The Boston Consulting Group, Boston, Massachusetts, USA.
The Bruce Henderson Institute, New York, New York, USA.
Liver Int. 2022 Jul;42(7):1503-1516. doi: 10.1111/liv.15245. Epub 2022 Mar 26.
High unit prices of treatments limit access. For epidemics like that of hepatitis C virus (HCV), reduced treatment access increases prevalence and incidence, making the infectious disease increasingly difficult to manage. The objective of the current study was to construct and test an alternative pricing model, the Payer License Agreement (PLA), and determine whether it could improve outcomes, cut costs and incentivize innovation versus the current unit-based pricing model.
We built and used computational models of hepatitis C disease progression, treatment, and pricing in historical and future scenarios and quantitatively analyzed their economic and epidemiological impact in three high-income countries.
This study had three key results regarding HCV treatment. First, if the PLA model had been implemented when interferon-free direct-acting antiviral (DAA) combinations launched, the number of patients treated and cured would have more than doubled in the first three years, while the liver-related deaths (LRDs) would have decreased by around 40%. Second, if the PLA model had been implemented beginning in 2018, the year that several Netflix-like payment models were under implementation, the number of treated and cured patients would nearly double, and the LRDs would decline by more than 55%. Third, implementing the PLA model would result in a decline in total payer costs of more than 25%, with an increase to pharmaceutical manufacturer revenues of 10%. These results were true across the three healthcare landscapes studied, the USA, the UK and Italy, and were robust against variations to critical model parameters through sensitivity analysis.
These results suggest that implementation of the PLA model in high-income countries across a variety of health system contexts would improve patient outcomes at lower payer cost with more stable revenue for pharmaceutical manufacturers. Health policy-makers in high-income countries should consider the PLA model for application to more cost-effective management of HCV, and explore its application for other infectious diseases with curative therapies available now or soon.
高昂的治疗单价限制了治疗的可及性。对于丙型肝炎病毒（HCV）这类传染病，治疗可及性的降低会导致患病率和发病率的增加，从而使传染病的管理变得愈发困难。本研究的目的是构建并测试一种替代定价模式，即支付方许可协议（Payer License Agreement，PLA），并确定其是否能够改善结果、降低成本、激励创新，与现行的按单位计价模式相比具有优势。
我们构建并使用了 HCV 疾病进展、治疗和定价的历史和未来情景下的计算模型，并在三个高收入国家中对其经济和流行病学影响进行了定量分析。
本研究在 HCV 治疗方面有三个关键发现。首先，如果在无干扰素直接作用抗病毒（direct-acting antiviral，DAA）联合治疗推出时就采用 PLA 模式，那么在最初的三年中，接受治疗和治愈的患者数量将增加一倍以上，而与肝脏相关的死亡（liver-related deaths，LRDs）将减少约 40%。其次，如果从 2018 年开始实施 PLA 模式，即几个网飞式支付模式开始实施的那一年，接受治疗和治愈的患者数量将几乎翻一番，LRDs 将减少超过 55%。第三，实施 PLA 模式将导致支付方总成本下降超过 25%，同时制药商的收入增加 10%。这些结果在我们研究的三个医疗保健环境中（美国、英国和意大利）都是成立的，并且通过敏感性分析对关键模型参数的变化具有稳健性。
这些结果表明，在各种卫生系统背景下，在高收入国家实施 PLA 模式将改善患者的预后，降低支付方的成本，同时为制药商带来更稳定的收入。高收入国家的卫生政策制定者应考虑将 PLA 模式应用于 HCV 的更具成本效益的管理，并探索其在其他具有现有或即将推出治愈疗法的传染病中的应用。
