Presentation of the Vintura report 2023 by Casper Paardekooper from Vintura at the European Health Forum Gastein 2023. Recording at https://ehfg.live/recordings/s24

1. © VINTURA
1
BROADENING THE
PERSPECTIVE
R e c o m m e n d a t i o n s f o r i m p r o v i n g
p h a r m a c e u t i c a l a f f o r d a b i l i t y
Sep t emb er 2023

2. © VINTURA
2 © VINTURA
2
Despite clinical value and being cost effective, medicines still face affordability
challenges. The rise of total healthcare costs will further add to the challenge
Affordable
Cost-
effective
Clinical
value
?
Total healthcare spending as a
share of GDP is projected to
increase with 25% by 2040 in
OECD countries due to
population ageing

3. © VINTURA
3 © VINTURA
3
Consequent pure cost containment measures targeting innovative pharmaceuticals creates
a risk of breaking the positive investment loop created by improved health outcomes
Health as investment
Increase in productivity
Increase in GDP per capita
Improvements in health outcomes
Increase in ratio
working age people to
dependent people
Increase in
per-person
income
Increase in
health care
funding
Cost containment
risks breaking positive
feedback loop

4. © VINTURA
4 © VINTURA
4
However, is there an affordability issue with pharmaceuticals? Research shows
pharmaceutical expenditure has remained ~15% of healthcare expenditure since 2000…
Source: World Health Organization (WHO), 2018 (extracted on 18 November 2021), WHO SHE 1.0 data (extracted on 18 November 2021); OECD, 2019 (extracted on 18 November 2021).
Notes: Drug spending includes medicines dispensed in both retail and non-retail sectors. Methods for estimating total drug spending on a net basis are detailed in the methodology appendix. Health spending from WHO database. Both the drug and
health spend data were adjusted for population, Purchasing Power Parity (PPP) and GDP growth to represent in 2020 values.
Net pharmaceutical expenditure as a percentage of healthcare, 2000-2018

5. © VINTURA
5 © VINTURA
5
To improve affordability of pharmaceuticals, the easy solution would be either to increase
the ability to pay or to decrease costs – both are not viable solutions
Ability to pay Costs
Defining affordability
3 key reasons not to decrease pharmaceutical expenditure
Share of pharmaceutical expenditure as a proportion of total
healthcare expenditure has not increased
Pharmaceutical expenditures are primarily a necessary
investment in better health outcomes
Sustainability of the economic model for developing innovative
therapies is already under pressure
Improving affordability

6. © VINTURA
6 © VINTURA
6
Therefore, taking a broader perspective on affordability is needed to identify cost offsets
created by pharmaceuticals – over time and/or across budgets
Time dimension
Budget dimension
COST OFFSETS
created by the
therapy
Short term Medium term Long term
Pharmaceutical
spending
Healthcare
spending
Beyond healthcare
Faster dismissals from
care location
Reduced need to
revisit care location
Increased ability to
go back to work

Example

7. © VINTURA
7 © VINTURA
7
Improving affordability in the long-term might require
investments in the short-term
Investments now pay off in lower costs in the future as
cost offsets are realized
Overall affordability improves if the upfront investment
can be financed
Pharmaceutical spending can improve affordability by generating cost offsets over time
Source: Lichtenberg, Frank R. “The association between pharmaceutical innovation and both premature mortality and hospital
utilization in Switzerland, 1996–2019.” Swiss Journal of Economics and Statistics 158.1 (2022): 7.
Affordability across time
E.g. when investments are made into therapies that:
- are preventive or curative
- reduce complications
- slow or stop disease progression
- reduce the need to visit the hospital
Example: Haemophilia B gene therapy
• Without gene therapy, patients with moderate to
severe hemophilia B can cost health care systems
more than $20 million over their lifetimes
• A new gene therapy has been found with clinical
effectiveness for up to 23 years, resulting in
significant cost reductions over time – despite a
multi-million price tag for the drug

8. © VINTURA
8 © VINTURA
8
Pharmaceutical spending can also improve affordability by generating cost offsets
across budgets
Source: Lichtenberg, Frank R. “The association between pharmaceutical innovation and both premature mortality and hospital
utilization in Switzerland, 1996–2019.” Swiss Journal of Economics and Statistics 158.1 (2022): 7.
Affordability across budgets
Pharmaceutical spending in budget A can generate cost offsets
for another budget holder in budget B, e.g. when a therapy:
- Reduces the need for nursing care (at home)
- Enables patients to return to the workforce sooner
When managed in siloes these cross-budget cost offsets are
not valued by the budget holders resulting in underinvestment
from a cross-budget, societal, point of view
If budgets are managed with a cross-budget perspective, cost
offsets created are considered and allocation is optimized
Example: Biologics for rheumatoid arthritis
• Disease-modifying antirheumatic drug biologics
(bDMARDs) significantly reduce absenteeism from
and presenteeism at work
• Society benefits from this through higher
productivity and tax incomes, but these benefits
are generally not included in cost-effectiveness
assessments of new drugs

9. © VINTURA
9 © VINTURA
9
Five solutions can be used to take a broader perspective and acknowledge these long -
term, cross-budget cost offsets – therewith contributing to pharmaceutical affordability
Long-term horizon
scanning
& multi-year
budgeting
Societal value
perspective in HTA
Innovative
reimbursement
agreements
Integrated
budgeting
Social impact bonds
for healthcare

10. © VINTURA
10 © VINTURA
10
If you want to further improve affordability, few viable options are
available to increase budgets or decrease costs, with a risk of decreasing
patient access to valuable pharmaceuticals
Taking a broader perspective on affordability, across time and budgets is
needed to identify and acknowledge cost offsets that contribute to solving
the affordability challenge
Is there an affordability issue with pharmaceuticals? Research shows
pharmaceutical expenditure has remained ~15% of healthcare expenditure
since 2000
In many cases we see that pharmaceutical expenditure is actually an
investment in health
Taking a broader perspective across time and budgets can improve the affordability of
pharmaceuticals and safeguard future patient access to valuable therapies