Importance The financial consequences of high-expenditure innovative drugs and the association of these consequences with access to cancer treatment are substantial. With oncology being one of the major spending blocks of care and research, innovative policies are needed to secure the sustainability and accessibility of health care systems. Despite this strong interest, structured approaches are missing to date, and proposals are often based on opinion rather than fact.

Objectives To evaluate an inventory of policies to reduce drug prices at market launch and analyze the quantitative evidence on which these policies are based.

Evidence Review For this systematic review, a literature search of the Ovid MEDLINE, Embase, Business Source Premier, ABI/Inform, World Health Organization, and Organisation for Economic Co-operation and Development databases was conducted for articles published between January 1, 2001, and December 31, 2017. Publications that described proposed policies with a direct or obvious indirect association with pharmaceutical prices at market launch and with relevance to oncology and high-income countries were included. Evidence basis was assessed per article, and quantitative articles were categorized according to time and data use. Main price mechanisms and scored system disruptiveness per proposal were identified. Data were analyzed from January 1, 2018, to January 1, 2019.

Findings Of the 4775 articles screened, 80 were selected, and an inventory of 23 policies to reduce medicine prices was created. Proposals were diverse but mainly applied the strengthening of competition as an underlying mechanism to reduce drug prices. Of the 80 studies, 23 used quantitative models, but existing evidence was insufficient to deduce price effects, especially considering system disruptiveness. The available evidence was used to identify promising proposals for which testing may be beneficial: transparency, delinkage, 2-part pricing, public research, orphan drug reform, and public clinical trials.

Conclusions and Relevance The findings suggest that despite the urgency of the search for proposals that lead to sustainable drug prices, careful and structured testing of proposals is needed because the implications for access to drug treatment can be substantial.

重要性 昂贵的创新药物的财务后果以及这些后果与癌症治疗机会的关联是巨大的。由于肿瘤学是医疗保健和研究的主要支出之一，因此需要创新性的政策来确保医疗保健系统的可持续性和可及性。尽管有这种强烈的兴趣，但迄今为止缺少结构化的方法，并且提案通常基于观点而不是事实。

目的 评估在市场推出时降低药品价格的政策清单，并分析这些政策所基于的定量证据。

证据审查 为了进行系统的审查，我们对2001年1月1日之间发表的文章进行了文献检索，该文献包括Ovid MEDLINE，Embase，商业资料来源总理，ABI / Inform，世界卫生组织和经济合作与发展组织的数据库，以及2017年12月31日。其中包括描述拟议政策的出版物，这些政策与上市时的药品价格具有直接或明显的间接关联，并且与肿瘤学和高收入国家相关。评估每篇文章的证据依据，并根据时间和数据使用情况对定量文章进行分类。确定了主要价格机制和每个提案的评分系统破坏性。分析了2018年1月1日至2019年1月1日之间的数据。

结果 在筛选的4775篇文章中，选择了80篇，并创建了23种降低药品价格的政策清单。提案各不相同，但主要将加强竞争作为降低药品价格的基本机制。在80项研究中，有23项使用了定量模型，但是现有证据不足以推论价格效应，尤其是考虑到系统破坏性。现有证据被用于确定有希望的建议，这些建议可能会对测试有益：透明度，脱链，两部分定价，公共研究，孤儿药改革和公共临床试验。

结论与相关性 研究结果表明，尽管迫切需要寻求导致可持续药物价格的提案，但仍需要对提案进行仔细且结构化的测试，因为对获得药物治疗的影响可能很大。