PMU55 UNDERSTANDING STAKEHOLDER PERSPECTIVES ON DRUG AFFORDABILITY: EVALUATING USE AND APPLICATION IN VALUE-BASED CARE

Conduct a literature review to identify and synthesize studies published in peer-reviewed journals reporting findings on how patients, clinical providers, payers, manufacturers, and policy makers define and describe affordability of pharmaceutical treatments. Drug affordability is intrinsically tied to value-based healthcare, yet is perceived and experienced differently by stakeholders. Understanding those differences, as well as similarities, allows for more informed decisions around cost-sharing, willingness to pay, optimal financing schemes, and clinical choices. We conducted a global systematic literature review and interviewed experts in seven countries to interpret and refine analyses. Papers published in peer-reviewed journals and conference abstracts were included in thematic synthesis (ATLAS.ti), an inductive approach that allows themes to organically emerge. EMBASE, MEDLINE, PubMed and EconLit was searched from 2009-2019. We screened 7,372 unique citations and 477 full texts, of which 126 studies were included for qualitative coding. Studies covered more than 39 high to low income countries and 42 diseases. Most studies represented the perspective of patients (45%), followed by providers (17%), payers (9%), policymakers (7%), manufactures (2%), and other/researcher (20%). Major themes that emerged included, cost as a barrier to adherence and access, payer resistance to new financing schemes, physician prescribing patterns, policymaker critique of affordability metrics, and the manufacturer trade-off between innovation and cost. There was little overlap between stakeholders. Drug affordability is a cornerstone in value-based healthcare, yet peer-reviewed perspectives on drug affordability appear stakeholder-specific. For example, important aspects of the patient and physician view may not align with the perspectives and current practices of other stakeholders that largely view drug affordability as a balance of risk and demonstrated value. Cross-stakeholder research is needed that bridges these gaps in understanding of affordability. The body of evidence may suggest a possible bias toward researcher interests in characterizing aspects of the patient perspective.