Editorial: Role of Health Economic Data in Policy Making and Reimbursement of New Medical Technologies

摘要

This Research Topic was created with a mission to tackle the core challenges for the provision of new medical technologies across the globe considering increasing prices and finite financial resources (Malmstr?m et al., 2013 ; Permanand and Pedersen, 2015 ). A key area certainly includes anti-cancer drugs where prices have increased 10-fold in recent years (Kelly and Smith, 2014 ) leading to concerns with affordability for both health services and patients (Ghinea et al., 2015 ; Tefferi et al., 2015 ). The objective was to reveal some of the hidden underlying causes of unequal access to the medicines as well as the growing proportion of out-of-pocket health spending in many world regions (Global Burden of Disease Health Financing Collaborator Network, 2017 ). In line with the joint efforts of the editors and authors we received an exceptionally high response worldwide. The topic attracted a total of 36 self-standing research submissions out of which 31 ultimately passed external peer review and got published. Base affiliations of the authors spread across academia, pharmaceutical and medical device industry, governmental authorities and clinical medicine. Their home institutions were situated in 15 different countries inclusive of Japan, Israel, Russia, USA, Germany, Italy, Netherlands, Austria, Spain (Basque), Malta, Serbia, Poland, Bulgaria, Hungary and Malaysia.In published health economics literature, there is straightforward evidence that accelerated growth of health spending began in the 1960s exceeding the historical 4% GDP threshold (Jakovljevic and Ogura, 2016 ). This phenomenon was noticed early on in mature market economies led by the US, and during the following decades spread to many global regions (Getzen, 2000 ). Health policy makers became increasingly exposed to new harsh challenges in the uneasy task to provide universal health coverage and decent equity of access to medical services. Among the most prominent demand-side issues are population aging (Murata et al., 2010 ), rise of non-communicable diseases (Jakovljevic and Milovanovic, 2015 ), and growing patient expectations. Supply-side causes include improvements in societal welfare (Yamada et al., 1992 ) and living standards, technological innovation in medicine, and continuing rapid urbanization in developing world regions. Experience with implementation of insurance-based risk sharing agreements which aim to facilitate access to new medicine varies substantially (Adamski et al., 2010 ; Ferrario and Kanavos, 2013 ; Ferrario et al., 2017 ). There are growing measures to enhance the prescribing of low cost generics and biosimilars across Europe and other countries without compromising care as the savings can be considerable and used to fund new technologies (Cameron et al., 2012 ; Simoens, 2012 ; Vogler, 2012 ; Godman et al., 2014 ). Published studies have shown that prices of good quality generics can as low as 2% of prepatent loss prices (Woerkom et al., 2012 ). Also, the considerable build-up of workforce capacities and strengthening of primary care and hospital networks contributed to the “supplier induced demand” phenomenon (Richardson and Peacock, 2006 ).There is straightforward historical evidence of long term growth in pharmaceutical and overall health spending both in absolute and GDP % terms worldwide (Dieleman et al., 2017 ). The accumulated constraints resulting from rising costs of care were felt in many areas of clinical medicine even among the richest societies (Kotlikoff and Hagist, 2005 ). Examples of expensive and hardly affordable novel therapeutic areas are orphan drugs indicated to treat rare diseases (Cohen and Felix, 2014 ; Taruscio et al., 2015 ) and targeted biologicals used in autoimmune disorders and cancer; new cancer drugs often with limited health gain (Kantarjian et al., 2013 ; Wild et al., 2016 ). Frequently denied access to even essential generic pharmaceuticals (Jakovljevic et al., 2014 ) is still taking place, in rural and suburban areas of certain countries (e.g., Japan). These difficulties are worsened by the lack of evidence-based resource allocation strategies and less sustainable financing strategies (Jakovljevic et al., 2016 ).Core goals of the Editors of this collection of articles were to cover a growing gap between the medical technology innovation, its dissemination, and cost containment issues. The European Commission has estimated that there is almost 36% room for efficiency gains and costs reductions in most contemporary European health systems (COST Action, 2016 ). So-called “emerging costs for healthcare” have an estimated growth of almost €1,400 billion annually EU wide. Similar issues were clearly recognized in other major global health care markets such as USA (Anderson et al., 2005 ) and Japan (Ogura and Jakovljevic, 2014 ) among the mature ones, and the BRICs led by People's Republic of China among the emerging ones (Jakovljevic, 2015 ). In addition, situation in China is hampered b