AISAIS

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 InstitutionsNew Delhi, 12-13 May, 2011

Jon Pedersen and Jing Liu

AISAIS

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

AISAIS

The basic measurement

• 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

A B(Q -Q ) An

d

A B(Q -Q ) An

d

AISAIS

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)

AISAIS

What is the real world like?

Healthy

Sick

No Access

Access Not diag- nosed

Diagnosed Not Correct treatment

Correct treatment

Bad Quality Drug

Quality drug

Not com-pliance

Compliance

Sick

Healthy

AISAIS

Thus one can break up the question into several

• Not black box of RCT• But several estimation procedures

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…)

1

( )n

i i i i ii

H e d p q u

AISAIS

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