Health care decision-makers face several uncertainties regarding pharmaceutical products. For new and expensive drugs, the performance outside of clinical trials could be uncertain. For old and low-profit pharmaceutical products, the supply could be uncertain, causing drug shortages. In three essays, I study mitigating strategies to deal with different types of uncertainties associated with pharmaceutical products.
In the first essay, I compare two types of pharmaceutical reimbursement contracts to mitigate the uncertainties associated with new and expensive drugs. I construct a game-theoretic model to analyze the interactions between a pharmaceutical manufacturer and a payer. The payer’s reimbursement of a drug is either related to the cost-effectiveness or the sales volume of the drug in the two contracts, respectively. I find key factors that determine the two parties’ preferences for the two contracts. I also find conditions under which each type is preferred by both parties and can achieve a Pareto improvement.
In the second essay, I study mitigating strategies for drug shortage, which has become a serious problem in many countries in recent years. I construct a multi-period supply chain model to analyze the interactions between a representative hospital and an unreliable pharmaceutical manufacturer. The hospital owns an in-house manufacturer and can procure the drug from the two manufacturing facilities. I also assume that the hospital can make emergency production. I study the two parties’ procurement and production decisions and examine the impacts of the hospital’s optimal decisions on the external manufacturer’s profit.
In the third essay, I study mitigating strategies for drug shortages from the governments’ perspective. I construct a game-theoretic model consisting of a pharmaceutical manufacturer, a wholesaler, and a government. I compare two types of mitigating strategies that the government can implement: providing subsidies to the wholesaler, or using a government-owned manufacturer. I identify key factors for the government’s preference over the two strategies and examine the impact on the private sector.
The three essays have theoretical contributions to game theory and supply chain risk management literature and have policy implications for policymakers to manage drug supply and patient access to drugs
