Department of Health Policy and LSE Health, Medical Technology Research Group, Cowdray House, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
Eur J Health Econ. 2019 Dec;20(9):1375-1397. doi: 10.1007/s10198-019-01100-y. Epub 2019 Aug 23.
External reference pricing (ERP) seeks to rationalize prices and contain costs using foreign prices as a reference for the determination of domestic prices and is often used as the starting point for the facilitation of negotiations between health authorities and pharmaceutical manufacturers.
A systematic literature review was used to identify characteristics of ERP implementation across 29 countries. Primary data collection, in the form of surveys directed at key stakeholders, was also used to supplement data in instances where information received from the systematic literature review was outdated or minimal. Findings from the systematic literature review and primary evidence from key stakeholders were bench-marked against 14 best practice principles inherent to an optimal ERP system.
Significant heterogeneity in ERP implementation across countries was identified. Country basket size, pricing calculation, and frequency of price revisions varied between countries. Belgium, France, and South Africa were more likely to adhere to the best practice principles, whilst Bulgaria, Hungary, and Romania had the most instances of non-adherence.
The observed heterogeneity has policy implications for governments including globally declining pharmaceutical prices, launch delays in lower income countries, reduced incentive for continued R&D, and reduced access to medicines. Overcoming this issue to ensure that ERP is beneficial to all stakeholders will require a focus on developing sustainable, transparent, simple, and stable systems using a set of key guidelines that should maximize the benefits of the pricing policy.
外部参考定价（ERP）旨在通过将国外价格作为确定国内价格的参考，来合理化价格并控制成本，通常被用作卫生当局和制药商之间谈判的起点。
采用系统文献综述的方法，确定了 29 个国家实施 ERP 的特点。还采用了主要数据收集的方法，以调查的形式针对主要利益攸关方进行，以补充系统文献综述中收到的信息过时或很少的情况。系统文献综述的结果和主要利益攸关方的主要证据与一个最佳 ERP 系统所固有的 14 条最佳实践原则进行了基准比较。
发现各国在 ERP 实施方面存在显著的异质性。国家篮子规模、定价计算和价格修订频率在各国之间存在差异。比利时、法国和南非更有可能遵守最佳实践原则，而保加利亚、匈牙利和罗马尼亚则存在最多的不遵守情况。
所观察到的异质性对政府具有政策影响，包括全球药品价格下降、低收入国家的推出延迟、持续研发的激励减少以及药品获取减少。为了确保 ERP 对所有利益攸关方都有益，需要关注制定可持续、透明、简单和稳定的系统，使用一套关键准则，最大限度地发挥定价政策的效益。
