, Volume 35, Issue 8, pp 777–791 | Cite as

Defining and Measuring the Affordability of New Medicines: A Systematic Review

  • Fernando AntoñanzasEmail author
  • Robert Terkola
  • Paul M. Overton
  • Natalie Shalet
  • Maarten Postma
Systematic Review



In many healthcare systems, affordability concerns can lead to restrictions on the use of expensive efficacious therapies. However, there does not appear to be any consensus as to the terminology used to describe affordability, or the thresholds used to determine whether new drugs are affordable.


The aim of this systematic review was to investigate how affordability is defined and measured in healthcare.


MEDLINE, EMBASE and EconLit databases (2005–July 2016) were searched using terms covering affordability and budget impact, combined with definitions, thresholds and restrictions, to identify articles describing a definition of affordability with respect to new medicines. Additional definitions were identified through citation searching, and through manual searches of European health technology assessment body websites.


In total, 27 definitions were included in the review. Of these, five definitions described affordability in terms of the value of a product; seven considered affordability within the context of healthcare system budgets; and 15 addressed whether products are affordable in a given country based on economic factors. However, there was little in the literature to indicate that the price of medicines is considered alongside both their value to individual patients and their budget impact at a population level.


Current methods of assessing affordability in healthcare may be limited by their focus on budget impact. A more effective approach may involve a broader perspective than is currently described in the literature, to consider the long-term benefits of a therapy and cost savings elsewhere in the healthcare system, as well as cooperation between healthcare payers and the pharmaceutical industry to develop financing models that support sustainability as well as innovation.


Healthcare System Gross Domestic Product Oseltamivir Budget Impact Sofosbuvir 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Author contributions

All authors designed the study, analysed the results, reviewed all draft versions of the manuscript and approved the final version for submission. Paul Overton conducted the systematic review and wrote the manuscript.

Compliance with Ethical Standards


This work was supported by Novartis Pharma AG (Basel, Switzerland) under the AGORA initiative (Advisory Group On Reimbursement and Access, a European Think Tank aiming to optimise access for patients to innovative treatments).

Conflict of interest

Fernando Antoñanzas, Robert Terkola and Maarten Postma have received honoraria and travel support related to this study from Novartis Pharma AG under the AGORA initiative. At the request of the AGORA Think Tank, support for the systematic review was provided by Paul Overton (Beacon Medical Communications Ltd) and Natalie Shalet (NAS Healthcare Solutions Ltd), whose organisations received project funding from Novartis Pharma AG. Maarten Postma has received research grants and honoraria from various pharmaceutical companies, unrelated to this study.

Data availability

All data generated during this study are included in this published article and its supplementary information files.

Supplementary material

40273_2017_514_MOESM1_ESM.docx (36 kb)
Supplementary material 1 (DOCX 35 kb)


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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of EconomicsUniversity of La RiojaLogronoSpain
  2. 2.College of PharmacyUniversity of FloridaGainesvilleUSA
  3. 3.Unit of PharmacoTherapy, Epidemiology and Economics (PTE2), Department of PharmacyUniversity of GroningenGroningenThe Netherlands
  4. 4.Beacon Medical CommunicationsBrightonUK
  5. 5.NAS Healthcare SolutionsSurbitonUK
  6. 6.University Medical Center Groningen, Institute of Science in Healthy Aging & healthcaRE (SHARE)University of GroningenGroningenThe Netherlands
  7. 7.Department of Epidemiology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands

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