Defining and Measuring the Affordability of New Medicines: A Systematic Review
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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.
KeywordsHealthcare System Gross Domestic Product Oseltamivir Budget Impact Sofosbuvir
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.
All data generated during this study are included in this published article and its supplementary information files.
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