Aim: Regenerative medicines (RMs) are expected to transform the treatment paradigm of rare, life-threatening diseases, while substantial challenges impede its market access. This study aimed to present these challenges. Materials & methods: Publications identified in the Medline and Embase databases until December 2020 were included. Results: Uncertainties around the relative effectiveness and long-term benefits of RMs are most scrutinized. A new reference case for RMs is questionable, but examining impacts of study perspective, time horizon, discount rate and extrapolation methods on estimates is advised. Establishing reasonable prices of RMs requires increased transparency in the development costs and better values measurements. Outcome-based payments require considerable investments and potential legislative adjustments. Conclusion: Greater flexibility for health technology assessment and economic analyses of RMs is necessary. This comprehensive review may prompt more multi-stakeholder conversations to discuss the optimized strategy for value assessment, pricing and payment in order to accelerate the market access of RMs.
Keywords: affordability; economic analysis; health technology assessment; regenerative medicines.
Plain language summary Regenerative medicines (RMs) potentially offered new hopes for severe diseases without effective treatments. However, substantial challenges must be overcome to make them available for patients. This systematic review aims to present these challenges. Publications identified in the Medline and Embase databases until December 2020 were included. The limited clinical evidence causes the biggest uncertainties around the relative effectiveness and long-term benefits of RMs. The current methodology for economic analysis of RMs is questionable because broader, societal values related to RMs are not sufficiently captured. The high price of RMs seems unjustified and should be lowered by balancing the development costs and values delivered. Outcome-based payments could be employed to address the long-term financial challenges, but they will require investments to implement it. More flexibility for health technology assessment and economic analysis of RMs is necessary to safeguard the accelerated patient access.