Review of Economic Studies · 2024 · [{"name": "Tuba Tunçel", "affiliation": ["Florida State University"]}]
中文摘要
摘要 药品获得上市许可后，其实际使用情况取决于针对未获批适应症的标签外处方监管。我们借助一个结构性需求与供给模型，研究标签外处方监管对医生行为、患者健康、治疗成本以及制药企业定价的影响。利用法国9年间医生诊疗活动和门诊就诊的丰富面板数据，我们构建了一个包含处方选择与健康结果、并允许患者层面存在不可观测异质性的模型。我们由此识别了标签内与标签外药品的需求，以及处方选择对健康结果的影响。在供给侧，我们采用政府与制药公司之间的 Nash-in-Nash 讨价还价模型，该模型允许对药品边际成本进行部分识别。反事实模拟表明，若将标签外药品从医生的选择集中剔除，在价格保持不变的情况下转向标签内药品的替代将使处方药支出增加15%。若允许在禁止标签外处方的条件下对药品价格进行讨价还价调整，该禁令将进一步使治疗成本增加26%，且不会改善健康结果。
Abstract
Abstract After a drug obtains marketing authorisation, the usage depends on the regulation of off-label prescriptions for unapproved indications. We investigate the impact of off-label prescription regulation on physicians’ behaviour, patients’ health, treatment costs, and pharmaceutical firms’ pricing with a structural demand and supply model. Exploiting rich panel data on physicians’ activities and office visits in France over 9 years, we use a model of prescription choice and health outcomes with unobserved patient-level heterogeneity. We identify the demand for on-label and off-label drugs and the effect of prescription choice on health outcomes. On the supply side, we use a Nash-in-Nash bargaining model between the government and the pharmaceutical companies that allows the partial identification of the marginal costs of drugs. Counterfactual simulations show that when we remove off-label drugs from the choice set of physicians, substitution to on-label drugs at constant prices would lead to an increase of 15% in the expenditure on prescription drugs. If we allow bargaining adjustment on drug prices under a ban on off-label prescriptions, the ban would further increase the treatment cost, by 26%, without improving health outcomes.