Nicole Bechard, Anna Kobylianskii, Amro Qaddoura, and Harkanwal Randhawa
One-third of the world’s population lacks access to essential medicines. In Asia and Africa, this figure rises to one-half of the population. Even more astounding, over 14 million people are killed by infectious diseases each year, 90 percent of whom reside in developing countries. The majority of these diseases can be treated and perhaps even cured with existing medicines. However, many of these drugs are too expensive for individuals to purchase and some drugs are completely unavailable in certain countries.
This lack of access arises because some medically necessary drugs are simply unprofitable for drug companies to produce. Estimates for the cost of developing a new drug range from $800 million to more than $1 billion. Although these estimates are often criticized for being inflated, it is clear that drug innovation requires enormous investments by pharmaceutical companies.
Typically, these investments are protected by patents that afford the innovator exclusive rights to produce and sell the drug for a set period of time. To profit—while recouping its research and development costs—pharmaceutical companies charge high prices for this drug while they have a monopoly over the market. Naturally, these prices cause the cost of medicines to be prohibitively high, limiting access to the medicine.
Although public pressures on the pharmaceutical industry and increased competition from generic drugs have been of great help, the issue with access remains and many people worldwide still cannot fulfill their medicinal needs. Any solution that aims to increase access to medicine by decreasing their market price must also account for the fact that in order to drive innovation, there must be a financial incentive for pharmaceutical companies to invest in research and development.
The Health Impact Fund (HIF) is a proposed financing scheme for pharmaceuticals that would incentivize innovation based on the measured performance (health impact) of a drug. It is a pay-for-performance scheme that simultaneously addresses both the innovation and access to care problems. This is in contrast to the patent system, which is effective in encouraging innovation but primarily favours the development of highly profitable drugs rather than those that have the largest impact in society. By allowing innovators to be compensated based on the assessed health impact of their drug and having the drugs sold at cost, the HIF would provide financial incentive for innovation and increase access to lifesaving medications.
The HIF would be financed by countries that contribute to a fixed pool of funds, which would be paid out annually to eligible innovators. Pharmaceutical companies would have the opportunity to register their drugs with the HIF, and the assessed health impact of the drug during the previous year would determine the proportion of the fund that would be awarded for that drug. It is estimated that with a pool of $6 billion, the HIF would support a total of 20 drugs, each of which would be eligible for HIF funding for 10 years. This model could easily be expanded to more than 20 drugs if government and other donors increased their contributions. Essentially, this model provides a long-term and stable source of income that would encourage ongoing innovation.
When assessing health impact, the HIF would take into account a variety of factors to estimate the difference between the health status of people who used the product in question and their estimated health status had that product not been available to them. To inform this assessment, the HIF would utilize data from many sources, including clinical trials, practical trials, sales data, sampling of product use, and data on the global burden of disease. Although the HIF system recognizes the significant difficulty incumbent to assessing health impact, it is a more informed reward mechanism than the one currently in place.
As of today, the HIF is planning its pilot projects. Since the HIF is currently a proposal, these pilots are necessary in order to test its effectiveness. The aim of the pilot is to reward a pharmaceutical manufacturer on the basis of measured health impact in a region. This pilot will allow the pay-for-performance approach to be field-tested and refined before it is implemented on a wider scale.
Ultimately, the HIF is an exciting and novel proposal that could fundamentally change the pharmaceutical industry and lower the cost of medicines, not only in lower-income countries, but in countries around the world. By harnessing the primary driving force behind corporations—financial gain—and tying it to health impact, the HIF is a practical solution to the critical access-to-medicine problem. If the Health Impact Fund is to become a reality, it requires the support and commitment of politicians, academics, and corporations around the world.
1. Doctors Without Borders. Access to Medicines. 2012 [cited 2012 Oct 17]. Available from: http://www.doctorswithoutborders.org/news/issue.cfm?id=2379
2. Mercurio B. Resolving the public health crisis in the developing world: problems and barriers of access to essential medicines. Northwestern University Journal of International Human Rights. 2007 Feb:5(1). Available from: http://www.law.northwestern.edu/jihr/v5/n1/1/
3. Collier R. Drug development cost estimates hard to swallow. CMAJ. 2009 Feb;180(3):279-280. Available from: http://www.cmaj.ca/content/180/3/279.full
4. Health Impact Fund. Proposal and Pilot. [cited 2012 Oct 17]. Available from: http://www.healthimpactfund.org/pilot.html
5. Hollis A and Pogge T. The Health Impact Fund: Making New Medicines Accessible for All. Incentives for Global Health; 2008 [cited 2012 Oct 17]. Available from: http://www.healthimpactfund.org/e-‐library.html
No comments:
Post a Comment