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 Institutions New Delhi, May, 2011 Jon Pedersen and Jing Liu

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

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

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)

What is the real world like?

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…)

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