Advances in the understanding of the molecular basis of diseases have expanded the number of plausible therapeutic targets for the development of innovative agents in recent decades. However, although investment in pharmaceutical research and development (R&D) has increased substantially in this time, the lack of a corresponding increase in the output in terms of new drugs being approved indicates that therapeutic innovation has become more challenging. Here, using a large database that contains information on R&D projects for more than 28,000 compounds investigated since 1990, we examine the decline of R&D productivity in pharmaceuticals in the past two decades and its determinants. We show that this decline is associated with an increasing concentration of R&D investments in areas in which the risk of failure is high, which correspond to unmet therapeutic needs and unexploited biological mechanisms. We also investigate the potential variations in productivity with regard to the regional location of companies and find that although companies based in the United States and Europe differ in the composition of their R&D portfolios, there is no evidence of any productivity gap.

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T his paper compares the innovation performance of established pharmaceutical firms and biotech companies, controlling for differences in the scale and scope of research. We develop a structural model to analyze more than 3,000 drug research and development projects advanced to preclinical and clinical trials in the United States between 1980 and 1994. Key to our approach is careful attention to the issue of selection. Firms choose which compounds to advance into clinical trials. This choice depends not only on the technical promise of the compound, but also on commercial considerations such as the expected profitability of the market or concerns about product cannibalization. After controlling for selection, we find that (a) even after controlling for scale and scope in research, established pharmaceutical firms are more innovative than newly entered biotech firms; (b) older biotech firms display selection behaviors and innovation performances similar to established pharmaceutical firms; and (c) compounds licensed during preclinical trials are as likely to succeed as internal compounds of the licensor, which is inconsistent with the "lemons" hypothesis in technology markets.

During the last 30 years, health care expenditure (HCE) has been growing much more rapidly than GDP in OECD countries. In this paper, we review the determinants of HCE dynamics in Europe, taking into account the role of income, aging population, technological progress, female labor participation and public budgetary variables. We show that HCE is a multifaceted phenomenon where demographic, social, economic, technological and institutional factors all play an important role. The comparison of total, public and private HCE reveals an imbalance of European welfare toward the care of the elderly. European Governments should increasingly rely on pluralistic systems to balance sustainability and access and equilibrate the distribution of resources across the functions of the public welfare system.

Innovation is a trial and error process in which both successes and failures contribute to knowledge creation and destruction. In this paper we test theoretical predictions about the role of failures in new product development on private and public knowledge and interfirm knowledge transfer. We analyse the outcomes of world‐wide R&D projects in the pharmaceutical industry, and proxy knowledge flows with forward citations received by patents associated with each project. We find that patents covering successfully completed projects (i.e., leading to drug launch on the market) receive more citations than those associated to failed (terminated) projects, which in turn are cited more often than patents lacking clinical or preclinical information. Failures by specialized firms are cited more frequently than the ones of generalist companies. We therefore offer evidence of the value of failures as research inputs in (pharmaceutical) innovation.