Next Step: A Pilot
Performance measurement is at the heart of the Health Impact Fund. Measurement needs to be robust across different products and in diverse settings. Working with leading health care assessment organizations such as the George Institute for International Health, NICE International, and the Institute for Health Metrics and Evaluation, Incentives for Global Health will perform evaluations of the health impact of products in a variety of countries. The HIF would expand assessment beyond pre-approval clinical trials, using epidemiological data from actual usage, practical trials, physician surveys, and patient demographics, as modifiers to the core health impact assessment. We aim to pilot the proposed HIF mechanism by rewarding a pharmaceutical manufacturer on the basis of measured health impact in a region. This will allow the pay-for-performance approach to be field-tested and refined before it is implemented on a wider scale.
What is needed by the HIF
Requirements for the HIF:
- Patented, and sole-sourced in the pilot jurisdiction.
- Priced significantly above cost with scope for increased volumes, and no/limited access in the pilot jurisdiction.
- Therapeutically valuable compared to other medications available generically.
In advance of the creation of the HIF, the proposal must be piloted to test the ideas on which it is founded. These concepts include:
- Pay for performance health solutions
- Measurement and comparison of health outcomes
- The ability to contract with pharmaceutical companies in advance of the development or delivery of a product.
To begin the process of field-testing and refining the HIF a pilot would require a drug(s) and pharmaceutical manufacturer that fits the following criteria:
- The product should be patented and sole-sourced in the pilot jurisdiction.
- It should be priced significantly above cost with scope for increased volumes, and no/limited access in the pilot jurisdiction.
- It should be therapeutically valuable compared to other medications available generically.
After the appropriate drug(s) has been identified, relevant pharmaceutical companies will hold preliminary, discussion with IGH about the feasibility of a pilot to discuss preliminary assessment of measurement of health impact for the product and potential for increased use with lowered price and redirected incentives for company promotion of the product. Next, the IGH will approach funders and other interested parties, such as the national health ministry of pilot country or international foundations. Finally, all parties will jointly agree on a plan for execution of pilot.
Possible Impact of the HIF
Outcomes and Benefits of the Pilot:
- Create a comprehensive metric to evaluate the health impact of medicines based on the actual reductions in mortality and morbidity each achieves.
- Determine how to apply this metric reliably through a field-test that focuses on a new drug’s introduction into a specific area. No attempt has ever been made to measure the health impact of a newly introduced medicine.
- Benefit people in the field-test area by giving them access to an important new product at an affordable price and by rewarding the innovator promoting its wide and effective use by those who can benefit from it.