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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 May 12; 334(7601): 968.
PMCID: PMC1867923
Drug Cost Initiative

Link cost to clinical outcome

Jeremiah Norris, director

The laudable UK initiative to drive the costs of drugs down to affordable assumes that there is consistency in drug pricing between producer and recipient countries and that price is a barrier to their use.1

When generics are included in pricing studies and compared with the price per gram of active ingredient, Japan and Switzerland are more expensive than the United States. When price per standard unit (a rough measure of dose, which differs across countries) is compared, Canada, Germany, Switzerland, and Sweden are more expensive than the US. And many governments subsidise research and development of their pharmaceutical and vaccine industries, making international comparisons difficult.2

Other factors contribute to a drug's price when it finally reaches a patient. Some governments procure medicines efficiently but charge markedly higher prices to patients.3

Yet the problem remains more profound than simply a matter of prices: the fragility of health systems. The UK would help the developing world more by disseminating best practices for disease management through the principle of rational choices between therapeutic alternatives which promise the most advantageous economic value relative to clinical outcome.


Competing interests: None declared.


1. Short R. UK leads initiative to drive down cost of drugs in poor countries. BMJ 2007;334:870 (28 April.) 10.1136/bmj.39195.388356.DB [PMC free article] [PubMed]
2. Danzon P. Price comparisons for pharmaceuticals: a review of US and cross-national studies Washington, DC: American Enterprise Institute, 1999
3. World Health Organization. Price, availability and affordability: an international comparison of chronic disease medicines Geneva: WHO, 2006

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