Wettstein Dominik J, Boes Stefan
Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, P.O. Box 4466, CH-6002, Lucerne, Switzerland.
Health Econ Rev. 2020 May 21;10(1):13. doi: 10.1186/s13561-020-00267-y.
The necessity to measure and reward "value for money" of new pharmaceuticals has become central in health policy debates, as much as the requirement to assess the "willingness to pay" for an additional, quality-adjusted life year (QALY). There is a clear need to understand the capacity of "value-based" pricing policies to impact societal goals, like timely access to new treatments, sustainable health budgets, or incentivizing research to improve patient outcomes. Not only the pricing mechanics, but also the process of value assessment and price negotiation are subject to reform demands. This study assesses the impact of a negotiation situation for life-extending pharmaceuticals on societal outcomes. Of interest were general effects of the bargaining behaviour, as well as differences caused by the assigned role and the magnitude of prices.
We ran an online experiment (n = 404) on Amazon Mechanical Turk (MTurk). Participants were randomly assigned into four treatment groups for a reimbursement negotiation between two roles (health minister, pharma representative) in two price framings. Payoff to players consisted of a fixed salary and a potential bonus, depending on their preferences, their price offer and the counter offer of a randomly paired negotiation partner. Success had real social consequences on other MTurk users (premium payers, investors) and via donations to a patient association.
Margins between reservation prices and price offers increased throughout the game. Yet, 47% of players reduced at least once and 15% always their bonus probability to zero in favour of an agreement. 61% of simulated negotiation pairs could have reached an agreement, based on their preferences. 63% of these were successful, leaving 61% of patients with no access to the new treatment. The group with "real world" prices had lower prices and less agreements than the unconverted payoff group. The successful markets redistributed 20% of total assets from premium payers to investors over five innovation cycles.
The negotiation situation for pharmaceutical reimbursement has notable impact on societal outcomes. Further research should evaluate policies that align preferences and increase negotiation success.
衡量和奖励新药物的“性价比”的必要性已成为卫生政策辩论的核心，这与评估为额外的质量调整生命年（QALY）支付的“意愿”的要求一样重要。显然有必要了解“基于价值”的定价政策对社会目标的影响能力，如及时获得新治疗方法、可持续的卫生预算或激励研究以改善患者预后。不仅定价机制，而且价值评估和价格谈判过程都受到改革要求的影响。本研究评估了延长生命药物谈判情况对社会结果的影响。感兴趣的是讨价还价行为的总体影响，以及由指定角色和价格幅度引起的差异。
我们在亚马逊土耳其机器人（MTurk）上进行了一项在线实验（n = 404）。参与者被随机分配到四个处理组，在两种价格框架下，就两个角色（卫生部长、制药代表）之间的报销谈判进行分组。参与者的收益包括固定工资和潜在奖金，这取决于他们的偏好、报价以及随机配对的谈判伙伴的还价。成功对其他MTurk用户（高级付费者、投资者）以及通过向患者协会捐款会产生实际的社会影响。
在整个游戏过程中，保留价格和报价之间的差距不断增大。然而，47%的参与者至少有一次降低了奖金概率，15%的参与者总是将奖金概率降至零以达成协议。根据他们的偏好，61%的模拟谈判对本可以达成协议。其中63%的谈判对成功了，导致61%的患者无法获得新治疗。与未转换收益组相比，具有“现实世界”价格的组价格更低且达成的协议更少。在五个创新周期内，成功的市场将20%的总资产从高级付费者重新分配给了投资者。
药品报销谈判情况对社会结果有显著影响。进一步的研究应评估使偏好一致并提高谈判成功率的政策。
