A question of balance : Sustainability and Ethics of drug pricing : A Systematic Review
Background: Sustainability in healthcare is a crucial concept in public health, and currently, there are ongoing debates regarding controlling the high cost of drugs in many countries, including the United States and the Republic of Korea. Each country manages access to high-cost drugs differently because of variations in the structure and financing of the health system. However, there is no summary of the various strategies which have been implemented, with a close analysis to elevate it to a global standard and improve sustainability.
Objectives: To analyse current trends in high-cost drugs, review literature, and summarize the factors of high-cost drug listing, financing strategies, assessment & monitoring process, and ethical considerations implemented across countries to facilitate access to high-cost drugs.
Methods: We conducted a systematic review of articles referenced in PubMed, Embase, Cochrane Library, and Web of Science through February 22, 2023. Articles published in the English language from 2000 that describe strategies implemented in different countries to facilitate access to high-cost drugs were included. Letters, news articles, and proposed strategies were excluded. Data were analysed by thematic analysis.
Results: The study included 204 studies from 176 countries. The results of the review showed that many countries have implemented a combination of strategies to increase access to high-cost drugs. High-income countries (HICs) tended to use funding strategies targeting high-cost drugs (71% of HICs vs 0%-20% of the rest), such as managed entry agreements (MEAs) or dedicated funds for high-cost drugs. In contrast, lower-income countries tended to implement financial assistance programs for patients as a tool to increase access (37% of HICs vs 62%-72% of the rest). The national level of funding strategies has advantages and disadvantages.
Conclusions: There is a need for a global standard or working groups on high-cost drugs to improve financial sustainability in healthcare. Many drug companies have built global strategies to sell their expensive products, but nations have not yet fully developed ethical considerations and strategies for financial sustainability. Patient, public, and/or healthcare consumer involvement: Not applicable.