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Published online by Cambridge University Press:  10 July 2018

Oriol de Solà-Morales
Health Innovation Technology Transfer (HITT)
David Cunningham
Independent Consultant
Mathias Flume
Kassenärztliche Vereinigung Westfalen Lippe
Paul M. Overton
Beacon Medical Communications
Natalie Shalet
NAS Healthcare Solutions
Stefano Capri
School of Economics and Management, LIUC University
E-mail address:



The aim of this study was to investigate how innovation is defined with respect to new medicines.


MEDLINE, Embase, and EconLit databases were searched for articles published between January 1, 2010 and May 25, 2016 that described a relevant definition of innovation. Identified definitions were analyzed by mapping the concepts described onto a set of ten dimensions of innovation.


In total, thirty-six articles were included, and described a total of twenty-five different definitions of innovation. The most commonly occurring dimension was therapeutic benefit, with novelty and the availability of existing treatments the second and third most common dimensions. Overall, there was little agreement in the published literature on what characteristics of new medicines constitute rewardable innovation.


Alignment across countries and among regulators, health technology assessment bodies and payers would help manufacturers define research policies that can drive innovation, but may be challenging, as judgements about what aspects of innovation should be rewarded vary among stakeholders, and depend on political and societal factors.

Copyright © Cambridge University Press 2018 

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All authors designed the study, analyzed the results, reviewed all draft versions of the manuscript, and approved the final version for submission. Paul Overton conducted the systematic review and wrote the manuscript. The authors thank the other members of the AGORA Think Tank for helpful discussions during this work. This work was supported by Novartis Pharma AG (Basel, Switzerland) under the AGORA initiative (Advisory Group On Reimbursement and Access, a European Think Tank which aims to optimize access for patients to innovative treatments).


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