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This comprehensive text presents a rigorous framework from within
which regulators can respond strategically to the claim by the
pharmaceutical industry that lower drug prices today lead to a loss
for the population's future health due to less innovation. It
starts with a critical review of the empirical evidence of the
return to consumers on their ongoing investment into high drug
prices in order to increase future innovation. The implicit,
critical and unrealistic assumption inherent in these studies is
identified, namely that the health budget can be expanded to
purchase drugs at higher prices without an opportunity cost, for
example, the foregone benefits of alternative investments in health
care infrastructure. Price effectiveness analysis (PEA), is
introduced. PEA informs the question of how the innovative surplus
from the new drug should be allocated between the manufacturer and
the consumer so as to optimise society's welfare. The method allows
the decisions by the regulator and the firm to be analysed jointly
by specifying the firm's production and revenue functions in terms
of the clinical innovation of a new drug; the incremental effect
used in the summary metric of cost effectiveness analysis. An
economic value of innovation that takes into account opportunity
cost under conditions of economic efficiency in the health system
is proposed: the health shadow price. The limitations of the
non-strategic methods that currently inform the highly contested
new drug subsidy game are presented and the relative strengths of
PEA are demonstrated. Health technology assessment quantifies both
the clinical innovation of a new drug and its financial impact on
the health system. Cost effectiveness analysis tests the
relationship between the incremental cost and incremental effect of
a new drug for target patients, at a given price. PEA tests the
relationship between the price of a new drug and the health of the
whole population, now and into the future. It achieves this by
taking into account current inefficiency in both resource
allocation and the displacement process, and the relationship
between price and future innovation.
This comprehensive text presents a rigorous framework from within
which regulators can respond strategically to the claim by the
pharmaceutical industry that lower drug prices today lead to a loss
for the population's future health due to less innovation. It
starts with a critical review of the empirical evidence of the
return to consumers on their ongoing investment into high drug
prices in order to increase future innovation. The implicit,
critical and unrealistic assumption inherent in these studies is
identified, namely that the health budget can be expanded to
purchase drugs at higher prices without an opportunity cost, for
example, the foregone benefits of alternative investments in health
care infrastructure. Price effectiveness analysis (PEA), is
introduced. PEA informs the question of how the innovative surplus
from the new drug should be allocated between the manufacturer and
the consumer so as to optimise society's welfare. The method allows
the decisions by the regulator and the firm to be analysed jointly
by specifying the firm's production and revenue functions in terms
of the clinical innovation of a new drug; the incremental effect
used in the summary metric of cost effectiveness analysis. An
economic value of innovation that takes into account opportunity
cost under conditions of economic efficiency in the health system
is proposed: the health shadow price. The limitations of the
non-strategic methods that currently inform the highly contested
new drug subsidy game are presented and the relative strengths of
PEA are demonstrated. Health technology assessment quantifies both
the clinical innovation of a new drug and its financial impact on
the health system. Cost effectiveness analysis tests the
relationship between the incremental cost and incremental effect of
a new drug for target patients, at a given price. PEA tests the
relationship between the price of a new drug and the health of the
whole population, now and into the future. It achieves this by
taking into account current inefficiency in both resource
allocation and the displacement process, and the relationship
between price and future innovation.
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