Enhancing the Accessibility and Affordability of Healthcare

Rob Abbott, CEO & Executive Director, ISPOR

Anyone who cares about healthcare—and who looks objectively at the current state of healthcare systems around the world—knows that accessibility and affordability are huge barriers that create pervasive health inequities. Globally, nearly 2 billion people have no access to essential medicines—and these challenges of accessibility and affordability aren’t limited to low- and middle-income countries (LMICs). In the United States, many Medicare beneficiaries don’t even fill their prescription or skip taking it because of the expense. The same is true in Canada. Access to affordable, high-quality medicines is crucial to reducing unnecessary pain and suffering, shortening the duration of illness, and addressing the financial burden of care worldwide. All of these elements are embodied in ISPOR’s vision of a world where healthcare is accessible, effective, efficient, and affordable for all.

I’m therefore proud that this issue of Value & Outcomes Spotlight focuses squarely on the twin issues of accessibility and affordability. Too often, we become excited over the arrival of a new treatment (gene therapies come to mind) without considering the cost, or we assume that conditions of patient access in other parts of the world mirror those in our home country. As the articles in this issue make clear, accessible and affordable care is a common challenge around the world.

"Access to affordable, high-quality medicines is crucial to reducing unnecessary pain and suffering, shortening the duration of illness, and addressing the financial burden of care worldwide."

This challenge is most acutely felt in LMICs, resulting in profound health inequities. Far too many people in LMICs don’t have access to essential healthcare services, and this lack of access is exacerbated by social determinants of health like poverty, entrenched discrimination, gender inequality, and climate change, to cite some of the more prominent examples. Further, the rise of noncommunicable diseases such as cancer and heart disease, coupled with the ongoing burden of infectious diseases, is stressing already fragile health systems to the breaking point. The World Health Organization estimates that more than three-quarters of global deaths due to noncommunicable diseases occur in LMICs. The lack of access to medicines and diagnostics only compounds the problem and creates an unacceptable social opportunity cost. I have a chart in my office showing life expectancy at birth for every country on Earth. The contrast between high-income and low-income countries is stark. At the extreme (Monaco versus Afghanistan), the gap can be as much as 30 years.

The news is not all bad; several pharmaceutical companies have made genuine efforts to prioritize LMICs within their business models, but the pace of progress is slow. The 2024 Access to Medicine Index, which ranks 20 of the world’s largest pharmaceutical companies based on their efforts to improve access to essential medicines in LMICs, showed that current efforts are falling short. In particular, momentum in licensing activity has stalled, with only 2 new nonexclusive voluntary licensing agreements identified in the 2024 Index, compared with 6 in 2022. More broadly, there is a gap in clinical trial activity in LMICs. Roughly 40% of clinical trials take place in the 113 LMICs covered by the Index analysis, despite being home to 80% of the global population. The fate of healthcare in LMICs is not a problem to be solved exclusively by pharmaceutical companies, but it is a future to be created through multistakeholder collaboration. ISPOR stands ready to build on our previous efforts in LMICs, leveraging our network of chapters across more than 100 countries, to assist in this critical work.

Closer to home, the Inflation Reduction Act of 2022 included several provisions to make prescription drugs more affordable and accessible for Medicare beneficiaries, most notably putting a $2000 yearly cap on beneficiaries’ out-of-pocket costs for Part D prescription drugs. A key feature of the law, of course, is the ability of the US government to negotiate drug prices for Medicare. The first 10 price-protected drugs—including the blood thinner apixaban (Eliquis) and the diabetes medicine sitagliptin (Januvia)—take effect in 2026. While it is not yet clear how the new administration in Washington, DC will approach future negotiations, one can only hope that more drugs will be added to this list each year. Still, with more than 20,000 approved drugs on the market, other steps are needed to improve accessibility and affordability.

"I have a chart in my office showing life expectancy at birth for every country on Earth. The contrast between high-income and low-income countries is stark. At the extreme (Monaco versus Afghanistan), the gap can be as much as 30 years."

With the above in mind, our field of health economics and outcomes research (HEOR) has much to offer in the search for solutions that enhance accessibility and affordability. It’s worth remembering that HEOR emerged as a combination of 2 separate fields. Health economics focuses on determining the value of medical interventions while also considering broader issues such as the overall healthcare market and available healthcare funding. Outcomes research focuses on the results of medical interventions as observed by actual patients. This latter point is crucial; the evidence that HEOR compiles is different from clinical trial data because it is based on real-world clinical, health, and economic issues encountered by patients and healthcare providers. It is here that we have an opportunity to engage first-hand with patients, especially in LMICs, to grow our collective understanding of the challenges associated with accessibility and affordability. I should add that ISPOR’s Global Access to Medical Innovation special interest group has a twofold purpose: (1) to educate and inform ISPOR members and stakeholders on the basics of global access, especially as it relates to the role of HEOR across health systems, as well as new methodological and policy developments; and (2) to leverage the high motivation and skills of ISPOR’s global community of researchers, patient representatives, and other life science professionals to improve global access to medical innovation while stimulating its production.

There is much to be done to make progress toward ISPOR’s vision, and to address some of the challenges highlighted in the articles in this issue of Value & Outcomes Spotlight. Our new 2030 strategy provides a roadmap for how we can make progress over the next 5 years. As your CEO, I pledge to work with my staff, my Board, ISPOR’s incredible membership, and our collaborating partners around the world to make it happen.