Objectives:
The objective of this study was to review existing definitions of fair prices for new, potentially innovative, health technologies, to understand which elements make up these definitions, and to analyse how these definitions align with economic theory on the generation and distribution of economic surplus.
Methods:
We reviewed existing definitions of fair prices for medicines and medical devices published from 2014-2023. Records with such definitions were identified through database searches in MEDLINE via PubMed and Google Scholar using pre-specified inclusion and exclusion criteria, and through searches on websites of organisations and associations active in the field of pricing and reimbursement of pharmaceuticals and medical devices. In addition, experts in pharmaceutical policy representing various stakeholder groups and disciplines were consulted. Definitions of fair prices were extracted from included records and analysed to identify common themes.
Results:
Of 1,206 reviewed unique records, 37 definitions of fair pricing for new health technologies were included, none of which focused on medical devices. Authors from academia contributed to the most definitions (54% of all definitions), most often representing legal or health care research perspectives, and only rarely economic research. Four core themes were commonly included in existing definitions (i.e. mentioned in >50% of definitions): affordability of medicines and financial sustainability for health systems and patients, costs of bringing a medicine to the market, value of new health technologies, and incentives for companies (i.e. profits). The distribution of social welfare from an economic perspective was explicitly discussed in few definitions. However, the concept of sharing the economic surplus (even if referred to in different terms) featured in several definitions as a key aspect for achieving fairness, including in definitions from authors with non-economic backgrounds. Other key concepts underpinning existing definitions of fair pricing included moral considerations regarding access to medicines, and transparency in pricing. Included definitions reflected the core European health care values (universality, access to quality care, equity, solidarity), but did not consider environmental sustainability.
Discussion:
While a variety of definitions of fair pricing for medicines exists, economists have contributed to few of them as authors. Nevertheless, the concept of the economic surplus features in existing definitions. Overall, existing definitions of fair pricing for medicines focus on notions of fairness, reflecting societal preferences.