the health impact of new pharmaceutical products in the context of health impact funds international...
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AISAIS
The Health Impact of New Pharmaceutical Products in the Context of Health Impact Funds
International Conference on Equity and Access to Medicines: Role of Innovation and InstitutionsNew Delhi, 12-13 May, 2011
Jon Pedersen and Jing Liu
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AISAIS
The Health Impact Fund
• If a pharmaceutical company decides to get remuneration through the HIF-mechanism, then the problem is to measure impact
• Two over arching issues Scientific credibility Practical credibility
• The measurement metric is not the difficult issue LY QALY DALY
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AISAIS
The basic measurement
• Two parts, the difference between QALYs for new product (A) and old (if any) and the number of treatments (packages sold/packages per treatment)
• Two estimation issues Impact given delivery Delivery
A B(Q -Q ) An
d
A B(Q -Q ) An
d
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AISAIS
Impact
• Typically done by Randomized Controlled Trials (RCTs) Efficacy: If everything is done according to the book Effectiveness: In the real world
• Problem is that designing RCTs that have anything to do with the real world is tricky
• It is also difficult to measure outcomes in the real world (for many, but obviously not all diseases)
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AISAIS
What is the real world like?
Healthy
Sick
No Access
Access Not diag- nosed
Diagnosed Not Correct treatment
Correct treatment
Bad Quality Drug
Quality drug
Not com-pliance
Compliance
Sick
Healthy
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AISAIS
Thus one can break up the question into several
• Not black box of RCT• But several estimation procedures
e is RCT efficacy , d is distributed doses, p proportion correctly diagnosed, q proportion receiving quality drugs u proportion complying with treatment
Aggregation is across social groups (gender, age, location, class…)
1
( )n
i i i i ii
H e d p q u
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AISAIS
Agreeing on procedure
• Need agreement on precise formula• Need agreement on standardized estimation
procedures for each part• Need prior commitment from stakeholders to
abide by results of correctly performed estimation/data gathering