Multi-Indication Pricing: Nice in Theory but Can it Work in Practice?
Multi-Indication Pricing: Nice in Theory but Can it Work in Practice?
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DOI：
10.1007/s40273-018-0716-4
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发表时间：
2018-12-01
影响因子：
4.4
通讯作者：
Hidalgo-Vega, Alvaro
中科院分区：
文献类型：
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作者：
Mestre-Ferrandiz, Jorge;Zozaya, Neboa;Hidalgo-Vega, Alvaro
对于具有不同价值适应症（用途）的药品，多适应症定价意味着针对不同的用途收取不同的价格。在本文中，我们评估了多适应症定价如何有助于实现定价控制的总体战略目标，总结了其优点和缺点（与统一定价相比），并估计了西班牙特定肿瘤药物向多适应症定价转变对价格的假设影响。国际经验表明，多指标定价可以在实际操作中实施，目前确实有一些举措正在使用，尽管大多是通过保密定价协议间接实施的，这种协议提供了一种在不改变标价的情况下区分各国价格的方法。然而，一些更复杂的系统在意大利到位，最近在西班牙，其目标是监测每个患者/适应症的使用情况，并最终为结果付费。根据现有经验，我们还概述了多指标定价所需的六个条件。多适应症定价是确定多种（不同价值）适应症药物相对价格的有用工具，但其本身并不能提供绝对价格应该是多少的解决方案。除其他事项外，这将受到成本效益门槛（如果存在的话）的推动。总的来说，我们认为多适应症定价在理论上是好的，它可以在实践中发挥作用，尽管在临床实践中需要改变药物定价、采购和监测的方式。
For medicines with different valued indications (uses), multi-indication pricing implies charging different prices for different uses. In this article, we assess how multi-indication pricing could help achieve overall strategic objectives of pricing controls, summarise its advantages and disadvantages (vs. uniform pricing) and estimate the hypothetical impact on prices of moving towards multi-indication pricing for specific oncologic medicines in Spain. International experience shows that multi-indication pricing can be implemented in real practice, and indeed a few initiatives are currently in use, albeit mostly applied indirectly through confidential pricing agreements that offer a way to discriminate prices across countries without altering list prices. However, some more sophisticated systems are in place in Italy, and more recently in Spain, where the objective is to monitor usage per patient/indication, and ultimately pay for outcomes. Based on the existing experience, we also outline six conditions required for multi-indication pricing. Multi-indication pricing is a useful tool to determine the relative prices of a drug for multiple (different-valued) indications, but by itself will not offer the solution' to what the absolute price should be. That will be driven, among other things, by cost-effectiveness thresholds, if they exist. Overall, we argue multi-indication pricing is nice in theory and it could work in practice, although changes in the manner in which medicines are priced, procured and monitored in clinical practice need to be applied.