Background The necessity to measure and reward “value for money” of new pharmaceuticals has become central in health policy debates, as much as the requirement to assess the “willingness to pay” for an additional, quality-adjusted life year (QALY). There is a clear need to understand the capacity of “value-based” pricing policies to impact societal goals, like timely access to new treatments, sustainable health budgets, or incentivizing research to improve patient outcomes. Not only the pricing mechanics, but also the process of value assessment and price negotiation are subject to reform demands. This study assesses the impact of a negotiation situation for life-extending pharmaceuticals on societal outcomes. Of interest were general effects of the bargaining behaviour, as well as differences caused by the assigned role and the magnitude of prices. Methods We ran an online experiment ( n = 404) on Amazon Mechanical Turk (MTurk). Participants were randomly assigned into four treatment groups for a reimbursement negotiation between two roles (health minister, pharma representative) in two price framings. Payoff to players consisted of a fixed salary and a potential bonus, depending on their preferences, their price offer and the counter offer of a randomly paired negotiation partner. Success had real social consequences on other MTurk users (premium payers, investors) and via donations to a patient association. Results Margins between reservation prices and price offers increased throughout the game. Yet, 47% of players reduced at least once and 15% always their bonus probability to zero in favour of an agreement. 61% of simulated negotiation pairs could have reached an agreement, based on their preferences. 63% of these were successful, leaving 61% of patients with no access to the new treatment. The group with “real world” prices had lower prices and less agreements than the unconverted payoff group. The successful markets redistributed 20% of total assets from premium payers to investors over five innovation cycles. Conclusions The negotiation situation for pharmaceutical reimbursement has notable impact on societal outcomes. Further research should evaluate policies that align preferences and increase negotiation success.

中文翻译：

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报销谈判对新药成本和供应的影响：在线实验的证据。

背景技术衡量和奖励新药“物有所值”的必要性已成为卫生政策辩论的中心，这与评估额外的质量调整生命年（QALY）的“支付意愿”的要求一样重要。显然有必要了解“基于价值的”定价政策影响社会目标的能力，例如及时获得新疗法，可持续的卫生预算或激励研究以改善患者的结局。不仅定价机制，而且价值评估和价格谈判的过程都受到改革要求的影响。这项研究评估了谈判情况对延长寿命的药物对社会结果的影响。有趣的是讨价还价行为的一般影响，以及因分配的角色和价格幅度而引起的差异。方法我们在Amazon Mechanical Turk（MTurk）上进行了在线实验（n = 404）。将参与者随机分配到四个治疗组中，以在两个价格框架中的两个角色（卫生部长，制药代表）之间进行报销谈判。给玩家的收益包括固定薪水和潜在的奖金，具体取决于他们的喜好，报价和随机配对的谈判伙伴的还价。成功对其他MTurk用户（溢价付款者，投资者）以及对患者协会的捐赠都产生了实际的社会后果。结果在整个游戏中，预订价格和价格报价之间的利润增加了。然而，有47％的玩家至少减少了一次，而有15％的玩家总是将其奖励概率降至零，以达成协议。根据偏好，模拟协商对中有61％可以达成协议。其中63％成功，使61％的患者无法获得新疗法。具有“真实世界”价格的组比未转换的收益组具有更低的价格和更少的协议。成功的市场在五个创新周期内将总资产的20％从保费支付者重新分配给了投资者。结论药品报销的谈判情况对社会成果产生了显着影响。进一步的研究应评估符合偏好并增加谈判成功的政策。具有“真实世界”价格的组比未转换的收益组具有更低的价格和更少的协议。成功的市场在五个创新周期内将总资产的20％从保费支付者重新分配给了投资者。结论药品报销的谈判情况对社会成果产生了显着影响。进一步的研究应评估符合偏好并增加谈判成功的政策。具有“真实世界”价格的组比未转换的收益组具有更低的价格和更少的协议。成功的市场在五个创新周期内将总资产的20％从保费支付者重新分配给了投资者。结论药品报销的谈判情况对社会成果产生了显着影响。进一步的研究应评估符合偏好并增加谈判成功的政策。