title: Antihypertensive drugs: a perspective on pharmaceutical price erosion and its impact on cost-effectiveness.
abstract: OBJECTIVE
  When comparators' prices decrease due to market competition and loss of exclusivity, the incremental clinical effectiveness required for a new technology to be cost-effective is expected to increase; and/or the minimum price at which it will be funded will tend to decrease. This may be, however, either unattainable physiologically or financially unviable for drug development. The objective of this study is to provide an empirical basis for this discussion by estimating the potential for price decreases to impact on the cost-effectiveness of new therapies in hypertension.
  
  
  METHODS
  Cost-effectiveness at launch was estimated for all antihypertensive drugs launched between 1998 and 2008 in the United Kingdom using hypothetical degrees of incremental clinical effectiveness within the methodologic framework applied by the UK National Institute for Health and Clinical Excellence. Incremental cost-effectiveness ratios were computed and compared with funding thresholds. In addition, the levels of incremental clinical effectiveness required to achieve specific cost-effectiveness thresholds at given prices were estimated.
  
  
  RESULTS
  Significant price decreases were observed for existing drugs. This was shown to markedly affect cost-effectiveness of technologies entering the market. The required incremental clinical effectiveness was in many cases greater than physiologically possible so, as a consequence, a number of products might not be available today if current methods of economic appraisal had been applied.
  
  
  CONCLUSIONS
  We conclude that the definition of cost-effectiveness thresholds is fundamental in promoting efficient innovation. Our findings demonstrate that comparator price attrition has the potential to put pressure in the pharmaceutical research model and presents a challenge to new therapies being accepted for funding.
authors.affiliation: HTA Policy--International Affairs, Pfizer Inc., Surrey, United Kingdom. rodrigo.refoioscamejo@pfizer.com
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Refoios Camejo
authors.forename: Clare
authors.initials: C
authors.lastname: McGrath
authors.forename: Ron
authors.initials: R
authors.lastname: Herings
authors.forename: Willem-Jan
authors.initials: WJ
authors.lastname: Meerding
authors.forename: Frans
authors.initials: F
authors.lastname: Rutten
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000145:classification / Q000191:economics*; D003362:Cost-Benefit Analysis; D005252:Fees, Pharmaceutical; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008875:Middle Aged; D018803:Models, Economic; D012106:Research / Q000191:economics; D006113:United Kingdom
chemical_list: D000959:Antihypertensive Agents