Study: Drug Reimbursements are Not Consistently Aligned with Value

Unlike many other countries, health care reimbursements for medications in the United States are not consistently aligned with their value or net health benefits, according to a new study.

The study, published in Health Affairs, revealed that United States drug prices are not always aligned with the health outcomes achieved.

Researchers from the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences used data from 1985 to 2011 to determine average lifetime quality-adjusted life-years (QALYs), which is used to measure 1 year of perfect health, and payer-related costs to calculate incremental cost-effectiveness ratios for commonly reimbursed cardiovascular drugs.

Using cost-effectiveness as a driver for coverage and reimbursement decisions can inform manufacturers as to what constitutes an acceptable cost per unit of health gained for drugs, the researchers noted.

“Solutions toward fair drug pricing include the US sending more signals about what we value in health and US decision makers being willing and able to walk away from unfair pricing,” lead author Jon Campbell, PhD, associate professor of pharmacy, said in a prepared statement.

The findings indicated a wide spectrum of cost-effectiveness across the 30 drugs evaluated, ranging from cost-saving with increased QALYs to costlier with decreased QALYs. According to the researchers, this range suggests that drug pricing in the United States is not consistently influenced by value, or that such influence is masked by inaccessible factors, such as price discounts.

“When we purchase a medical treatment, we expect to get something in return, such as living a longer life or having fewer symptoms,” co-author Melanie Whittington, PhD, research faculty at the CU School of Pharmacy, said in the statement. “The results of our study show the amount insurance providers pay to get 1 more unit of health, such as 1 additional year of life in perfect health, varies considerably and can exceed what is considered good value in other parts of the world. This contributes to higher-priced medical treatments.”

The findings highlight the need to debate how to define and use value-based evidence to inform United States coverage and reimbursement decision making, the researchers concluded.

This article was originally published at SpecialtyPharmacyTimes.com.

References

Campbell J, Belozeroff V, Whittington MD, et al. Prices for common cardiovascular drugs in the US are not consistently aligned with value. Health Affairs. 2018. https://doi.org/10.1377/hlthaff.2018.0221.

Drug prices not always aligned with value, CU Anschutz researchers say [news release]. University of Colorado’s website. https://www.cuanschutztoday.org/drug-prices-not-always-aligned-with-value-cu-anschutz-researchers-say/. Accessed August 7, 2018.