Transatlantic Convergence with Respect to the Fourth Hurdle?
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There appears to be movement towards convergence between the US and Europe in terms of the objectives of prescription drug cost containment, improvement in and more equitable access to pharmaceuticals, and minimisation of variation in clinical practice. In addition, policymakers in the US and Europe are resorting to the use of similar evidence-based approaches to achieve these policy objectives. However, using the examples of clinical practice guidelines, new drug appraisals for reimbursement, reference pricing and prescription to over-the-counter switching, I illustrate how the development and implementation of such approaches are a function not only of evidence but also of politics. Because all politics is local and differs across countries, and settings within countries, this logically has resulted in instances of divergence in the development and implementation of evidence-based approaches. Evidence improves policy decisions by offering quantitative insight into how well new technologies work, and for whom, but such data do not eliminate vexing trade-offs between the benefits provided and the acceptability of risks and costs incurred to achieve those benefits. Judgments on trade-offs depend in part on the interests and values of stakeholders. And these interests and values help shape how policy makers responsible for drug reimbursement in the US and Europe develop and apply the same types of evidence-based approaches differently.
KeywordsReference Price Pharmaceutical Care Coverage Decision Reference Price System Reimbursement Mechanism
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- 4.Docteur E, Oxley H. Health care systems: lessons from the reform experience. Organisation for Economic Cooperation and Development (OECD) 2003 working paper no. 9. Paris: OECD, 2003Google Scholar
- 5.CMS urges states to adopt disease management programs, agency will match state costs [online]. Available from URL: http://www.cms.hhs.gov/media/press/release.asp?Counter=967 [Accessed 13 Sep 2005]
- 6.Felder S. Disease management programmes in Germany: a fundamental fault. Pharmacoeconomics 2006; 24 Suppl 2:55–57.Google Scholar
- 7.OECD Health Data 2002. Paris: OECD, 2002Google Scholar
- 9.NICE or nasty? Available from: http://www.civitas.org.uk/pdf/NICE.pdf 2003 [Accessed 13 Sep 2005]
- 11.NICE home page [online]. Available from URL: http://www.nice.org.uk [Accessed 13 Sep 2005]
- 13.Cohen J, Grijseels E, van Willigenburg T. Normative considerations underlying priority setting in Dutch clinical practice. The Hague: Nederlandse Stichting voor Wetenschappelijk Onderzoek (NWO), 2005Google Scholar
- 14.Cohen J. Cost issues increasingly drive US formulary and clinical guidelines. Tufts CSDD Impact Report 2004; 6(5)Google Scholar
- 15.Furniss J. Price controls in France: budgeting for medical benefit. EuroHealth 2001; 7(2): 9–10Google Scholar
- 18.Q&A with Bryan Luce [online]. Available from URL: http://www.unitedbiosource.com/pdfs/PE8-35-05e.pdf [Accessed 12 Sep 2005]
- 19.US Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS). Medicare coverage database: national coverage determinations (NCDs) [online]. Available from URL: http://www.cms.hhs.gov/mcd/index_list.asp?list_type=ncd [Accessed 1 Sep 2005]
- 20.Garber A. Cost-effectiveness and evidence evaluation as criteria for coverage policy. Health Affairs 2004; web exclusive: W4-284-96 [online]. Available from URL: http://content.healthaffairs.org/cgi/reprint/hlthaff.w4.284v1 [Accessed 1 Sep 2005]Google Scholar
- 21.Danzon P. Reference pricing: theory and evidence. 2001 [online]. Available from URL: http://hc.wharton.upenn.edu/danzon/PDF%20Files/barcelonaEditfinal%20.pdf [Accessed 4 Aug 2005]
- 23.Some insurers employing reference prices to reduce prescription drug spending [online]. Available from URL: http://www.kaisernetwork.org/daily_reports/rep_hpolicy_rece nt_rep.cfm?dr_cat=3&show=yes&dr_DateTime=03-22-04#22804 [Accessed 18 May 2006]
- 25.World Self-Medication Industry home page [online]. Available from URL: http://www.wsmi.org [Accessed 21 Oct 2005]
- 28.British Medical Association; Board of Science. Over-the-counter medication [online]. Available from URL: http://www.bma.org.uk/ap.nsf/AttachmentsByTitle/OTC0505/$FILE/OTC0505.pdf [Accessed 18 May 2006]
- 29.Ham C. Health care reform: learning from international experience. Buckingham, UK: Open University Press, 1997Google Scholar