Assessing the Population-Health Loss From Funding High-Cost Medicines: Case Studies From Colombia and the Dominican Republic

OBJECTIVES: Colombia and the Dominican Republic are funding high-cost medicines (HCMs) whose effectiveness is uncertain or, in some cases, limited, whereas essential health services remain underfunded. Public financing of each HCM entails an opportunity cost because these resources could yield greater health benefits if used elsewhere. This study quantifies the population-health impact of funding HCMs in both Latin American countries. METHODS: We selected 10 publicly financed HCMs in each country based on their substantial budgetary impact or high per-case treatment cost. We applied the net health benefit methodology to estimate the population-health impact associated with funding these medicines. RESULTS: The selected HCMs primarily treat chronic conditions and yield incremental health gains of less than 2 years of life in full health per patient. In Colombia, allocating resources to these HCMs instead of better alternatives required an additional spending of $642 million to treat 22 155 patients, resulting in a net health loss of approximately 122 507 quality-adjusted life-years (QALYs). In the Dominican Republic, the $154 million directed to 1807 patients generated a net population-health loss of 35 221 QALYs. CONCLUSIONS: Public financing of HCMs with limited effectiveness can entail significant population-health losses. These losses must be explicitly accounted for in resource allocation decisions because they reflect missed opportunities to advance universal health coverage.