What is the value for money of medicines? A registry study

Economic evaluation is used to assess the value for money of medicines and inform pharmaceutical pricing/reimbursement decisions in many countries. This paper aims to report on estimates of the value for money of medicines in Europe.

Estimated cost-utilities were derived from studies included in the Tufts Medical Center Cost-Effectiveness Analysis Registry between 2000 and 2007. For each study, the following variables were examined: publication year, target population, intervention type, country of patient sample, disease classification, prevention stage, funding source, study perspective, discounting, sensitivity analysis, incremental cost-utility ratio (ICUR) and methodological quality.

Six hundred and eight ICURs were reported in 231 cost-utility analyses. Around 17·1% of ratios related to medicines that were more effective and less expensive than the comparator; 76·5% related to medicines that improved outcomes, but increased costs; and 6·4% related to medicines that were less effective and more expensive than the comparator. The median ratio was 12,238 € per quality-adjusted life year (QALY). Using threshold values of 20,000 and 50,000 € per QALY, the probability that medicines provided value for money was 58% and 81%, respectively. Preventive medicines studied provided more value for money than curative medicines (P=0·002). Studies sponsored by industry generated more favourable results than studies sponsored from other sources (P<0·001). However, no association was observed between the funding source and the methodological quality of economic evaluations.

The evidence base suggests that the majority of medicines provided value for money. Such information informs policy decisions relating to the allocation of scarce health care resources in Europe.