Price-effectiveness: pharmacoeconomics, value and the right price for HPV vaccines

ABSTRACT

Drawing on a pragmatist approach to pricing, this article discusses the impact of cost-effectiveness analysis (CEA) in the pricing strategies of pharmaceutical companies. Through an analysis of the human papillomavirus (HPV) vaccination, this article illustrates the strategic appropriation of evidence-based medicine (narratives and practices) that pharmaceutical companies have undertaken to enhance the value of their products. While governments are concentrated on the measurement of costs and efficiency (cost-effectiveness), companies attempt to find the threshold of effectiveness that supports their estimation of value. I have called such mode of calculation, price-effectiveness. Pharmaceutical companies engage in different ways with CEA in devising their own price strategies. First, CEA is used as an instrument to raise HPV vaccines as a matter of interest for health authorities. Second, companies produce models to maximise the effectiveness of their products. Third, the expense side of CEA has opened an opportunity to represent some conditions as diseases in order to increase the potential value of the vaccine, expressed in a higher price. Debates and practices of pricing offer a unique opportunity to trace how particular forms of quantification have become the common ground in the demonstration of value in healthcare and the adaptation of companies.

KEYWORDS:

• Pricing
• value
• vaccines
• valuation
• human papillomavirus vaccine

Acknowledgements

The author would like to thank Lotta Björklund, C.-F. Helgesson, Ericka Johnson, Francis Lee, Steve Woolgar and Teun Zuiderent-Jerak for their helpful comments and observations. The author is also very grateful for the support of his supervisors, Maggie Mort and Celia Roberts, in the development of this research. The author would also like to thank the anonymous reviewers for their helpful and encouraging comments on earlier versions of this article.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes on contributor

Oscar Javier Maldonado is a Postdoctoral Research Fellow in the Department of Thematic Studies (TEMA-T) at Linköping University (Sweden) and Associated Researcher of the Group of Social Studies of Science, Technology and Medicine at the National University of Colombia (Colombia). His main research interest is to understand the intersections between governance and quantification in healthcare using the analytical resources provided by material semiotics, anthropology of markets and political sociology of science. Oscar completed his PhD in Sociology (Lancaster University) in 2015.

Notes

1. Gardasil protects against four types (tetravalent) of HPV: HPV 6 and 11 associated with genital warts and HPV 16 and 18 associated with cervical cancer. Cervarix protects against two types (bivalent) of HPV: HPV 16 and 18.

Additional information

Funding

This work was supported by the European Research Council [grant number 263657], Project: Prescriptive Prescriptions. Pharmaceuticals and 'Healthy’ Subjectivities, PPPHS.