25 January 2018 - Concern over pricing of pharmaceuticals and other health technologies in both high- and low-income countries is not new. It has been high on the World Health Organisation agenda for a number of years. 

Affordability of products, both to individual patients and to health systems, is one of the main barriers to accessing many effective medicines. In high income countries this debate has been focused primarily on medicines for cancer and orphan diseases, but in 2014 the pricing of sofosbuvir expanded the issue much more broadly: here was a ‘cost-effective’ treatment for hepatitis C that was unaffordable to countries of any income. 

The price being asked on the basis of cost-effectiveness evaluations might be considered to be ‘value based’, but as described in Iyengar et al., was completely unaffordable for countries to use to treat all eligible patients. So what has gone wrong with so-called value-based pricing?

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