Does external reference pricing deliver what it promises? Evidence on its impact at national level
Does external reference pricing deliver what it promises? Evidence on its impact at national level
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DOI：
10.1007/s10198-019-01116-4
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发表时间：
2019-10-03
影响因子：
4.4
通讯作者：
Efthymiadou, Olina
中科院分区：
文献类型：
--
作者：
Kanavos, Panos;Fontrier, Anna-Maria;Efthymiadou, Olina
背景外部参考定价（ERP）被广泛用于调节药品价格和帮助确定报销。它的执行情况在各国之间差异很大，因此很难研究和了解其对关键政策目标的影响。ObjectivesTo评估在不同环境中的ERP证据及其对关键卫生政策目标的影响，特别是成本控制、药品价格水平、药物使用、公平、效率、可用性、可负担性和产业政策;第二，批判性地评估ERP证据的质量。方法通过对主要专家的调查和系统的文献回顾，分别收集初级和二级数据，结果45项研究纳入系统评价（2000年1月-2016年12月）。主要证据是通过向21个国家的专家分发调查问卷收集的（2017年1月至7月）。企业资源规划系统有助于控制成本，但这是一种短期效果，在很大程度上取决于企业资源规划系统的设计和实施方式。由于实施电子资源规划，价格低廉，可能会损害药品的供应，导致上市延迟或产品撤回。向下的价格趋同会阻碍创新投资。ERP似乎并没有提高实现卫生系统目标的效率。由于证据不足，结果需要谨慎解释。ConclusionsERP没有有效地调节价格，并有意想不到的后果，减少了它带来的好处。如果ERP是精心设计的最低价格修订，谨慎选择篮子大小和国家，并考虑交易价格，它可能是一个更有效的机制，提高福利，在国家内部公平获得药品，并帮助促进行业创新。
BackgroundExternal reference pricing (ERP) is widely used to regulate pharmaceutical prices and help determine reimbursement. Its implementation varies substantially across countries, making it difficult to study and understand its impact on keypolicy objectives.ObjectivesTo assess the evidence on ERP in different settings and its impact on key healthpolicy objectives, notably, cost-containment, pharmaceuticalprice levels, drug use, equity, efficiency, availability, affordability and industrial policy; and second, to critically assess the quality of evidence on ERP.MethodsPrimary and secondary data collection through a survey of leading experts and a systematic literature review, respectively, over the 2000-2017 period.ResultsForty five studies were included in the systematic review(January 2000-December 2016). Primary evidence was gathered via survey distribution to experts in 21 countries(January-July 2017). ERP contributes to cost-containment, but this is a short-term effect highly dependent on the way ERP is designed and implemented. Low prices, as a result of ERP, can undermine the availability of medicines and lead to launch delays or product withdrawals. Downward price convergence can hamper investment in innovation. ERP does not seem to promote efficiency in achieving health system goals. As evidence is weak, results need to be interpreted with caution.ConclusionsERP has not regulated prices efficiently and has unintended consequences that reduce the benefits arising from it. If ERP is carefully designed with minimal price revisions, prudent selection of basket size and countries, and consideration of transaction prices, it could be a more effective mechanism enhancing welfare, equitable access to medicines within countries and helppromote industry innovation.