Drummond M, Jönsson B, Rutten F
Centre for Health Economics, University of York, Heslington, UK.
Health Policy. 1997 Jun;40(3):199-215. doi: 10.1016/s0168-8510(97)00901-9.
In most countries, governments or health insurers have taken initiatives to influence the price and utilization of medicines. One stated objective of these schemes is to encourage efficiency, or cost-effectiveness. In principle, economic evaluation should to be relevant to decisions about the pricing and reimbursement of health technologies, since it offers a way of estimating the additional value to society of a new intervention (e.g. medicine) relative to current therapy. However, the application of economic evaluation in drug pricing and reimbursement schemes is variable. Therefore, this paper reviews the actual and potential role of economic evaluation in different drug pricing and reimbursement schemes, such as 'free pricing' systems (United Kingdom, United States), two-stage administered systems (France), reference pricing systems (Germany, Netherlands, Sweden) and economic evaluation systems (Australia, Canada). It is concluded that, other than in the case of Australia and Canada, the potential role of economic evaluation could be greatly developed, especially in the case of new medicines, for which there is no close substitute. Comments are also given on the practical problems of using this approach. However, it is noted that economic evaluation alone cannot set a price for a medicine, since a decision has to be made about the proportion of added value going to society and the proportion going to the pharmaceutical company as a reward for innovation.
在大多数国家，政府或健康保险公司已采取措施来影响药品价格和使用情况。这些计划的一个既定目标是提高效率或成本效益。原则上，经济评估应与卫生技术定价和报销决策相关，因为它提供了一种方法来估计相对于当前治疗方法，一种新干预措施（如药品）给社会带来的额外价值。然而，经济评估在药品定价和报销计划中的应用情况各不相同。因此，本文回顾了经济评估在不同药品定价和报销计划中的实际和潜在作用，如“自由定价”系统（英国、美国）、两阶段管理系统（法国）、参考定价系统（德国、荷兰、瑞典）和经济评估系统（澳大利亚、加拿大）。得出的结论是，除了澳大利亚和加拿大的情况外，经济评估的潜在作用可以得到极大发展，尤其是对于没有相近替代品的新药。本文还对使用这种方法的实际问题进行了评论。然而，需要注意的是，仅靠经济评估无法确定药品价格，因为必须就新增价值中归社会的比例和归制药公司作为创新奖励的比例做出决策。
