School of Pharmacy, Sungkyunkwan University, Suwon 16419, Korea.
Int J Environ Res Public Health. 2022 Mar 30;19(7):4105. doi: 10.3390/ijerph19074105.
We aimed to calculate the value-based price of each indication and compare the drug price and budget impact among value-based pricing (VBP) scenarios, using immunotherapy as a case. Atezolizumab, nivolumab, and pembrolizumab prices were estimated for VBP scenarios, namely indication value-based pricing (IBP), IBP with refund, and weighted-average pricing (WAP). To estimate the value-based price of each indication, cost-effectiveness analyses were conducted by setting the incremental cost-effectiveness ratio of the first reimbursed indication to the threshold. The budget impact for each scenario was compared with that of the pricing system in Korea (which has a 4.75% price reduction). The value-based prices of non-reimbursed indications were lower for atezolizumab and higher for nivolumab than those for the reimbursed indication. The drug price fluctuations were the largest in IBP, varying between 28.56-328.81% of the current list price. The net price of the non-reimbursed indications decreased from 0% to 71.44% in IBP with refund, and the budget impact was the lowest among VBPs. Although the fluctuation in the budget impact in WAP was smaller than IBP, higher drug prices were identified for low-value indications. In conclusion, IBP with refund is a viable method for multi-indication drugs, because it has minimal drug price and budget impact changes.
我们旨在计算每种适应症的基于价值的价格，并比较基于价值的定价（VBP）方案中的药物价格和预算影响，以免疫疗法为例。我们估计了 VBP 方案（即适应症价值定价（IBP）、IBP 与退款和加权平均定价（WAP））中阿特珠单抗、纳武利尤单抗和帕博利珠单抗的价格。为了估计每种适应症的基于价值的价格，我们通过将第一个获得报销的适应症的增量成本效益比设定为阈值来进行成本效益分析。我们比较了每个方案的预算影响与韩国的定价系统（降价 4.75%）的预算影响。对于未报销的适应症，阿特珠单抗的基于价值的价格低于报销适应症，而纳武利尤单抗的基于价值的价格则高于报销适应症。在 IBP 中，药物价格波动最大，在现行目录价格的 28.56%至 328.81%之间变化。在 IBP 中，有退款的非报销适应症的净价从 0%降至 71.44%，是 VBPs 中预算影响最低的。虽然 WAP 中的预算影响波动小于 IBP，但对于低价值的适应症，药物价格较高。总之，IBP 与退款对于多适应症药物是一种可行的方法，因为它对药物价格和预算影响的变化最小。
