8 - Medical Technologies: Aligning Private Rewards with Health Impacts

项目总结/摘要 项目8 -医疗技术：使私人奖励与健康影响保持一致 在过去的几十年里，新的医疗技术使健康状况得到了显著改善 对许多患者群体的影响。虽然在任何新的医疗发展的关键因素， 技术是一种科学突破，市场激励往往是一个关键的决定因素， 可行的医疗技术成功地从科学家的实验室过渡到病人的床边。 因此，影响市场激励的公共政策设计--如专利制度和法规 例如美国食品和药物管理局（FDA）的那些 医学创新的方向。 - 可能对利率产生重要影响， 本项目的目标是调查我们目前的专利制度和FDA政策是否未能提供 鼓励开发一些科学上可行的医疗技术， 对患者的好处。我们的重点是所谓的“新用途”失真，这可能会出现在案件中，一个关闭- 专利药物有一个新的用途发现，如发现，一个非专利糖尿病药物可能是一个 有效的癌症治疗。私人研究投资于这种旧的新用途的动机很少 药物和公共研究补贴的目的并不是为了鼓励研究这些新用途。 我们将制定政策分析的概念框架（目标1），并将开发新构建的数据 (Aim 2）以经验检验（目标3）这种“新用途”的扭曲是否会导致一些科学上可行的药物 从未接触过病人。然后，我们将尝试量化这些“缺失”的医疗服务对患者的健康价值。 （目标4），以便估计在替代技术下可能实现的潜在健康收益。 施政纲要而 该项目的成果旨在更广泛地促进正在进行的关于如何最好地提供 循证医学对患者的影响，特别是在个性化医疗的新兴领域。具体地说， 在“新用途”问题存在的范围内，“缺失”的无形成本的规模 随着个性化医疗变得越来越重要，它可能引起的创新也在增长。个性化 医学是基于将病人分成小组的想法，假设药物， 对一个亚组的患者的工作可能对另一个亚组不起作用。随着科学和医学的进步 关于如何最好地将患者分类到这些亚组，将出现新的医学价值的机会， 药物和更有针对性的群体之间的匹配-许多或大多数这些新的匹配可能会 来自现有药物的库存。因此，最大限度地提高老龄化人口的健康水平将越来越重要。 这取决于促进在患者和疾病中最有效地使用药物的政策。

PROJECT SUMMARY/ABSTRACT Project 8 – Medical Technologies: Aligning Private Rewards with Health Impacts Over the past several decades, new medical technologies have generated dramatic improvements in health outcomes for many groups of patients. While a key ingredient in the development of any new medical technology is a scientific breakthrough, market incentives are often a critical determinant of which scientifically feasible medical technologies successfully make the transition from a scientist's lab to a patient's bedside. Hence, the design of public policies that affect market incentives —such as the patent system and regulations such as those of the US Food and Drug Administration (FDA) direction of medical innovation. —can have important effects on the rate and The goal of this project is to investigate whether our current system of patent and FDA policies fails to provide incentives for the development of some scientifically feasible medical technologies that would generate health benefits to patients. Our focus is the so-called “new uses” distortion, which may arise in cases where an off- patent drug has a new use discovered, such as the discovery that an off-patent diabetes drug may be an effective cancer treatment. There are few incentives for private research investments into such new uses of old drugs, and public research subsidies are not explicitly designed to encourage research into such new uses. We will develop a conceptual framework for policy analysis (Aim 1) and will develop newly-constructed data (Aim 2) to empirically test (Aim 3) whether this “new uses” distortion results in some scientifically feasible drugs never reaching patients. We will then attempt to quantify the health value to patients of these “missing” medical technologies (Aim 4), in order to estimate the potential health gains that could be realized under alternative policies. The results of this project aim to contribute more broadly to the ongoing debate about how best to deliver evidence-based medicine to patients, particularly in the emerging field of personalized medicine. Specifically, to the extent that the “new uses” problem exists, the magnitude of the invisible costs of the “missing” innovations it may cause are growing as personalized medicine becomes increasingly important. Personalized medicine is based on the idea of separating patients into subgroups, under the assumption that drugs that work for one subgroup of patients may not work well for another. As progress is made in science and medicine about how best to classify patients into such subgroups, opportunities will arise for new medically valuable matches between drugs and more targeted groups—and many or most of these new matches would likely come from the stock of existing drugs. Maximizing the health of an aging population will thus increasingly depend on policies that promote the most effective use of medications across patients and conditions.