Pauly Mark V
Health Care Management Department, The Wharton School of the University of Pennsylvania, Philadelphia, PA, USA.
Value Health. 2017 Feb;20(2):278-282. doi: 10.1016/j.jval.2016.11.017.
This article investigates the economic theory and interpretation of the concept of "value-based pricing" for new breakthrough drugs with no close substitutes in a context (such as the United States) in which a drug firm with market power sells its product to various buyers. The interpretation is different from that in a country that evaluates medicines for a single public health insurance plan or a set of heavily regulated plans. It is shown that there will not ordinarily be a single value-based price but rather a schedule of prices with different volumes of buyers at each price. Hence, it is incorrect to term a particular price the value-based price, or to argue that the profit-maximizing monopoly price is too high relative to some hypothesized value-based price. When effectiveness of treatment or value of health is heterogeneous, the profit-maximizing price can be higher than that associated with assumed values of quality-adjusted life-years. If the firm sets a price higher than the value-based price for a set of potential buyers, the optimal strategy of the buyers is to decline to purchase that drug. The profit-maximizing price will come closer to a unique value-based price if demand is less heterogeneous.
本文探讨了在（如美国）这样的背景下，对于没有相近替代品的新型突破性药物，“基于价值定价”概念的经济理论及解释。在这种背景下，具有市场支配力的制药公司将其产品销售给不同的买家。这种解释与在为单一公共医疗保险计划或一系列严格监管的计划评估药品的国家有所不同。研究表明，通常不会存在单一的基于价值的价格，而是会有一个价格表，每个价格对应不同数量的买家。因此，将某个特定价格称为基于价值的价格，或者认为利润最大化的垄断价格相对于某些假设的基于价值的价格过高，都是不正确的。当治疗效果或健康价值存在异质性时，利润最大化价格可能高于与假设的质量调整生命年价值相关的价格。如果公司为一组潜在买家设定的价格高于基于价值的价格，买家的最优策略是拒绝购买该药物。如果需求的异质性较小，利润最大化价格将更接近唯一的基于价值的价格。
