A French approach to cost-effectiveness analysis?

Abstract

France is still considered as a paradigmatic country in terms of its refusal to consider economic assessments when deciding on access to reimbursement and pricing of drugs and medical devices. In a recent editorial of this journal [1], Claude Le Pen has argued that this may reflect a continental view of economics and in particular a specific philosophical conception of illness, and medicine, which resists the idea that health and illness differ only in quantitative and thus cannot be plotted in the same space. My purpose here is not to challenge this ambitious view, and it is fair to say that Claude Le Pen also mentioned some founding principles of the French Securite Sociale implemented in 1945. In particular, as far as new medicines are concerned, the French Code de la Securite Sociale states that all drugs with a favourable benefit/risk ratio, as assessed by the Transparency Commission, should be accessible to patients through reimbursement, independent of their price. The only mention of economics in the code is in its Article R163-11 that states that medicines should not be reimbursed if they potentially induce unjustified expenditures for the Sickness Fund, either because their public interest is low because their efficacy is not well proven, or because they bring a minor contribution in existing therapeutic strategies, or because of the absence of severity of the diseases they address ? Thus, clinical efficacy is the leading criterion in access to reimbursement, independent of any price consideration. A drug will not be reimbursed if it is not considered as truly effective or if the problem it addresses is not