New medicines

A small number of drug classes account for a large share of the fall in mortality over the last fifty years — antihypertensives, statins, antiretrovirals, the vaccines — and the question this driver keeps open is which of the classes now arriving belong on that list. The candidates are identifiable. The GLP-1 drugs are the obvious one and have their own page. Beyond them: the SGLT2 inhibitors, which reduce death and hospital admission in heart failure and kidney disease well beyond the diabetes they were designed for; the RSV vaccines and the long-acting injectables for HIV prevention, each of which changes the population risk of an infection; the anti-amyloid antibodies, whose effect is small; and the first cancer vaccines, in late trials. The historical evidence that pharmaceutical innovation drives life expectancy is real and contested — the estimates depend on how the counterfactual is built — and the trials that establish a drug's effect say nothing about its effect on a population that takes it late, partially or not at all.

That is the second question, and the data are worse. Uptake of a new medicine differs severalfold between countries with similar income, by price, by approval and reimbursement timing, and by the structure of the health system; the countries that link prescribing to outcomes — Denmark, Scotland, Korea — can measure it, and most cannot. Persistence is measured mainly through claims data and is generally poor.

The filing rule: a medicine is filed under the disease it treats when the question is the disease, and here when the question is the medicine — its approval, price, uptake, persistence, safety after launch, or the pipeline as a whole.

Status

building

Direction

strengthening

Would change our view

A national series showing a mortality or morbidity effect attributable to a drug class other than the GLP-1s; evidence that uptake of an effective medicine is failing on price in a high-income country; or a quantified account of the current pipeline's plausible population effect.

Trackers

Gaps

Uptake and persistence data across countries on a common basis; post-launch outcomes for most new classes; the price actually paid rather than the list price; Japan, where approval and uptake follow a different path.