It also places pressure on manufacturers to lower the price of new treatments in order to achieve favourable incremental costs relative to the lowest cost comparator, potentially decreasing incentives for innovation.
Often, there was also a higher price than comparators, raising the importance of an economic model to determine incremental value.
The relevant comparator price types applicable for medicines used in out-patient care were the ex-factory price, the pharmacy retail price net and the reimbursement price ("Kassenpreis") as of 30 September 2009: The pharmacy retail price is applicable at community pharmacy level, and the reimbursement price is the price which Austrian sickness funds pay for the medicine in the out-patient sector.
The Bureau of Taiwan's NHI has tried to manage the potential contribution of new drugs by using reference prices through international comparisons, which require the introductory prices be less than or equal to the median of their list prices in 10 comparator countries (France, Germany, Italy, Sweden, Switzerland, Belgium, Australia, Japan, the United Kingdom, and the United States).
Further probabilistic sensitivity analysis revealed similar results when the price of generic comparators was considered in the model.
For accepted surrogates, price was greater than comparators for only 33% of submissions, but price was greater almost twice as often for non-accepted surrogates (57%, OR for price greater than comparator for non-accepted versus accepted surrogates: 2.8; p = 0.046, Table 3).
Surrogate acceptance was more common when price was commensurate with comparators: the bar for clinical certainty, and the acceptability of a surrogate, is partially set by the price of the new intervention.
The retail price of denosumab and the comparator treatments were used, including a mandatory 7.5% reduction in the cases of strontium ranelate and denosumab, as mandated for branded drugs in Spain.
If we ignore the future introduction of lower-cost generic versions, the real prices of the new and comparator drugs will stay constant over time (ie, Pj t) = Pj).
The scientific rigor of the process of experimentation, the unflinching focus on the question 'Is drug A performing better than the comparator?' comes with a price, often poor generalizability.
