Department of Pharmacy, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa.
J Eval Clin Pract. 2012 Apr;18(2):343-51. doi: 10.1111/j.1365-2753.2010.01565.x. Epub 2010 Nov 18.
RATIONALE, AIMS AND OBJECTIVES: Value-based pricing has recently been discussed by international bodies as a means to estimate a drug price that is linked to the benefits it offers patients and society. The World Health Organization (WHO) has recommended using three times a country's per capita gross domestic product (GDP) as the threshold for economic value. Using the WHO criteria, pharmacoeconomic modelling was used to illustrate the application of value-based price towards bevacizumab, a relatively new drug that provides a 1.4-month survival benefit to patients with metastatic colorectal cancer (mCRC).
A decision model was developed to simulate outcomes in mCRC patients receiving chemotherapy ± bevacizumab. Clinical data were obtained from randomized trials and costs from Canadian cancer centres. Utility estimates were determined by interviewing 24 oncology nurses and pharmacists. A price per dose of bevacizumab was then estimated using a target threshold of $CAD117,000 per quality adjusted life year gained, which is three times the Canadian per capita GDP.
For a 1.4-month survival benefit, a price of $CAD830 per dose would be considered cost-effective from the Canadian public health care perspective. If the drug were able to improve patient quality of life or survival from 1.4 to 3 months, the drug price could increase to $CAD1560 and $CAD2180 and still be considered cost-effective.
The use of the WHO criteria for estimating a value-based price is feasible, but a balance between what patients/governments can afford to pay and the commercial viability of the product in the reference country would be required.
背景、目的和目标：国际组织最近讨论了基于价值的定价，将其作为一种估计药物价格的方法，该价格与药物为患者和社会带来的益处相关联。世界卫生组织（WHO）建议将一个国家的人均国内生产总值（GDP）的三倍作为经济价值的阈值。根据 WHO 的标准，使用药物经济学模型来阐述贝伐单抗的基于价值的定价的应用，贝伐单抗是一种相对较新的药物，为转移性结直肠癌（mCRC）患者提供了 1.4 个月的生存获益。
开发了一个决策模型，以模拟接受化疗±贝伐单抗的 mCRC 患者的结局。临床数据来自随机试验，成本来自加拿大癌症中心。效用估计值通过访谈 24 名肿瘤护士和药剂师确定。然后使用目标阈值为每获得 1 个质量调整生命年（QALY）$CAD117000，即加拿大人均 GDP 的三倍，估计贝伐单抗的每剂量价格。
从加拿大公共卫生保健的角度来看，对于 1.4 个月的生存获益，每剂量$CAD830 的价格被认为是具有成本效益的。如果药物能够将患者的生活质量或生存时间从 1.4 个月延长至 3 个月，那么药物价格可以增加到$CAD1560 和$CAD2180，仍然被认为是具有成本效益的。
使用 WHO 标准来估计基于价值的价格是可行的，但需要在患者/政府能够负担得起的价格与参考国家产品的商业可行性之间取得平衡。
