A Transparent and Consistent Approach to Assess US Outpatient Drug Costs for Use in Cost-Effectiveness Analyses
A Transparent and Consistent Approach to Assess US Outpatient Drug Costs for Use in Cost-Effectiveness Analyses
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DOI：
10.1016/j.jval.2017.06.013
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发表时间：
2018-06-01
期刊：
影响因子：
4.5
通讯作者：
Vanness, David
中科院分区：
文献类型：
--
作者：
Levy, Joseph;Rosenberg, Marjorie;Vanness, David
背景资料：在美国，用于成本效益分析（CEA）的药物成本评估并不简单，因为药物支付的价格不公开，并且支付者之间存在差异。消费者评价机构所依赖的标价并不反映与这些采购有关的回扣和折扣。目的：审查可用的成本措施，并提出一个新的战略，是透明的，一致的，并适用于所有CEA采取美国医疗保健部门的角度或社会付款人的角度。研究方法：我们建议使用全国平均药品采购成本（NADAC），退伍军人事务部联邦供应时间表（VAFSS），和他们的中点作为上限，下限，和基本情况下，分别估计净药品价格为各种付款人。我们比较这种方法与批发收购成本（WAC），在我们的文献综述中观察到的最常见的措施。最小WAC用于提供最保守的比较。结果：共获得1436个品牌药品和1599个仿制药。平均而言，品牌和仿制药的上限（NADAC）分别比WAC低1%和9.8%，而下限（VAFSS）分别比WAC低48.3%和54.2%。89.6%的药物组NADAC小于WAC。这些关系的分布没有明确的模式，有很大的变化。结论：我们的研究表明，WAC可能是一个高估的基础情况下，因为最低WAC是高于大多数药物的NADAC。我们的方法平衡了药品成本的不确定性和缺乏数据，并需要一个透明和一致的方法来进行有效的CEA。
Background: Assessment of drug costs for cost-effectiveness analyses (CEAs) in the United States is not straightforward because the prices paid for drugs are not publicly available and differ between payers. CEAs have relied on list prices that do not reflect the rebates and discounts known to be associated with these purchases. Objectives: To review available cost measures and propose a novel strategy that is transparent, consistent, and applicable to all CEAs taking a US health care sector perspective or a societal payer's perspective. Methods: We propose using the National Average Drug Acquisition Cost (NADAC), the Veterans Affairs Federal Supply Schedule (VAFSS), and their midpoint as the upper bound, lower bound, and base case, respectively, to estimate net drug prices for various payers. We compare this approach with wholesale acquisition cost (WAC), the most common measure observed in our literature review. The minimum WAC is used to provide the most conservative comparison. Results: Our sample consists of 1436 brand drugs and 1599 generic drugs. On average, the upper bound (NADAC) is 1% and 9.8% lower than the WAC for brand and generic drugs respectively, whereas the lower bound (VAFSS) is 48.3% and 54.2% lower than the WAC. The NADAC is less than the WAC in 89.6% of drug groups. The distributions of these relationships do not show a clear mode and have wide variation. Conclusions: Our study suggests that the WAC may be an overestimate for the base case because the minimum WAC is higher than the NADAC for most drugs. Our approach balances uncertainty and lack of data for the cost of pharmaceuticals with the need for a transparent and consistent approach for valid CEAs.