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

PharmacoEconomics volume 35, pages 777–791 (2017)Cite this article

Abstract

Background

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.

Objectives

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

Methods

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.

Results

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.

Conclusions

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.

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Author information

Affiliations

  1. Department of Economics, University of La Rioja, C/La Ciguena 60, 26004, Logrono, Spain

    Fernando Antoñanzas

  2. College of Pharmacy, University of Florida, Gainesville, FL, USA

    Robert Terkola

  3. Unit of PharmacoTherapy, Epidemiology and Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands

    Robert Terkola & Maarten Postma

  4. Beacon Medical Communications, Brighton, UK

    Paul M. Overton

  5. NAS Healthcare Solutions, Surbiton, UK

    Natalie Shalet

  6. University Medical Center Groningen, Institute of Science in Healthy Aging & healthcaRE (SHARE), University of Groningen, Groningen, The Netherlands

    Maarten Postma

  7. Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Maarten Postma

Authors
  1. Fernando Antoñanzas
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  2. Robert Terkola
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  3. Paul M. Overton
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  4. Natalie Shalet
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  5. Maarten Postma
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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.

Corresponding author

Correspondence to Fernando Antoñanzas.

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Funding

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.

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Antoñanzas, F., Terkola, R., Overton, P.M. et al. Defining and Measuring the Affordability of New Medicines: A Systematic Review. PharmacoEconomics 35, 777–791 (2017). https://doi.org/10.1007/s40273-017-0514-4

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  • DOI: https://doi.org/10.1007/s40273-017-0514-4

Keywords

  • Healthcare System
  • Gross Domestic Product
  • Oseltamivir
  • Budget Impact
  • Sofosbuvir