Stargardt Tom, Schreyögg Jonas
Department of Health Care Management, Faculty of Economics and Management, Berlin University of Technology, Berlin, Germany.
Appl Health Econ Health Policy. 2006;5(4):235-47. doi: 10.2165/00148365-200605040-00005.
Several EU countries are determining reimbursement prices of pharmaceuticals by cross-referencing prices of foreign countries. Our objective is to quantify the theoretical cross-border spill-over effects of cross-reference pricing schemes on pharmaceutical prices in the former EU-15 countries.
An analytical model was developed estimating the impact of pharmaceutical price changes in Germany on pharmaceutical prices in other countries in the former EU-15 using cross-reference pricing. We differentiated between the direct impact (from referencing to Germany directly) and the indirect impact (from referencing to other countries that conduct their own cross-reference pricing schemes).
The relationship between the direct and indirect impact of a price change depends mainly on the method applied to set reimbursement prices. When applying cross-reference pricing, the reimbursement price is either determined by the lowest of foreign prices (e.g. Portugal), the average of foreign prices (e.g. Ireland) or a weighted average of foreign prices (e.g. Italy). If the respective drug is marketed in all referenced countries and prices are regularly updated, a price reduction of 1.00 euro in Germany will reduce maximum reimbursement prices in the former EU-15 countries from 0.15 euros in Austria to 0.36 euros in Italy.
On one side, the cross-border spill-over effects of price reductions are undoubtedly welcomed by decision makers and may be favourable to the healthcare system in general. On the other side, these cross-border spill-over effects also provide strong incentives for strategic product launches, launch delays and lobbying activities, and can affect the effectiveness of regulation.
To avoid the negative effects of cross-reference pricing, a weighted index of prices from as many countries as possible should be used to determine reimbursement prices in order to reduce the direct and indirect impact of individual countries.
几个欧盟国家通过参照外国药品价格来确定药品报销价格。我们的目的是量化参照定价方案对前欧盟15国药品价格的理论跨境溢出效应。
开发了一个分析模型，以估计德国药品价格变化对前欧盟15国其他国家药品价格的影响，采用参照定价法。我们区分了直接影响（直接参照德国）和间接影响（参照其他实施自身参照定价方案的国家）。
价格变化的直接和间接影响之间的关系主要取决于用于设定报销价格的方法。采用参照定价时，报销价格要么由外国最低价格确定（如葡萄牙），要么由外国平均价格确定（如爱尔兰），要么由外国加权平均价格确定（如意大利）。如果相关药品在所有参照国家销售且价格定期更新，德国药品价格每降低1.00欧元，前欧盟15国的最高报销价格将从奥地利的0.15欧元降至意大利的0.36欧元。
一方面，降价的跨境溢出效应无疑受到决策者欢迎，总体上可能有利于医疗保健系统。另一方面，这些跨境溢出效应也为战略产品推出、推出延迟和游说活动提供了强大动力，并可能影响监管效果。
为避免参照定价的负面影响，则应使用尽可能多国家的加权价格指数来确定报销价格，以减少个别国家的直接和间接影响。
