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This comprehensive text presents a rigorous framework from within which regulators can respond strategically to the claim by the pharmaceutical industry that lower drug prices today lead to a loss for the population’s future health due to less innovation. It starts with a critical review of the empirical evidence of the return to consumers on their ongoing investment into high drug prices in order to increase future innovation. The implicit, critical and unrealistic assumption inherent in these studies is identified, namely that the health budget can be expanded to purchase drugs at higher prices without an opportunity cost, for example, the foregone benefits of alternative investments in health care infrastructure. Price effectiveness analysis (PEA), is introduced. PEA informs the question of how the innovative surplus from the new drug should be allocated between the manufacturer and the consumer so as to optimise society’s welfare. The method allows the decisions by the regulator and the firm to be analysed jointly by specifying the firm’s production and revenue functions in terms of the clinical innovation of a new drug; the incremental effect used in the summary metric of cost effectiveness analysis. An economic value of innovation that takes into account opportunity cost under conditions of economic efficiency in the health system is proposed: the health shadow price. The limitations of the non-strategic methods that currently inform the highly contested new drug subsidy game are presented and the relative strengths of PEA are demonstrated. Health technology assessment quantifies both the clinical innovation of a new drug and its financial impact on the health system. Cost effectiveness analysis tests the relationship between the incremental cost and incremental effect of a new drug for target patients, at a given price. PEA tests the relationship between the price of a new drug and the health of the whole population, now and into the future. It achieves this by taking into account current inefficiency in both resource allocation and the displacement process, and the relationship between price and future innovation.
This book provides a robust set of health economic principles and methods to inform societal decisions in relation to research, reimbursement and regulation (pricing and monitoring of performance in practice). We provide a theoretical and practical framework that navigates to avoid common biases and suboptimal outcomes observed in recent and current practice of health economic analysis, as opposed to claiming to be comprehensive in covering all methods. Our aim is to facilitate efficient health system decision making processes in research, reimbursement and regulation, which promote constrained optimisation of community outcomes from a societal perspective given resource constraints, available technology and processes of technology assessment. Importantly, this includes identifying an efficient process to maximize the potential that arises from research and pricing in relation to existing technology under uncertainty, given current evidence and associated opportunity costs of investment. Principles and methods are identified and illustrated across health promotion, prevention and palliative care settings as well as treatment settings. Health policy implications are also highlighted.
This second volume of the Handbook includes original contribution by experts in the field. It provides up-to-date surveys of the most relevant applications of game theory to industrial organization. The book covers both classical as well as new IO topics such as mergers in markets with homogeneous and differentiated goods, leniency and coordinated effects in cartels and mergers, static and dynamic contests, consumer search and product safety, strategic delegation, platforms and network effects, auctions, environmental and resource economics, intellectual property, healthcare, corruption, experimental industrial organization and empirical models of R&D.
The major pharmaceutical companies, according to John le Carré – who has based his novel The Constant Gardener on their depredations – “are engaged in the systematic corruption of the medical profession, country by country.” Jeffrey Robinson can back up that charge. In Prescription Games, Jeffrey Robinson exposes the yawning abyss between the claims to altruism made by pharmaceutical companies and the harsh reality of their everyday practice. When the industry claims that the enormous markup they charge for new drugs pays the cost of developing new ones, they don’t say that as much as 80 per cent of R&D money is actually directed at developing drugs designed to compete with existing brands, or at creating variations on drugs whose patents are about to expire – expenditures only the industry itself (and its shareholders) will benefit from. Within the industry, there are “blockbuster” drugs that create vast wealth for the companies that manufacture them. Most are designed to treat conditions that are endemic among prosperous, western populations that can afford them. But there are no blockbuster drugs to treat diseases like tuberculosis, cholera, and malaria that ravage the Third World, because Third World countries can’t afford the prices. People in Africa and Asia die from new strains of tuberculosis while people in Europe and North America are offered expensive treatments for obesity, hair loss, and sexual dysfunction. In this hard-hitting exposé, Robinson also examines the extension of patent protection, the end of generic drug competition in Canada, the Nancy Olivieri scandal (how a drug manufacturer fought to conceal research findings that would damage sales of its product), the illicit drug trade, and espionage among drug manufacturers.

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