Reducing pharmaceutical reimbursement price risk to lower national health expenditures without lowering R&D incentives
Reducing pharmaceutical reimbursement price risk to lower national health expenditures without lowering R&D incentives
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降低药品报销价格风险，在不降低 R 的情况下降低国家卫生支出
DOI：
10.1007/s42495-018-0002-7
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Wakutsu Naohiko
中科院分区：
文献类型：
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作者：
Nakamura Hiroshi;Wakutsu Naohiko
在日本，报销药品价格的提高给制药企业带来了更强的研发动力，但也增加了国民健康保险和患者的经济负担。考虑到政府面临的严峻财政状况，分析如何在不降低制药企业现有研发激励的情况下实现更低的国家卫生支出是重要的。在本研究中，我们探讨了降低医药企业面临的补偿价格风险对他们的R&D激励的影响。从理论上讲，产出价格风险的存在降低了风险规避型企业的研发激励。因此，在制药公司表现出风险规避的程度上，如果制定指导方针，加快信息披露和/或促进公私对话可以降低报销价格风险，那么即使降低报销药品价格水平，也可以保持甚至增加研发激励。具体而言，我们解决（1）在多大程度上，一个给定的水平的报销价格风险降低制药公司的R&D激励;（2）在多大程度上，报销药品价格可以降低，保持制药公司的R&D激励不变，如果一个人可以成功地消除风险;以及（3）影响的大小如何随企业面临的价格风险程度和风险规避水平而变化。为此，根据日本药品市场的实际数据构建了一种假设的新品牌药品。假设一家制药公司是一个期望效用最大化，该公司的瞬时效用函数的形式是恒定的相对风险厌恶效用函数和其R&D激励量化的标准贴现现金流估值，我们使用模拟计算的确定性等价物和风险溢价与不同程度的价格风险和风险厌恶。参考风险偏好的经验文献，我们将制药公司的相对风险厌恶水平的参数值设置为3.0，贴现率设置为0.08。出现了以下结果。(1)在存在20%的价格风险的情况下，报销价格为100（即，范围从80到120），制药公司的确定性当量为96.0。因此，在存在20%价格风险的情况下，风险报销药品价格100相当于确定报销药品价格96.0。(2)如果报销价格为100，存在20%的价格风险，则价格溢价为4.0。因此，通过增加未来价格的可预测性，偿还价格可能会降低4.0，而企业的研发激励保持不变。(3)影响的程度随着价格风险程度的增加而增加，随着风险规避程度的增加而减少。
In Japan, higher reimbursement drug prices give pharmaceutical firms stronger R&D incentives, but they also increase the financial burden on national health insurance and patients. Considering the severe financial situation that the government faces, analyzing how to achieve lower national health expenditures without lowering pharmaceutical firms’ existing R&D incentives is important. In this research, we investigate the effect of reducing the reimbursement price risk that pharmaceutical firms face on their R&D incentives. Theoretically, the presence of output price risks reduces risk-averse firms’ R&D incentives. Therefore, to the extent that pharmaceutical firms exhibit risk aversion, if creating guidelines, accelerating information disclosure and/or enabling public–private dialogue can reduce reimbursement price risks, then maintaining or even increasing R&D incentives is possible, even if the level of reimbursement drug prices is reduced. Specifically, we address (1) by how much a given level of reimbursement price risk reduces pharmaceutical firms’ R&D incentives; (2) by how much reimbursement drug prices can be reduced, keeping pharmaceutical firms’ R&D incentives constant, if one can successfully remove the risk; and (3) how the magnitude of the impact changes with the degree of price risk that firms face and with the level of their risk aversion. To this end, a hypothetical new branded drug is constructed from actual data on the Japanese drug market. Assuming that a pharmaceutical firm is an expected-utility maximizer, that the firm’s instantaneous utility function is in the form of the constant-relative-risk-aversion utility function and that its R&D incentives are quantified by the standard discounted cash flow valuation, we use simulations to compute the certainty equivalent and risk premium associated with various degrees of price risk and risk aversion. Referring to the empirical literature on risk preference, we set the parameter value for the level of relative risk aversion of a pharmaceutical firm to 3.0 and that for the discount rate to 0.08. The following results emerged. (1) In the presence of a 20% price risk regarding a reimbursement price of 100 (i.e., ranging from 80 to 120), a pharmaceutical firm’s certainty equivalent is 96.0. Hence, in the presence of a 20% price risk, a risky reimbursement drug price of 100 is equivalent to a sure reimbursement drug price of 96.0. (2) In the presence of a 20% price risk regarding a reimbursement price of 100, the price premium is 4.0. Therefore, by increasing the predictability of future prices, the reimbursement price may decrease by 4.0, while the firm’s R&D incentives remain unchanged. (3) The magnitude of the impact increases at an increasing rate with the degree of price risk and increases at a decreasing rate with the level of risk aversion.