Price comparison of high-cost originator medicines in European countries

Background: In recent years, high-cost medicines have increasingly been challenging the public health budget in all countries including high-income economies. In this context, this study aims to survey, analyze and compare prices of medicines that likely contribute to high expenditure for the public payers in high-income countries. Methods: We chose the following 16 European countries: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Hungary, Ireland, Italy, the Netherlands, Portugal, Sweden, Slovakia, Spain and United Kingdom. The ex-factory price data of 30 medicines in these countries were collected in national databases accessible through the Pharmaceutical Price Information (PPI) service of Gesundheit Österreich GmbH (Austrian Public Health Institute). Results: The ex-factory prices (median) per unit (e.g. per tablet, vial) ranged from 10.67 cent (levodopa + decarboxylase inhibitor) to 17,000 euro (ipilimumab). A total of 53% of the medicines surveyed had a unit ex-factory price (median) above 200 Euro. For two thirds of the medicines, price differences between the highest-priced country and lowest-priced country ranged between 25 and 100%; the remaining medicines, mainly low-priced medicines, had higher price differential, up to 251%. Medicines with unit prices of a few euros or less were medicines for the treatment of diseases in the nervous system (anti-depressants, medicines to treat Parkinson and for the management of neuropathic pain), of obstructive airway diseases and cardio-vascular medicines (lipid modifying agents). High-priced medicines were particularly cancer medicines. Conclusion: Medicine prices of Greece, Hungary, Slovakia and UK were frequently at the lower end, German and Swedish, as well as Danish and Irish prices at the upper end. For high-priced medicines, actual paid prices are likely to be lower due to confidential discounts and similar funding arrangements between industry and public payers. Pricing authorities refer to the higher undiscounted prices when they use price data from other countries for their pricing decisions.

背景：近年来，高额药品费用正日益对包括高收入经济体在内的所有国家的公共卫生预算构成挑战。在此背景下，本研究旨在对高收入国家中可能对公共支付方造成高额支出的药品价格开展调研、分析与比较。
方法：本研究选取了以下16个欧洲国家：奥地利、比利时、丹麦、芬兰、法国、德国、希腊、匈牙利、爱尔兰、意大利、荷兰、葡萄牙、瑞典、斯洛伐克、西班牙及英国。通过奥地利公共卫生机构Gesundheit Österreich GmbH（奥地利公共卫生研究所）的药品价格信息（Pharmaceutical Price Information, PPI）服务可访问的国家数据库，我们收集了上述国家30种药品的出厂价数据。
结果：每单位（如每片、每瓶）的出厂价中位数范围为10.67分（左旋多巴+脱羧酶抑制剂）至17000欧元（伊匹单抗）。总计53%的受访药品单位出厂价中位数高于200欧元。对于三分之二的药品而言，最高价国家与最低价国家之间的价格差异介于25%至100%之间；剩余药品（主要为低价药品）的价格差异更高，最高可达251%。单位价格为数欧元及以下的药品主要为神经系统疾病治疗药物（抗抑郁药、帕金森病治疗药物及神经性疼痛管理药物）、阻塞性气道疾病治疗药物与心血管药物（调脂药物）。高价药品则以抗肿瘤药物为主。
结论：希腊、匈牙利、斯洛伐克及英国的药品价格普遍处于较低区间，而德国、瑞典以及丹麦、爱尔兰的药品价格则处于较高区间。对于高价药品，由于药企与公共支付方之间的保密折扣及类似融资安排，实际支付价格可能更低。定价当局在参考他国价格数据制定本国定价决策时，通常采用未折扣的较高标价。