The imminent explosion of cell and gene therapies raises issues of affordability for all health systems, not just for low and middle income countries. The one off cost of £0.25m up to £1m per treatment might not be that much more than the lifetime cost of these patients to the health system, but the fact that it falls into the drug budget in one fell swoop is a problem for payers. If payers want to ensure access to these treatments, there will need to be a change in the cost curve; but current barriers to progress in this area include perverse financial incentives, separation of hospital and drug budgets and inefficiencies within the system.
In the US the drug budget comprises 11-15% of total healthcare expenditure and 90% of this is taken up by generics. Yet the drug budget is the only part of the health economy that is subject to cost containment. Inefficiencies in the other parts of the system, if addressed, could play a role in driving change and facilitating a bend in the cost curve to accommodate new and expensive cell and gene therapies. In addition to this, insurance plans demand lower co-pays for hospital costs i.e. 3% compared with 14% for drug costs; so there is a perverse incentive to hospitalise rather than adopt new technologies which keep patients out of hospital. Even the QALY is not considered to be perfect for setting prices by not including the wider societal benefits of new therapies which could be taken into consideration.
Differential pricing of these technologies based on willingness to pay is a key driver of equitable access across the globe and is implemented by manufacturers, but hampered at the same time by international reference pricing. If pricing in low income countries is adopted more widely across the globe, this will kill innovation by driving a race to the bottom. The plenary panel urged the consideration of access and innovation as a global enterprise where all stakeholders have a role to play and each economy should pay for innovation in so far as it can.