Access to high-cost medications

Abstract

The steady growth of health care costs has been a well-recognized macroeconomic phenomenon for decades. Multiple metrics show that, in high-, middle-, and low-income countries alike, the proportion of gross domestic product (GDP) devoted to the provision of health services—both public and private spending—tends to increase year after year. One of the contributing factors is the growing share of pharmaceutical products within total health care expenditure.

It is generally argued that each new therapeutic class entering the market carries a cost that is at least one order of magnitude higher than that of the drug it seeks to replace. The pharmaceutical industry has put forward multiple explanations for this progressive increase: regulatory agencies impose increasingly stringent requirements on clinical trials, as well as on post-marketing surveillance necessary to assess drug safety. In addition, new molecules tend to be progressively more complex and more difficult to synthesize.

Personalized medicine, which aims to develop drugs better tailored to individual patients, reduces the size of the target population for each product, thereby requiring higher per-patient costs. This is particularly evident in oncology drugs and in therapies for rare diseases, where substantial gains in survival have been achieved with treatments that often must be administered for life. Similarly, therapeutic advances over recent decades in neurological conditions such as epilepsy, migraine, and multiple sclerosis have been accompanied by significant increases in costs per patient-year.

However, not all growth in health care spending can be attributed to new technological developments. A population that is better informed about its rights, as well as about available diagnostic and therapeutic options, also exerts considerable pressure on the demand for health services. The internet and social media—sources that are not always reliable—have played a complicit role in fueling this growing demand for specialized, often highly complex services. Finally, demographic transition must be considered: increases in life expectancy come at a cost. In this context, the term “population longevity” is preferred over the more commonly used, and somewhat pejorative, term “aging.”