Department of Medicine, Faculty of Medicine, The Ottawa Hospital, University of Ottawa, 501 Smyth Rd., Ottawa, ON K1H 8L6, Canada.
Life Saving Therapies Network, 173 Heath St., Ottawa, ON K1H 5E6, Canada.
Curr Oncol. 2022 Feb 16;29(2):1176-1189. doi: 10.3390/curroncol29020100.
New drugs are expensive, in part due to excessive drug development costs. Governments are trying to reduce drug prices. This can delay access to effective agents. A country's access to new drugs correlates with prices they agree to pay. After Health Canada approves a drug, the Canadian Agency for Drug and Technologies in Health (CADTH) assesses it. CADTH's approval is usually contingent on it costing ≤CAD 50,000 per quality adjusted life year (QALY) gained. This value (unchanged from the 1970s) is inappropriately low. An inflation-adjusted CAD 50,000 1975 QALY should translate into a CAD 250,000 2021 QALY. CADTH's target also does not consider that drug development costs have risen much faster than inflation or that new precision therapies may only be used in small populations. In a separate process, proposals from the Patented Medicines Price Review Board (PMPRB) would decrease initial Canadian drug prices by 20%, but prices would fall further as sales increased, with ultimate price reductions of up to 80%. PMPRB claims its proposal would not reduce drug access, but multiple analyses strongly suggest otherwise. Government price controls target the symptom (high prices), not the disease. They translate into shortages without solving the problem. CADTH and PMPRB approaches both threaten access to effective drugs.
新药价格昂贵，部分原因是药物研发成本过高。政府正试图降低药品价格，但这可能会延迟有效药物的普及。一个国家获得新药的机会与其愿意支付的价格有关。在加拿大卫生部批准一种药物后，加拿大药物和技术评估机构（CADTH）会对其进行评估。CADTH 的批准通常取决于药物的成本是否低于每获得一个质量调整生命年（QALY）支付 5 万加元（CAD）。这个价值（自 20 世纪 70 年代以来一直没有变化）过低。经通胀调整后，1975 年 5 万加元的 QALY 应换算为 2021 年的 25 万加元的 QALY。CADTH 的目标也没有考虑到药物研发成本的增长速度远高于通胀，或者新的精准疗法可能只适用于小部分人群。在一个单独的过程中，专利药品价格审查委员会（PMPRB）的提案将使加拿大的初始药品价格降低 20%，但随着销售额的增加，价格将进一步下降，最终降幅高达 80%。PMPRB 声称其提案不会降低药物的可及性，但多项分析强烈表明并非如此。政府的价格控制针对的是症状（高价格），而不是疾病本身。这会导致短缺，而无法解决问题。CADTH 和 PMPRB 的方法都可能威胁到有效药物的可获得性。
