title: Cost-Effectiveness and Dynamic Efficiency: Does the Solution Lie Within?
abstract: The majority of the current systems spread across the world require the value of pharmaceuticals to be demonstrated with an acceptable degree of certainty before a technology is funded. Often involving the notion of cost-effectiveness, one of the key characteristics of such assessments tends to be the consideration of efficiency as a static outcome; with a strong emphasis on current health gains but a disregard for the impact of decision making on the potential health value over time. In this article, we argue that current systems using cost-effectiveness thresholds may provide an incomplete indicator of value. We defend the idea that funding decisions should also be informed by dynamic efficiency considerations and reflect both the current and the future value of achieving a certain level of effectiveness in a specific disease area. We further lay down the foundations for the implementation of such a value assessment framework.
authors.affiliation: Institute of Health Policy & Management, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands; GlaxoSmithKline, Value Evidence & Outcomes, London, UK. Electronic address: rodrigo.refoioscamejo@gmail.com.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Refoios Camejo
authors.affiliation: Imperial College Business School, Healthcare Management Group, London, UK.
authors.forename: Marisa
authors.initials: M
authors.lastname: Miraldo
authors.affiliation: Institute of Health Policy & Management, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Frans
authors.initials: F
authors.lastname: Rutten
mesh_terms: D000465:Algorithms; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006304:Health Status; D055553:Prescription Drugs; D019057:Quality-Adjusted Life Years; D013673:Technology Assessment, Biomedical / Q000191:economics*; D062505:Value-Based Purchasing
chemical_list: D055553:Prescription Drugs
keywords: cost-effectiveness; dynamic efficiency; pharmaceutical innovation; value framework