What do Americans get for paying premium prices for decades?

A recent publication in @HealthAffairs questions the 'value' Americans receive from paying higher prescription drug prices - in relation to the vast majority of the world.

Evaluating all 46 new drugs approved in the United States during the year 2017, researchers compared the corresponding critical appraisals from three other countries - Germany, France and Canada. The US currently has no government-funded organization with a mandate to make such assessments for use by patients and physicians. 

The Canadian Patented Medicine Prices Review Board classifies the incremental benefit of each new drug as conferring one of four levels of improvement.

In France, the Transparency Committee of the government’s National Authority for Health routinely assesses the medical benefit of recently approved drugs on a four-point scale.

In Germany, the Institute for Quality and Efficiency in Health Care is an independent nonprofit institute that evaluates the comparative effectiveness of medical interventions. It produces an assessment that informs the government of whether a new drug offers patients any added benefit. 

Of the 46 NMEs, 20 were found by at least one assessing agency to offer no or minor additional benefits over existing treatments. Of the remaining 26 NMEs, seven were determined to have moderate to considerable added benefits. 19 NMEs had not yet been assessed by any of the three national agencies. More than two out of every five new medications had not yet been evaluated by any of these three national assessment programs. 

This information raises the questions of how effectively both the existing 'innovation premium' imposed by the pharmaceutical industry and the assessments from national agencies are yielding gains for either patients or the public’s health.