Are medicines worth the money in Switzerland?

The people rejected the spending brake initiative in June, but health care is still on the agenda. Parliament is currently struggling with a package of measures to contain costs. One element could override all other steps: pricing models with automatic discounts should be possible in the future for high-selling drugs. This should allow savings of around 400 million francs per year.

In compulsory health insurance, more than 22 percent of the total costs of about 9 billion francs in 2023 were accounted for by medicines – about two percentage points more than in 2014. The pharmaceutical industry resists quick fixes and wants a holistic view. Last week, the industry received a response from the National Council’s Health Commission: The Commission postpone decisions on this matter, until an in-depth analysis of future price conditions is completed.

Heavy lips

Drug prices in Switzerland are widely criticized as “excessive”. But anyone who asks for a systematic comparison of the costs with the benefits in the form of years of life will be disappointed. The common answer: “We don’t have anything like that.” This can be a surprise, because according to the law, the medicines paid by the basic insurance must pass the “WZW test” in order to be approved: Efficiency, practicality and cost-effectiveness.

The medical benefits have a place here, but the main elements for evaluating cost effectiveness are the price comparison (often distorted due to discounts) with foreign countries and the price comparison with competing treatments. It is not common to make direct comparisons between costs and years of life.

The pharmaceutical industry likes to point one out Do an investigation by the American professor Frank Lichtenberg from 2022, funded by Novartis. Lichtenberg looked for statistical links between the newly approved drugs in Switzerland from 1990 to 2011 and the development of years of life lost and hospital stays up to 2018. a year of life saved was around 14 000 euros and filled after deducting the hospital savings it costs just over 2000 euros. That would be very cheap. For comparison: the Federal Court had 2010 About 100,000 francs per year of life saved is considered adequate.

A great approximation method

But Lichtenberg’s method of evaluation leaves questions unanswered. He assumes that there is a causal link behind the statistical link between new medicines and years of life gained. Third factors such as other medical developments may also play a role.

Systematic studies “from below” after the approval of new medicines would be more meaningful – comparing their prices and their effects on those who receive them. But such studies on just one drug are complex. Individual studies from time to time within the framework of the Free HTA program (“Health Technology Assessment”), in which dubious treatments are investigated. For example, 2024 is considered HTA Message, that a drug for the treatment of metabolic disease (cystic fibrosis) costs more than a million francs at the official price in almost all cases every year of life gained in full health.

However, a representative collection of several top-selling treatments would be desirable. Health insurance company Helsana, which publishes an annual drug report, cannot provide this either. According to the currently the latest edition The 20 most expensive preparations caused total costs of 1.7 billion francs in 2022. The range of costs per patient was between 300 and around 26,000 francs. In the report, Helsana criticizes the fact that of 45 new active pharmaceutical ingredients from 2022, only 4 were “innovative in nature”. However, this does not say anything definitive about the cost-benefit ratio.

“Politics and society have not yet considered the value of an extra year of life in good health,” said Helsana health economist Manuel Elmiger. Such a discussion is “desirable,” stresses Kerstin Vokinger, professor of law and medicine at the University of Zurich. It was and is on diverse Studies to Costs and benefits of medicine involved at home and abroad. Vokinger leaves it open whether the price level in Switzerland is generally excessive. But she says: “The prices are not the best.” She provides evidence from studies: Less than a third of drugs approved over time have a high therapeutic benefit; There is no statistical association between benefit medical and the price of cancer drugs; and cancer drugs, among other things, measured in terms of their benefits, are on average about three times more expensive than other treatments.