An assessment of innovative pricing schemes for the communication of value: is price discrimination and two-part pricing a way forward?

INTRODUCTION: With the introduction of new expensive medicines, traditional pricing schemes based on constructs such as price per pill/vial have been challenged. Potential innovative schemes could be either financial-based or performance-based. Within financial-based schemes the use of price discrimination is an emerging option, which we explore in this assessment. AREAS COVERED: In the short term the price per indication approach is likely to become more prevalent for high cost, high benefit new pharmaceuticals, such as those emerging in oncology (e.g. new combination immunotherapies). 'Two-Part Pricing' (2PP) is a frequently used payment method in other industries, which consists of an Entry Fee, giving the buyer the right to use the product, and a Usage Price charged every time the product is purchased. Introducing 2PP into biopharma could have cross-stakeholder benefits including broader patient access, and improvement in budget/revenue predictability. A concern however is the potential complexity of the negotiation between manufacturer and payer. EXPERT COMMENTARY: We believe 'price discrimination' and 2PP in particular can be relevant for some new, expensive specialist medicines. A recommended first step would be to initiate pilots to test to what degree the 2PP approach meets stakeholder objectives and is practical to implement within specialty care.

The cost effectiveness of orlistat in a 1-year weight-management programme for treating overweight and obese patients in Sweden : a treatment responder approach.

OBJECTIVE: To calculate the cost effectiveness (from the Swedish healthcare perspective) of orlistat plus diet for an obese and overweight population in a 1-year weight-management responder programme versus a 1-year weight-management programme based on diet only. As a reference, orlistat plus diet and diet only were also compared with a no-diet alternative. METHOD: Costs and effectiveness were calculated in a decision-tree model by means of Monte Carlo simulation. Efficacy was derived from a pooled analysis of the orlistat clinical trial programme. Acquisition costs for orlistat (euro, 2003 prices), healthcare costs for visits to doctors and dieticians related to weight management, and costs related to the difference in diabetes mellitus incidence between treatment arms were included in the analysis. The health benefit of temporary weight loss was measured in the number of quality-adjusted life-years (QALYs) gained. RESULTS: The number of responding (those with >5% weight loss) patients at month 3 was almost twice as high with orlistat compared with diet only: 48.9% versus 26.3%. Responding orlistat patients had a weight loss of 15.5% at month 12 compared with 7.9% for all patients on diet only. The incremental cost-effectiveness ratio (ICER) per QALY gained versus diet only was estimated to be 13,125 euro for the average patient starting on orlistat. When orlistat was compared with no diet, the cost effectiveness was improved. However, comparing diet only with no diet gave a slightly higher ICER, indicating that orlistat had an extended dominance over the diet-only alternative. CONCLUSION: Our estimates indicated that orlistat in a 12-month dietary responder programme increased the number of QALYs and reduced the cumulative incidence of diabetes compared with diet only. Patients starting on orlistat in addition to a dietary programme achieved an ICER that was similar to many other well accepted healthcare treatment programmes. In order to improve the precision of our calculations, we need to confirm the key assumptions regarding temporary weight loss and utility gains, and the relationship between temporary weight loss and diabetes, as well as other co-morbidities, and to have better knowledge of the long-term impact of weight-management programmes in clinical practice, such as changes in weight-controlling behaviours and sustainability of weight loss.

Какие фактические данные существуют в отношении профилактики остеопороза и скрининга с целью выявления этого заболевания?

Вашему вниманию предлагается синтезированный доклад Сети фактических данных по вопросам здоровья (СФДЗ), цель которого состоит в определении эффективности профилактики остеопороза и скрининга с целью выявления этого заболевания. Предлагаемый обзор фактических данных показывает, что эффективны несколько мер, такие, как умеренная физическая активность, прием в правильных дозах кальция и витамина D, прекращение курения и лекарственное воздействие в группах повышенного риска с целью профилактики остеопороза. В обзоре не выявлено каких-либо прямых доказательств того, что скрининг с целью выявления остеопороза способствует снижению числа случаев переломов, но показано, что имеются достаточно убедительные косвенные доказательства эффективности скрининга в выявлении женщин в постменопаузе, у которых низка минеральная плотность костной ткани, и возможности уменьшить риск переломов (запястья и позвоночника) в этой категории населения путем лечения остеопороза. Сеть фактических данных по вопросам здоровья (СФДЗ), работа которой была инициирована и координируется Eвропейским региональным бюро ВОЗ, представляет собой информационную службу для лиц, принимающих решения в области общественного здравоохранения и медицинской помощи, в Европейском регионе ВОЗ. СФДЗ может также быть полезна и другим заинтересованным сторонам.

What evidence is there for the prevention and screening of osteoporosis?

This is a Health Evidence Network (HEN) synthesis report seeking to determine the effectiveness of the prevention and screening of osteoporosis. The review of evidence shows that several measures, such as moderate physical activity, an appropriate intake of calcium and vitamin D, cessation of smoking and pharmaceutical intervention in high-risk groups for preventing osteoporosis are effective. The review found no direct evidence that screening for osteoporosis reduces fractures, but it shows that there is good indirect evidence that screening is effective in identifying postmenopausal women with low bone mineral density and that treating osteoporosis can reduce the risk of fractures (wrist and spine) in this population. HEN, initiated and coordinated by the WHO Regional Office for Europe, is an information service for public health and health care decision-makers in the WHO European Region. Other interested parties might also benefit from HEN.