Transcript The Future of the Nordic Model

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 Institutions
New Delhi, 12-13 May, 2011
Jon Pedersen and Jing Liu
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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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(Q A -Q B )
nA
d
The basic measurement
nA
(Q A -Q B )
d
• 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
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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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What is the real world like?
Healthy
No Access
Sick
Access
Not diagnosed
Diagnosed
Not Correct
treatment
Correct
treatment
Bad
Quality
Drug
Quality
drug
Not
compliance
Complia
nce
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Sick
Healthy
Thus one can break up the question into several
• Not black box of RCT
• But several estimation procedures
n
H   ei (d i pi qi ui )
i 1
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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…)
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
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