Deﬁning and Measuring the Affordability of New Medicines:
A Systematic Review
Paul M. Overton
Published online: 5 May 2017
Ó Springer International Publishing Switzerland 2017
Background In many healthcare systems, affordability
concerns can lead to restrictions on the use of expensive
efﬁcacious therapies. However, there does not appear to be
any consensus as to the terminology used to describe
affordability, or the thresholds used to determine whether
new drugs are affordable.
Objectives The aim of this systematic review was to
investigate how affordability is deﬁned and measured in
Methods MEDLINE, EMBASE and EconLit databases
(2005–July 2016) were searched using terms covering
affordability and budget impact, combined with deﬁnitions,
thresholds and restrictions, to identify articles describing a
deﬁnition of affordability with respect to new medicines.
Additional deﬁnitions were identiﬁed through citation
searching, and through manual searches of European health
technology assessment body websites.
Results In total, 27 deﬁnitions were included in the review.
Of these, ﬁve deﬁnitions described affordability in terms of
the value of a product; seven considered affordability
within the context of healthcare system budgets; and 15
addressed whether products are affordable in a given
country based on economic factors. However, there was
little in the literature to indicate that the price of medicines
is considered alongside both their value to individual
patients and their budget impact at a population level.
Conclusions Current methods of assessing affordability in
healthcare may be limited by their focus on budget impact.
A more effective approach may involve a broader per-
spective than is currently described in the literature, to
consider the long-term beneﬁts of a therapy and cost sav-
ings elsewhere in the healthcare system, as well as coop-
eration between healthcare payers and the pharmaceutical
industry to develop ﬁnancing models that support sustain-
ability as well as innovation.
Electronic supplementary material The online version of this
article (doi:10.1007/s40273-017-0514-4) contains supplementary
material, which is available to authorized users.
& Fernando Anton
Department of Economics, University of La Rioja, C/La
Ciguena 60, 26004 Logrono, Spain
College of Pharmacy, University of Florida, Gainesville, FL,
Unit of PharmacoTherapy, Epidemiology and Economics
(PTE2), Department of Pharmacy, University of Groningen,
Groningen, The Netherlands
Beacon Medical Communications, Brighton, UK
NAS Healthcare Solutions, Surbiton, UK
University Medical Center Groningen, Institute of Science in
Healthy Aging & healthcaRE (SHARE), University of
Groningen, Groningen, The Netherlands
Department of Epidemiology, University Medical Center
Groningen, University of Groningen, Groningen, The
PharmacoEconomics (2017) 35:777–791