Drugs for treating rare diseases had been neglected by the pharmaceutical industry for a long time, due to the complex and costly drug R&D process as well as a small unprofitable market. Since its introduction in 1983, the Orphan Drug Act (ODA) has sought to prompt the innovation of drugs for minority diseases by reducing the regulatory and economic barriers. The incentives of the ODA have been effected through market protection, tax credit, fee waiver and grants to increase the accessibility of orphan products for the public. The number of orphan drugs available in the market has risen sharply from just ten in the decade before 1983 to over 400 since 1983. This increase implies a substantial improvement of the healthcare of patients suffering rare diseases and a success of the orphan drug legislation with the aim to motivate the development and manufacture of products that have low commercial potentials. Although it is evident that the ODA has successfully stimulated drug companies to develop numerous orphan products, treatments are very expensive. The sales of blockbuster orphan drugs have provided drug companies with unusually highprofit margins and limited patient access to treatments. The dilemma presented by the ODA reflects many of the issues currently faced by policymakers. In this thesis, we have analyzed the long-term evolution of the biopharmaceutical industry. In particular, we have examined drug discovery in the period of random screening, rational design and network collaboration, and explored the influence of the ODA. We have taken the theory of the sectoral system of innovation, and combined it with the complex adaptive model of innovation, and found that the complex version of that theory is capable of explaining the comprehensive drug innovation system. A Multi-agent Based Model has been introduced to identify and analyze the dynamics of bio-pharmaceutical innovation. The model has explored the roles of the main players in the sector and the influence of their relationships embedded in the process of orphan drug innovation. Through this model, we have investigated the mechanisms of how the incentives stimulate orphan drug innovation during the period from 1983- 2012. Moreover, the model has been applied to solve the dilemma of the ODA through analyzing how to achieve the best trade-off between orphan drug developments. Drawing upon the results of the simulation, we provide a sound basis for adjusting the ODA incentives to strikes an appropriate balance between stimulating orphan drug innovation and providing benefits to society, propose some resolutions to the ODA, while also to motivate orphan drug development in a financial way. The Advice for other countries planning to enact the orphan drug legislation and directions for further research suggested by this model have been put forward.

Abstract : Rare diseases are debilitating conditions often leading to severe clinical manifestations for affected patients. Orphan drugs have been developed to treat these rare diseases affecting a small number of individuals. Incentives in the legal framework aimed to recoup the research and development cost of orphan drugs for pharmaceutical companies have been implemented in the United States and the European Union. At the present time, Canada is still lacking a legal and policy framework for orphan drugs. Several problems at the federal and provincial levels remain: lack of research funds for rare diseases, discrepancies on orphan drug policies between provinces, difficulties to access and reimburse these high price drugs. Recommendations and measures are proposed, such as a pan-Canadian (national) scientific committee to establish evidence-based guidelines for patients to access orphan drugs uniformly in all provinces with a disease specific registry, a formal agreement for a centralized Canadian public funding reimbursement procedure, and increasing the role of “guardian” for prices by the Patented Medicines Review Board in Canada. These recommendations and measures will be beneficial for the implementation of a policy framework for orphan drugs in Canada. / Résumé : Les maladies rares sont des maladies sérieuses pouvant causer des manifestations cliniques sévères chez les patients atteints. Les médicaments orphelins ont été développés pour le traitement de ces maladies rares qui touchent un petit nombre d’individus. Un cadre légal permettant des incitatifs pour les compagnies pharmaceutiques aux États-Unis et au niveau de l’Union Européenne a favorisé la recherche et le développement desdits médicaments. Présentement, il n’existe pas de cadre juridique et de politiques spécifiques au Canada entourant les médicaments orphelins. Ceci a mené à plusieurs problèmes tant au niveau fédéral que provincial dont: un manque de support financier consacré à la recherche pour les maladies rares, des disparités entre les provinces concernant les politiques pour les médicaments orphelins, des difficultés d’accès et de remboursement desdits médicaments dont les coûts sont élevés. Des recommandations et mesures sont proposées, telles l’implantation d’un comité scientifique pancanadien (national) afin d’établir des lignes directrices fondées sur des données probantes pour faciliter un accès uniforme aux médicaments orphelins pour les patients, y compris un registre spécifique élaboré pour chaque maladie, établir une entente formelle centralisée pour tout le Canada pour un financement public de remboursement des médicaments orphelins, augmenter le rôle de « gardien » des prix par le Conseil d’examen du prix des médicaments brevetés au Canada. Ces recommandations et mesures serviront à l’implantation d’un cadre de politiques pour les médicaments orphelins au Canada.

Zugl.: Augsburg, Universiẗat, Diss., 2007.

Cette thèse de doctorat met l’emphase sur les défis rencontrés par les patients atteints de maladies rares. Elle est structurée en trois parties, chacune d’entre elles dédiée aux enjeux d’un acteur au cœur de l’Odyssée diagnostique et thérapeutique des patients atteints de maladies rares. La première partie de la thèse s’intéresse au patient et à son réseau social. Le chapitre 1 considère les sources de délai à l’accès au diagnostic, et explore notamment l’effet du capital social sur le délai d’obtention du diagnostic. Le chapitre 2 évoque les externalités négatives sur la santé maternelle d’un diagnostic d’une maladie chronique chez l’enfant. La seconde partie de la thèse est dédiée à l’industrie pharmaceutique et s’intéresse aux décisions d’investissements de R&D ciblant les maladies rares. Le chapitre 3 évalue l’effet causal de l’Orphan Drug Policy sur l’effort de recherche, et le chapitre 4 envisage les inégalités d’allocation des investissements de R&D entre les maladies rares. La partie 3 est dédiée aux décideurs publics et discute des enjeux d’évaluation des bénéfices de l’innovation thérapeutique et de la définition des conditions d’accès à cette innovation. Le chapitre 5 évalue l’effet causal de l’innovation thérapeutique sur la longévité des patients atteints de maladies rares. Le chapitre 6 est une discussion critique relative à l’utilisation d’outils. / This dissertation emphasizes the challenges raised by the management of rare diseases and is structured around three key actors of the diagnostic and therapeutic “odyssey” of patients with rare diseases. Part I is devoted to patients and their social networks. Chapter 1 considers demand-side sources of delay in receiving a diagnosis; Chapter 2 explores the health spillover effects from patients’ health to their direct support structure. Part II considers pharmaceutical firms and examines how firms’ decisions to allocate R&D investment to rare diseases are impacted by innovation policies in rare arenas. Chapter 3 evaluates the causal impact of the EU Orphan Drug policy on R&D efforts in orphan drugs, while Chapter 4 investigates the inequality in allocation of R&D investment within rare diseases. Part III focuses on policymakers and addresses the issues in measuring pharmaceutical innovation benefits along with costs in rare disease arenas, while considering the opportunity cost of healthcare expenditures. Chapter 5 measures the causal impact of pharmaceutical innovation in rare diseases on longevity, while Chapter 6 is a critical discussion of decision-making tools for rational allocation of healthcare resources, and the use of a cost-effectiveness threshold.

Ce travail de recherche vise à investiguer la relation entre la critique à l'encontre des entreprises et les stratégies individuelles et collectives qu'elles déploient afin d'y faire face et de l'exploiter. L'étude du cas du champ du médicament orphelin aux États-Unis et en Europe permet de montrer la capacité des entreprises à récupérer la critique et à élaborer des réponses stratégiques leur permettant de saisir et/ou de créer de nouvelles opportunités et d'identifier et/ou faire face à de nouvelles menaces. Cette thèse contribue aussi à la compréhension du processus de construction d'un nouveau champ organisationnel et montre le rôle important des parties prenantes dans ce processus. / This research intends to investigate the relationship between criticism of firms and individual and collective strategies they use to address and exploit it. The case study of the orphan drug field in the United States and Europe shows the ability of firms to recover criticism and develop strategic responses allowing them to seize and/or create new opportunities and to identify and/or address new threats. This dissertation also contributes to the understanding of the process of constructing a new organizational field and shows the important role of stakeholders in this process.