4. Summary <strong>and</strong> conclusionsIn summary, our study as well as other studies clearly indicates that pharmaceuticalinnovation, on an aggregate level, contributes to improved health <strong>and</strong> might decreasethe need for other health care resources. It is therefore important to design pharmaceuticalpolicies that allow society <strong>and</strong> patients to fully benefit from the value of newmedicines. However, new medicines also add to pharmaceutical expenditures, which onaverage constitute about 15% of overall health expenditures in the OECD countries <strong>and</strong>about 10% in Sweden. Limited resources <strong>and</strong> budget constraints are challenges forpolicy makers. Clearly, policies of investment in health <strong>and</strong> access to medicines need tobe balanced <strong>and</strong> coordinated with other policy goals, i.e. economic, industrial <strong>and</strong>intergenerational policies.One important limitation of our study, since we use aggregate data, is that it lacksability to inform as to which products contributed to the increased life expectancy. Itcould be that some products contributed to a large extent, while others did not. It istherefore important to prioritize so that resources could be allocated to these products,where the most potential benefits exist.Several indicators show that the early uptake <strong>and</strong> use of new medicines have declinedduring the last decades in Sweden, which could be due to the pharmaceutical policiesintroduced during the period. An interesting question is therefore whether investment infaster uptake <strong>and</strong> increased use of medicines within the total health care budget couldproduce even more benefits. Neither the recent Swedish government inquiry nor ourstudy answered that question. However, we found that the introduction of new drugsaccounted for about a third of the longevity increase during the period, whileexpenditure for pharmaceuticals has been stable at around 10% of the total health carebudget. At the same time, our findings suggested that hospital days were reduced,indicating a decreasing pressure on other health care resources.Another important consideration is that in our study we only analyzed how newpharmaceuticals contributed to longevity, which is not the only contribution frompharmaceutical innovation. Many treatments affect mainly patients' quality of life, butthis is not captured in this study. Hence, the contribution of pharmaceutical innovationcould be strongly underestimated with this approach.Early availability of new drugs is just one step towards patients' access to new <strong>and</strong> moreeffective pharmaceutical therapies. Of crucial importance is the timing at which thehealth care providers adopt the new therapies. Our study showed that the benefits interms of longevity <strong>and</strong> decreasing number of hospital days depended on the introductionof new medicines several years earlier. This could mean that the benefits could occurearlier, if the rate of uptake was accelerated.Accessibility of new substances within a class <strong>and</strong> not the number of classes was foundto have significant effects on longevity. One conclusion could be that there is a benefitto encouraging incremental innovation as well as breakthrough innovation. The utilityof VBP in encouraging innovation <strong>and</strong> value-added health care depends largely on theassessment process, including when <strong>and</strong> how the review was performed, <strong>and</strong> resultingdecision-making procedures. Overall, it could be argued that the VBP approach <strong>and</strong>current methodologies are limited in their ability to deliver relevant knowledge on24
incremental innovation <strong>and</strong> on dynamic efficiency, <strong>and</strong> that this is one of itsfundamental flaws. It is however important to prioritize so that resources could beallocated to these products, where the potential of new pharmaceuticals that increase lifeexpectancy <strong>and</strong>/or lead to lower use of other resources exist.There is obviously a need for further discussions of how to shape a system in a way thatwould allow the correct balance between rewarding <strong>and</strong> encouraging manufacturers toproduce innovative new treatments, while at the same time ensuring sustainable healthcare budgets. The question is, did the policies that were introduced create a system thatbecame too restrictive to be optimal from a societal perspective? We believe that currentpolicies, such as the VBP together with the regional reforms <strong>and</strong> decentralized budgetsthat impact the rate of uptake <strong>and</strong> use of new medicines should be carefully reviewedbefore shaping a new system. This is critical to ensure a system with the right <strong>and</strong>desired balance.25
- Page 5 and 6: undersöks är relaterat till över
- Page 7 and 8: Executive SummaryLife expectancy ar
- Page 9 and 10: 1. IntroductionLongevity has consta
- Page 11 and 12: 2. Background2.1. Determinants infl
- Page 13 and 14: 2.3. Access, uptake and use of (new
- Page 15 and 16: 3. Value of innovationIncreased lon
- Page 17 and 18: Figure 1. Mean age at death: Actual
- Page 19 and 20: Table 1. Estimation of incremental
- Page 21 and 22: This could be explained by the fact
- Page 23: is not positively correlated with t
- Page 27 and 28: 18. Godman, B., Sakshaug, S., Berg,
- Page 29 and 30: 56. Bertrand, M., Duflo, E., Mullai
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