of this. So there remains the question as to whether democracy per se has any tangible economic or health benefits.

In a past discussion of an article on democratic reform and child health, I concluded that “Democratic reform is neither a sufficient nor necessary condition for improvements in child mortality.” Nevertheless democracy may still be beneficial, on average, given the in-built safeguards against poor leaders. This paper, which has been doing the rounds for years as a working paper, is another examination of the question of the impact of becoming democratic. Principally the article is focused on economic growth, but health and education outcomes feature (very) briefly. The concern I have with the article mentioned at the beginning of this paragraph and with this newly published article are that they do not consider in great detail why democratisation occurred. As much political science work points out, democratic reform can be demanded in poor economic conditions due to poor governance. For these endogenous changes economic growth causes democracy. Whereas in other countries democracy could come about in a more exogenous manner. Lumping them all in together may be misleading.

While the authors of this paper provide pages after pages of different regression specifications, including auto-regressive models and instrumental variables models, I remain unconvinced. For example, the instrument relies on ‘waves’ of transitions: a country is more likely to shift politically if its regional neighbours do, like the Arab Spring. But neither economic nor political conditions in a given country are independent of its neighbours. In somewhat of a rebuttal, Ruiz Pozuelo and other authors conducted a survey to try to identify and separate out those countries which transitioned to democracy endogenously and exogenously (from economic conditions). Their work suggests that the countries that transitioned exogenously did not experience growth benefits. Taken together this shows the importance of theory to guide empirical work, and not the other way round.

Effect of Novartis Access on availability and price of non-communicable disease medicines in Kenya: a cluster-randomised controlled trial. Lancet: Global Health Published February 2019

Access to medicines is one of the key barriers to achieving universal health care. The cost-effectiveness threshold for many low income countries rules out many potentially beneficial medicines. This is in part driven though by the high prices charged by pharmaceutical countries to purchase medicine, which often do not discriminate between purchasers with high and low abilities to pay. Novartis launched a scheme – Novartis Access – to provide access to medicines to low and middle income countries at a price of US$1 per treatment per month. This article presents a cluster randomised trial of this scheme in eight counties of Kenya.

The trial provided access to four treatment counties and used four counties as controls. Individuals selected at random within the counties with non-communicable diseases and pharmacies were the principal units within the counties at which outcomes were analysed. Given the small number of clusters, a covariate-constrained randomisation procedure was used, which generates randomisation that ensures a decent balance of covariates between arms. However, the analysis does not control for the covariates used in the constrained randomisation, which can lead to lower power and incorrect type one error rates. This problem is emphasized by the use of statistical significance to decide on what was and was not affected by the Novartis Access program. While practically all the drugs investigated show an improved availability, only the two with p<0.05 are reported to have improved. Given the very small sample of clusters, this is a tricky distinction to make! Significance aside, the programme appears to have had some success in improving access to diabetes and asthma medication, but not quite as much as hoped. Introductory microeconomics though would show how savings are not all passed on to the consumer.

Credits

OHE Lunchtime Seminar: Price Regulation of Generics and Drug Shortages

OHE Lunchtime Seminar with Dr. Aslam Anis on ‘Price Regulation of Generics and Drug Shortages’ to be held on 27th November 2018 from 12 p.m. to 2 p.m.
Generic pharmaceutical markets in Canada are subject to various ‘price-cap’ regulations referred to as the maximum allowable list price (MALP). When the MALP is set to high, the drug plans overpay. Conversely, when the MALP is set too low, firms either don’t enter the market, or exit the market often creating drug shortages. Drug shortages are an increasing concern in Canada and globally and it has been argued that one of the explanations for sudden shortages is the price pressures put on the generic drug industry. To address these shortcomings of the MALP, the pCPA implemented the “tiered-pricing” framework for new generic drugs in 2014, under which the MALP is initially set high and declines as the number of generic firms supplying the market increases.
In the seminar, Dr. Aslam Anis will discuss on the findings of his current research evaluating the impact of the pCPA tiered pricing framework on generic entry, the resulting drug expenditure levels from a drug plans’ perspective and, more importantly, the implications of price-capping policies on drug shortages.
Dr. Aslam Anis is a Professor in the School of Population and Public Health of the University of British Columbia. He is also the Director of the Centre for Health Evaluation and Outcome Sciences in Vancouver, Canada. Dr. Anis is one of Canada’s most distinguished health economists who has conducted numerous studies assessing the impact of various types of regulatory instruments and policies on the pharmaceutical marketplace in Canada. This includes price-cap regulations on brand-name and generic drug prices and their impact on the pharmaceutical market dynamics in Canada.
View the full seminar invite here.
The seminar will be held in the Sir Alexander Fleming Room, Southside, 7th Floor, 105 Victoria Street, London SW1E 6QT. A buffet lunch will be available from 12 p.m. The seminar will start promptly at 12:30 p.m. and finish promptly at 2 p.m.
If you would like to attend this seminar, please send an email to ohegeneral@ohe.org.