Preckler Víctor, Espín Jaime
Epidemiology, Health Policy and Health Management, Escuela Internacional de Doctorado Universidad de Sevilla, Sevilla, Spain.
Andalusian School of Public Health (EASP), Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Instituto de Investigación Biosanitaria (IBS), Granada, Spain.
Value Health. 2022 Apr;25(4):666-675. doi: 10.1016/j.jval.2021.11.1376. Epub 2022 Feb 25.
Indication-based pricing (IBP) has received growing attention because of the expected increase in the number of new medicines with multiple indications. In our systematic review, we assess the potential benefits, barriers, current experiences, and future perspectives of different IBP mechanisms.
We searched publications in English, Spanish, or French assessing the impact, international experience, and future context of IBP systems on PubMed, Scopus, Cochrane, EconLit, American Society of Clinical Oncology, and National Institute for Health Research Health Technology Assessment from 2000 to 2020. This was complemented by a gray literature search in Google Scholar.
A total of 29 publications that specifically addressed the topic of IBP were retained. The most commonly reported benefits of IBP were a better alignment of medicines' value and price, optimization of research and development incentives and increase of competition, and improvement of patients' access to treatments. Data collection and proper infrastructures, and the risk of high administrative burden and associated costs, were seen as the main barriers for proper IBP implementation. International experience lacks concrete examples of IBP. A single weighted average price according to volume, value, or a combination of both, appears to be the most used methodology, followed by different confidential net prices per indication. Different brands with distinct price per indication are less common, although it is considered a pure IBP system.
Evidence of IBP impact is still scarce, and there is a need for pilot projects and experiences to monitor its real consequences. An appropriate price and reimbursement model for multi-indication medicines should be a priority, but political will and proper data collection systems remain crucial.
由于具有多种适应症的新药数量预计会增加，基于适应症的定价（IBP）受到了越来越多的关注。在我们的系统评价中，我们评估了不同IBP机制的潜在益处、障碍、当前经验和未来前景。
我们检索了2000年至2020年期间在PubMed、Scopus、Cochrane、EconLit、美国临床肿瘤学会和英国国家卫生研究院卫生技术评估数据库中以英文、西班牙文或法文发表的评估IBP系统的影响、国际经验和未来背景的文献。此外，还在谷歌学术中进行了灰色文献检索作为补充。
共保留了29篇专门论述IBP主题的文献。IBP最常被报道的益处是使药品价值与价格更好地匹配、优化研发激励措施并增强竞争，以及改善患者获得治疗的机会。数据收集和适当的基础设施，以及高行政负担和相关成本的风险，被视为正确实施IBP的主要障碍。国际经验中缺乏IBP的具体实例。根据销量、价值或两者结合的单一加权平均价格似乎是最常用的方法，其次是每个适应症不同的保密净价。每个适应症价格不同的不同品牌较少见，尽管这被认为是一种纯粹的IBP系统。
关于IBP影响的证据仍然很少，需要开展试点项目和积累经验来监测其实际后果。为多适应症药物建立合适的价格和报销模式应是优先事项，但政治意愿和适当的数据收集系统仍然至关重要。
