Claxton Karl
Department of Economics and Related Studies and Centre for Health Economics, University of York, York, UK.
Health Econ. 2007 Jun;16(6):545-58. doi: 10.1002/hec.1249.
The report by the Office of Fair Trading (OFT) on the UK pharmaceutical price regulation scheme (PPRS) recommends the reform of the current scheme, which is a combination of profit and price controls, to one where price is based on the health benefits offered by a pharmaceutical. On closer examination some of the more commonly expressed concerns about these proposals do not seem to be well founded. In principle, the OFT's recommendations may contribute to allocative and dynamic efficiency in the NHS. However, there are some dangers and the details of how it will be implemented are crucial. For example, value-based pricing with an inappropriate threshold for cost-effectiveness, or an inappropriate pricing structure, could lead to technologies being adopted at prices where their benefits, in terms of health outcome, do not offset the health displaced elsewhere in the NHS, a situation in which the NHS is damaged rather than improved by innovation. A failure to account for uncertainty and the value of evidence in negotiating prices and coverage could also undermine the evidence base for future NHS practice. Whatever view is taken, the OFT report will inevitably shape the scope of future policy debates about value, guidance, price and innovation.
公平交易办公室（OFT）关于英国药品价格监管计划（PPRS）的报告建议，将现行的利润与价格控制相结合的计划改革为基于药品所提供的健康效益来定价的计划。仔细审视后可以发现，一些对这些提议较为常见的担忧似乎并无充分依据。原则上，公平交易办公室的建议可能有助于提高国民医疗服务体系（NHS）的配置效率和动态效率。然而，存在一些风险，且其实施细节至关重要。例如，基于价值的定价若采用不恰当的成本效益阈值或定价结构，可能导致采用某些技术的价格，从健康结果来看，其效益无法抵消国民医疗服务体系其他地方所损失的健康，在这种情况下，创新非但没有改善国民医疗服务体系，反而对其造成了损害。在谈判价格和覆盖范围时未能考虑不确定性及证据的价值，也可能破坏未来国民医疗服务体系实践的证据基础。无论持何种观点，公平交易办公室的报告都将不可避免地影响未来关于价值、指导方针、价格和创新的政策辩论范围。
