Mechanisms Considering Public Investment in Pricing and Reimbursement Decisions of Medicines and Other Health Technologies: A Scoping Review.

Background: Pricing and reimbursement (P&R) systems do not normally use public investments in research and development (R&D) as criteria when negotiating the prices and reimbursement of health technologies.

Objective: The objective was to find mechanisms that consider public investment in R&D when negotiating P&R or obtaining a fair return on this public investment METHODS: We conducted a scoping review. A total of four databases (PubMed, Embase, Scopus and Web of Science) and a grey literature information source (Google Scholar) were searched. Eligible articles were published before 2024 and described how public sector investment in R&D is considered in price negotiations or how the public sector can obtain a return on R&D investment.

Results: The review found 28 papers referring to mechanisms that take into account public investment in R&D to reduce prices in the P&R negotiation (e.g. delinkage R&D model, advance purchase agreement and government patent use), to obtain a fair return on investment (e.g. royalties and venture philanthropy) or to save costs or share risks (e.g. social impact bonds and prize fund). Examples are provided of health technologies that used these mechanisms.

Conclusions: Policymakers have several resources they can draw from to ensure a fair and efficient use of public R&D funds. However, there is little evidence that these instruments are widely used in practice, and there is no political consensus on what mechanism is the most appropriate and why. In view of the above, it is essential to create a common framework that will ensure a fairer and more affordable system for public health budgets.