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Cost-effectiveness, pharmaceutical pricing and the value flower - doing some gardening
Lars Sandman1, Martin Henriksson1, Erik Gustavsson2
1Department of health, medicine and caring sciences, National Centre for Priorities in Health, Linköping university, Hus 511, ingång 76 eller 78, plan 13, Campus US, Lasarettsbacken, 581 83, Linköping, Sweden.
Medicine, Health Care, and Philosophy
|July 7, 2026
Summary
ISPOR proposed new values for pharmaceutical pricing, but many are unsuitable for European healthcare systems. Some proposed values conflict or are redundant, while others, like equity, require further research before inclusion.
Area of Science:
- Health economics
- Pharmaceutical policy
- Ethical value theory
Background:
- ISPOR proposed incorporating novel values into health technology assessments for pharmaceutical pricing.
- These values include option value, value of hope, insurance value, value of avoiding contagion, and scientific spillover.
- Inclusion of these values could broaden traditional cost-effectiveness analyses.
Purpose of the Study:
- To scrutinize ISPOR's proposed value petals.
- To evaluate these values from ethical theory and practical implications for European public healthcare systems.
- To determine the suitability of these values for pharmaceutical pricing assessments.
Main Methods:
- Analysis based on ethical value theory.
- Assessment of practical implications for European welfare states.
- Consideration of traditional cost-effectiveness (net cost, QALYs) and justice (severity).
Main Results:
- Some proposed values are unsuitable due to ethical conflicts, lack of clear positive value, double counting, or existing inclusion in universal healthcare systems.
- Certain values may be better addressed through mechanisms other than pharmaceutical pricing.
- Equity is a potential merit but requires significant further normative and empirical work.
Conclusions:
- Not all proposed ISPOR values are appropriate for health economic assessments in European healthcare systems.
- Careful consideration of value theory and practical implications is necessary.
- Further research is essential for incorporating values like equity into pharmaceutical pricing.
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