DANBURY, Conn. — The types of medicines being developed, the way technology contributes to health and how the value of health is calculated are all changing dramatically, according to a new report from the IQVIA Institute for Human Data Science.

The study, “2018 and Beyond: Outlook and Turning Points,” looks at trends health care and global drug spending in which stakeholders and decision makers are increasingly using real-world evidence and technology to solve the problems of human health. The institute’s analysis produced predictions that promise to transform health care cost and spend, drug development and delivery, and approaches to determine the societal value of medicines.

Overall, the IQVIA Institute’s study forecasts modest global drug spending growth of 3% to 6% percent per year, estimated to exceed total cost of $1.44 trillion in 2022 worldwide.

Among the predictions for health care transformation ­are:

• Spending on branded medicines will dip. In 2018, net brand spending will decline in developed markets by 1% to 3%. This has the effect of reducing net spending overall on brands in developed markets by approximately $5 billion, to a total amount of $391 billion for this year. Manufacturers will continue to develop and launch drugs, but the inherent unpredictability of these novel medicines will drive greater caution among payers regarding reimbursement and access, according to IQVIA.

• Specialty brands will drive developed market growth. In 2018, the $318 billion specialty medicines market will represent 41% of developed market spending, up from $172 billion in 2013; in fact, specialty drugs will contribute all of the growth in medicine spending in 2018. Those increases, however, will be offset by declines in traditional therapies. The growth of spending on specialty medicines will be constrained by cost and access controls and a greater focus on assessments of value. Despite these trends, specialty brands are expected to reach 48% of total spending in developed markets by 2022.

• U.S. net per capita spending will stabilize. Real net per capita spending on medicines in the United States will decline in 2018 and continue almost unchanged at about $800 per person through 2022. Spending will remain flat after factoring in the robust pipeline of new drugs, moderating brand price increases of 2% to 5% on a net basis (7% to 10% on a list price basis) and the impact of brand losses of exclusivity, which will be greater in the next five years than the last five. While setting prices freely has been a unique feature of the U.S. market compared to other countries, the leverage payers have to negotiate net price discounts is effectively offsetting price increases, IQVIA noted.

• The Food and Drug Administration will guide the use of real-world evidence (RWE) to support the regulation of medicines. In 2018, the FDA will issue its first framework addressing the potential for RWE to support regulatory submissions and monitoring for drug safety.

• New wave of biosimilar competition and opportunity emerges. In 2018, $19 billion of current biotech spending will have competition from biosimilars for the first time in developed markets. That amount is significantly greater than the $3 billion in biosimilar revenue that became exposed in 2017, and it adds to the $26 billion already facing competition. The new exposure to competition in 2018 is the largest single-year change to date and signals the start of the next large wave of biosimilars.

• Use of telehealth will continue to expand. Nearly every privately insured patient in the United States will have some form of access to telehealth this year, although few will use it. In 2018, telehealth will account for 3% to 3.5% of doctor visits, up from 2.6% in 2017. Over the next five years telehealth will grow to between 4% and 7.5% of visits as patients’ concerns about being treated by a random doctor are outweighed by the dramatically lower co-payments offered by their insurers.

• Outcomes-based contracts will play a limited role. The basic framework for an outcomes-based contract contains a payment schedule based on how well a drug does or doesn’t deliver results. The most common approach is for insurers to pay less for a drug if it performs worse than the reported results from its clinical trial for FDA approval and pay more for better results. Under these contracts, successful medicines get covered at full price or for proportionately less based on unsuccessful patient results. These contracts can drive real savings for payers or providers, as well as more predictability for overall costs. As the health system gains a greater comfort with electronic medical records, as well as wider use of RWE, collecting data for these outcome requirements will become easier. However, IQVIA noted, the administrative burden on all parties will escalate and become prohibitive unless the outcomes are designed to be measurable.

“This report focuses on the most recent real-world evidence and analysis to balance emotional issues and intuition that can sometimes overshadow critical health care decisions,” stated Murray Aitken, IQVIA’s senior vice president and executive director of the IQVIA Institute for Human Data Science. “Based on that analysis, we’re convinced these evidence-based predictions will begin to come to pass later this year.”