Decision-making on the pricing and reimbursement of medicines is one of the major challenges facing today’s healthcare systems. This was the central focus of the lecture “Decision-making on drug pricing and reimbursement: value frameworks, elements, and structured decision-making”, delivered by Pilar Pinilla as part of the Santander Biomedical Lectures series. The session addressed how countries decide which medicines to fund with public resources, ensuring the greatest possible benefit for the population.
Pilar Pinilla holds a degree in Business Administration and Management from the University of La Laguna and a master’s degree in Health Economics, Policy and Law from Erasmus University Rotterdam. She currently serves as President of the Spanish Health Economics Association (AES) and is Programme Director – Methods, Research and Health Economics at NICE, the UK’s leading body for health technology assessment. She has more than 14 years of experience in economic evaluation, health policy, and advising governments and the pharmaceutical industry.
During her presentation, Pinilla invited attendees—most of them clinical professionals—to reflect on the concept of opportunity cost. “When a decision is made to invest in a health technology, those resources are no longer available for other needs,” she explained. Therefore, evaluation does not focus solely on the benefit to an individual patient, but rather on the overall impact on the entire population, taking into account limited resources and existing social and clinical diversity.
Evaluating to maximize health value
The speaker explained that health technology assessment (HTA) is an essential tool for prioritizing interventions, ranging from medicines and devices to diagnostic tests or digital technologies. Its aim is to ensure that decisions are based on the best available evidence, maximizing health gains and guaranteeing equity. “It is not about saving money, but about using resources wisely,” she emphasized.
In this process, it is crucial to distinguish between regulatory approval—which assesses safety and efficacy—and cost-effectiveness evaluation, which analyzes whether a medicine provides greater benefits compared with existing alternatives and at what cost. Pinilla noted that an expensive drug can be cost-effective if it delivers substantial health benefits, while a cheap one may not be if it leads to complications or limited outcomes.
The experience of NICE in England served as an example of an independent, transparent, and multidisciplinary model. Its committees include clinicians, patients, academics, economists, and industry representatives, and its recommendations on medicines are legally binding for the public healthcare system. This structure strengthens the legitimacy of decisions and facilitates their implementation in clinical practice.
A changing context in Spain and Europe
The lecture also addressed the current period of transformation in Spain in this area. The entry into force of the European Regulation on Health Technology Assessment and the forthcoming Spanish Royal Decree aim to enhance transparency, clearly separate assessment from decision-making, and improve the use of economic and clinical evidence in the funding of medicines.
Pinilla concluded by stressing that health technology assessment must be clear, inclusive, independent, and evidence-based, but also agile and useful for professionals. “Only in this way will we achieve decisions that reflect society’s values and ensure a sustainable and fair healthcare system,” she stated, thanking the audience for their participation and interest.
