Background: A common concern about universal health insurance coverage is how to control health expenditure. The escalation of health care costs raises public awareness of the optimization of drug price and increased demand for cost-effectiveness assessment. In this paper, we show the differences in patient access to new drugs and drug price among countries, in which the situation of introduction of cost-effectiveness assessment scheme is different.
Methods: We investigated the health insurance coverage proportion of newly approved drugs in Japan, France, Germany, and the United Kingdom (UK). Then, we calculated the ratios of the European to the Japanese price for products that were reimbursed in both countries.
Results: Japan had the highest health insurance coverage proportion (98.6%) in the 4 countries. In Japan, all the drugs that were approved in 2015 had been already listed in the latest formulary of February 2016. As for drug price, there wasn't much difference between Japan and the European countries in many cases.
Conclusion: From the viewpoint of the health insurance coverage proportion and the speed of reimbursement decision, the hurdle to access new drugs in Japan is lower than that in major European countries. While extensive coverage of health insurance and prompt reimbursement decision lower the hurdles to access new drugs and expand treatment options, they could lead to the increased medical expenditure. We should continue to discuss sustainable health insurance systems and drug price calculation schemes that properly reflect the drug's clinical value while keeping the availability of new drugs to patients.
Keywords: Health Technology Assessment (HTA); National Health Insurance (NHI); cost-effectiveness assessment; reimbursement price.