Table 1.

Factors influencing the value of any potential treatment.

Factor	Public health perspective	Manufacturer perspective
Drug characteristics
Treatment effectiveness	A therapeutic with significant health benefits, in reduced morbidity and mortality, will have greater value for consumers and for the countries purchasing them.	Manufacturers will be able to charge more for a product with significant health benefits.
Speed to market	The speed at which a treatment becomes available is essential, because the costs of illness can increase rapidly as the infectious disease spreads.	Manufacturers will also want to deliver their product quickly to become the standard of care and to make it more difficult for competitors to take market share.
Economies of scale	Countries will want to benefit from economies of scale, especially those countries with a large population and/or a high prevalence of COVID-19. Similarly, if there was pooled purchasing at a global or intercountry level, countries could negotiate a lower price.	Initially rapid scale-up can be costly, resulting in lower margins. Nevertheless, as production expands, the cost of producing the treatment should decline.
Drug route	There may be less demand for a drug that requires injection rather than oral administration, if there are health system capacity constraints.	Manufacturers will prefer a product that could be administered to the largest number of people possible.
Epidemiology
Severity	Medications that are used to treat more severe illnesses would have greater value than a medication that addresses more mild illnesses.	Manufacturers who treat diseases that are more severe are likely to be able to charge more for the medication.
Infectivity	A more infectious or more pathogenic organism makes it more important to have widespread, rapid access to treatment. A treatment that also reduces infectivity will also have a higher value to society.	A manufacturer is likely to be able to charge higher unit costs for a therapeutic agent that provides preventive as well as therapeutic characteristics.
Scale of demand	Larger-scale demand will pose more challenges of affordability. As the number of people needing treatment increases, the overall price tag becomes higher.	Manufacturers are likely to be willing to negotiate lower prices as countries commit to larger and longer-term purchases, including the purchase of stockpiles of the drug.
Likelihood of multiyear outbreaks	Countries may wish to negotiate lower prices and possibly longer contracts if they are planning to purchase stockpiles of medications for future use.	Manufacturers may have less need to recoup their investment costs immediately if the demand is going to continue in the future, especially if herd immunity effects are limited.
Potential for a vaccine or alternative treatments	Countries may not be willing to pay higher unit prices for treatment in the short run if a vaccine or alternative is imminent or already available.	Manufacturers may try to increase short-term prices if they do not expect long-term demand for their products.
Economic parameters
Market share	As countries can choose from alternative treatment approaches, they will have greater ability to negotiate lower prices.	Manufacturers will be limited in their ability to charge higher prices if multiple products are approved at the same time.
Cost-effectiveness and cost-benefit of treatment	The greater the cost-effectiveness of any treatment (including benefits from reductions in both morbidity and mortality), the more a country may value that treatment.	A manufacturer with a highly cost-effective product will be able to charge more for that product. On the other hand, products with smaller benefits will not be priced as highly.
Health financing system	Larger countries and those with strictly regulated or centralized purchasing mechanisms would have greater negotiating power to reduce the price of any therapeutic.	Manufacturers may target their sales, at least initially, to countries where purchases tend to be less regulated and ability and willingness to pay is higher (eg, United States).
Economic status of countries	Lower-income countries are likely to have less ability to pay for a treatment, particularly if it also requires other significant healthcare costs. Thus, lower-income countries will require discounted prices of products.	Manufacturers can benefit from differential pricing, charging higher prices in high-income countries and lower prices in low-income countries.
Social and political imperatives
Disease burden	As total mortality and morbidity rise in a country, the ability of the country to pay per course of treatment would decline, since the number of people needing the treatment would represent a significant commitment by the government.	Suppliers will face political pressure to deliver as quickly and affordably as possible, particularly as potential patients go untreated. Increased volume may compensate for reduced margins per dose or course.
Public relations/advocacy	Countries may encourage advocacy to laud suppliers who are viewed as prioritizing the public good while shaming suppliers who are viewed as taking advantage of a global crisis.	A manufacturer may view the launch of a new drug as perilous given the potential positive or negative perception of that company. Any perception of price gouging could significantly damage their reputation.

COVID-19 indicates coronavirus disease 2019.