Intended for healthcare professionals

Rapid response to:

Observations Briefing

NICE and value based pricing: what do we know?

BMJ 2010; 341 doi: (Published 10 November 2010) Cite this as: BMJ 2010;341:c6390

Rapid Response:

Comparison between real prices and value-based prices of innovative drugs

Part 1

In the debate on value-based pricing, one issue that the authors
always address either explicitly or implicitly is the comparison between
value-based pricing versus "traditional methods" of price determination
(Collier 2010; Coombes 2010; Delamothe 2010). These latter methods share a
common characteristic in that the value-based approach is not employed for
price determination; if one moves from a negative definition of the term
to a more positive definition, the term "traditional methods" implies that
an empiric approach for price determination is used in which the main
determinant is the need to keep an international homogeneity in prices and
to consequently discourage the parallel import between different

One feature of the Italian pharmaceutical market is that the
"universalistic" coverage provided by the National Health System has led
to the reimbursement of all innovative agents approved by EMA. Up to 2009,
value-based methods of price determination have not been used in Italy,
and so the "real" prices of innovative drugs approved in this country are
an excellent and systematic reference to document the results that
"traditional methods" can produce in terms of drug prices. In addition,
since one experience has been carried out in Italy in which the value-
based prices of new agents were systematically determined (Santarlasci et
al. 2008), the information available in Italy offers a unique chance to
compare real (or "traditional") prices and value-based prices with one

The experience by Santarlasci et al. (2008) has led to the comparison
between real vs value-based prices for 122 innovative interventions (data
from the website accessed on 30 November
2010). After excluding the subgroup of drugs or devices for which
superiority was not demonstrated and/or price was still unknown and/or the
analysis could not be made, the remaining innovative treatments were 77,
of which 60 belonged to the oncology area while 8 were non-oncologic
drugs, 8 were medical devices and 1 was a decontamination procedure.

The median ratio of real price vs value-based price was 1.15 in the
overall group of 60 oncologic agents. In the other subgroups, that were
less informative due to their small number, this median was 0.37 for the 8
non-oncological drugs and 1.39 for the 8 devices.

Among the 60 oncological drugs, 37 met the definition of
biotechnology drugs or "small molecules" designed as target therapies. The
analysis of these 37 cases showed a median ratio between real price and
value-based price of 2.15 (see Table 1 for details). This latter result is
of particular interest because of the large number of drugs included in
the analysis and also because it refers to the therapeutic area in which
most pharmacological innovations are being developed.


- Collier J. Drug pricing, NICE, and the PPRS: government gets it
right. BMJ 2010; 341:c6378

-Coombes R. Briefing: NICE and value based pricing: what do we know?
BMJ 341:doi:10.1136/bmj.c6390

-Delamothe T. A future for NICE, and the world's poorest children.
BMJ 2010; 341:c6422

-Santarlasci B, Burchini G, Simbula S, Trippoli S, Messori A.
Progetto 'Osservatorio sull'innovazione': schede web sui prodotti
innovativi comprensive di analisi economica semplificata. Giornale
italiano di Farmacia clinica 2008;22:24-30.

Table 1. This table can be seen either at the address or
in the second part of this Rapid Response.

Competing interests: No competing interests

06 December 2010
Valeria Fadda
Assistant Researcher
Dario Maratea, Sabrina Trippoli, Andrea Messori
Lab SIFO of Pharmacoeconomics, ESTAV, Firenze and Prato, 50100 Italy