Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, P.O. Box 4466, CH-6002, Lucerne, Switzerland.
BMC Health Serv Res. 2021 Mar 16;21(1):234. doi: 10.1186/s12913-021-06231-8.
Price negotiations for specialty pharmaceuticals take place in a complex market setting. The determination of the added value of new treatments and the related societal willingness to pay are of increasing importance in policy reform debates. From a behavioural economics perspective, potential cognitive biases and other-regarding concerns affecting outcomes of reimbursement negotiations are of interest. An experimental setting to investigate social preferences in reimbursement negotiations for novel, oncology pharmaceuticals was used. Of interest were differences in social preferences caused by incremental changes of the patient outcome.
An online experiment was conducted in two separate runs (n = 202, n = 404) on the Amazon Mechanical Turk (MTurk) platform. Populations were split into two (run one) and four (run two) equally sized treatment groups for hypothetical reimbursement decisions. Participants were randomly assigned to the role of a public price regulator for pharmaceuticals (buyer) or a representative of a pharmaceutical company (seller). In run two, role groups were further split into two different price magnitude framings ("real world" vs unconverted "real payoff" prices). Decisions had real monetary effects on other participants (in the role of premium payers or investors) and via charitable donations to a patient organisation (patient benefit).
56 (run one) and 59 (run two) percent of participants stated strictly monotone preferences for incremental patient benefit. The mean incremental cost-effectiveness ratio (ICER) against standard of care (SoC) was higher than the initial ICER of the SoC against no care. Regulators stated lower reservation prices in the "real world" prices group compared to their colleagues in the unconverted payoff group. No price group showed any reluctance to trade. Overall, regulators rated the relevance of the patient for their decision higher and the relevance of their own role lower compared to sellers.
The price magnitude of current oncology treatments affects stated preferences for incremental survival, and assigned responsibilities lead to different opinions on the relevance of affected stakeholders. The design is useful to further assess effects of reimbursement negotiations on societal outcomes like affordability (cost) or availability (access) of new pharmaceuticals and test behavioural policy interventions.
专科药物的价格谈判发生在一个复杂的市场环境中。新疗法的附加值以及相关的社会支付意愿在政策改革辩论中变得越来越重要。从行为经济学的角度来看，影响报销谈判结果的潜在认知偏差和他人关注的问题受到关注。本研究采用实验设计来调查新型肿瘤药物报销谈判中的社会偏好。研究兴趣在于患者结果的增量变化引起的社会偏好差异。
在亚马逊 Mechanical Turk (MTurk)平台上进行了两次独立运行（n=202，n=404）的在线实验。人群分为两个（运行 1）和四个（运行 2）大小相等的治疗组进行假设性报销决策。参与者被随机分配到药品公共价格监管者（买方）或制药公司代表（卖方）的角色。在运行 2 中，角色组进一步分为两种不同的价格幅度框架（“现实世界”与未转换的“实际收益”价格）。决策对其他参与者（作为保费支付者或投资者）和通过向患者组织（患者受益）进行慈善捐赠会产生实际的货币影响。
在运行 1 中有 56%的参与者和运行 2 中有 59%的参与者表示对增量患者获益有严格单调的偏好。与标准护理（SoC）相比，增量成本效益比（ICER）的平均值高于无护理时 SoC 的初始 ICER。与未转换收益组相比，“现实世界”价格组的监管者表示出较低的保留价格。没有价格组表现出任何不愿交易的迹象。总体而言，监管者认为患者对其决策的相关性更高，而对自身角色的相关性更低，而卖方则相反。
当前肿瘤治疗的价格幅度会影响增量生存的偏好，并分配责任会导致对受影响利益相关者的相关性有不同的看法。该设计可用于进一步评估报销谈判对新药物的社会结果（如可负担性（成本）或可获得性（机会））的影响，并测试行为政策干预措施。
