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Garattini L, Padula A. Comment on: 'The Impact of Hospital Costing Methods on Cost-Effectiveness Analysis: A Case Study'. PHARMACOECONOMICS 2019; 37:1301-1302. [PMID: 31250398 DOI: 10.1007/s40273-019-00823-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Garattini L, Padula A. Conflict of interest disclosure: striking a balance? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:633-636. [PMID: 30607655 DOI: 10.1007/s10198-018-1028-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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53
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54
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Garattini L, Padula A. Urgent reforms for general practice in Italy. Eur J Intern Med 2019; 64:e17. [PMID: 31014909 DOI: 10.1016/j.ejim.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
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Garattini L, Padula A. English and Italian national health services: Time for more patient-centered primary care? Eur J Intern Med 2018; 57:19-21. [PMID: 30279035 DOI: 10.1016/j.ejim.2018.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 09/15/2018] [Accepted: 09/18/2018] [Indexed: 11/26/2022]
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Garattini L, Padula A. Pharmaceutical pricing conundrum: time to get rid of it? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:1035-1038. [PMID: 30030646 DOI: 10.1007/s10198-018-0995-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Garattini L, Padula A. Hospital Pharmacists in Europe: Between Warehouse and Prescription Pad? PHARMACOECONOMICS - OPEN 2018; 2:221-224. [PMID: 29396660 PMCID: PMC6103922 DOI: 10.1007/s41669-018-0069-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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59
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Garattini L, Padula A. Dual practice of hospital staff doctors: hippocratic or hypocritic? J R Soc Med 2018; 111:265-269. [PMID: 29905490 DOI: 10.1177/0141076818783332] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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60
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Garattini L, Padula A. Patient empowerment in Europe: is no further research needed? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:637-640. [PMID: 29520521 DOI: 10.1007/s10198-018-0965-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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61
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Garattini L, Padula A. Pricing of HPV Vaccines in Europe: Back to the Future? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:275-277. [PMID: 29473121 DOI: 10.1007/s40258-018-0375-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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62
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Garattini L, Padula A. Multiple Criteria Decision Analysis in Health Technology Assessment for Drugs: Just Another Illusion? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:1-4. [PMID: 28822106 DOI: 10.1007/s40258-017-0345-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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63
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Garattini L, Padula A. Competition in pharmaceuticals: more product- than price-oriented? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:1-4. [PMID: 28993950 DOI: 10.1007/s10198-017-0932-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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64
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Garattini L, Padula A. Pharmaceutical care in Italy and other European countries: between care and commerce? Postgrad Med 2017; 130:52-54. [PMID: 29086617 DOI: 10.1080/00325481.2018.1399043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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65
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Curto A, van de Vooren K, Garattini L. Market approval for drugs in the EU: time to change direction? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:933-936. [PMID: 28028622 DOI: 10.1007/s10198-016-0863-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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66
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Garattini L, Padula A. Clinical Governance in Italy: 'Made in England' for Import? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:541-544. [PMID: 28432644 DOI: 10.1007/s40258-017-0328-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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67
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Garattini L, Padula A. Immunotherapies for advanced melanoma: as promising as they are expensive? J R Soc Med 2017; 110:395-399. [PMID: 28871843 DOI: 10.1177/0141076817731094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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68
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Garattini L, Padula A. Between pharmaceutical patents and European patients: is a compromise still possible? Expert Opin Ther Pat 2017; 27:1073-1076. [PMID: 28671001 DOI: 10.1080/13543776.2017.1350648] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Pharmaceutical regulation has always attempted to balance the public health objective to make safe and effective drugs available for patients while providing commercial incentives through patents. Here we discuss whether it is still possible to find a balance between the incentives on the supply side and the regulatory framework on the demand side. Areas covered: The current regulatory framework on pharmaceutical exclusivity has been harshly criticized by many experts, arguing about whether it is still fit for public purposes and needs. Here we envisage a different scenario without 'revolutionizing' the whole present system. The main radical change should concern the present management of pharmaceutical patents by introducing a specific agency dedicated to them. Secondly, specific pharmaceutical patents could be restricted to compounds for one (or more) declared indication(s). Thirdly, pharmaceutical patents should be kept only for compounds that start a first clinical trial within five years from the granting date. Expert opinion: We think it is time to reconsider the regulation of pharmaceutical patents in the light of their relevance in terms of public health. New models of enhancing research investments are required for long-term sustainability of public pharmaceutical expenditure and the EU can still play a leading role.
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Garattini L, Padula A. 'Appropriateness' in Italy: A 'Magic Word' in Pharmaceuticals? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:1-3. [PMID: 26987647 DOI: 10.1007/s40258-016-0240-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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70
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Garattini L, Padula A. Dutch guidelines for economic evaluation: 'from good to better' in theory but further away from pharmaceuticals in practice? J R Soc Med 2017; 110:98-103. [PMID: 28116955 DOI: 10.1177/0141076817690395] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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71
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Abstract
Long-term use of statin therapy is essential to obtain clinical benefits, but adherence is often suboptimal and some patients are also reported to fail because of 'statin resistance'. The identification of PCSK9 as a key factor in the LDL clearance pathway has led to the development of new monoclonal antibodies. Here we critically review the economic evaluations published in Europe and focused on statins. We searched the PubMed database to select the studies published from July 2006 to June 2016 and finally selected 19 articles. Overall, the majority of studies were conducted from a third-party payer's viewpoint and recurred to modelling. Most studies were sponsored by industry and funding seemed to play a pivotal role in the study design. Patients resistant to LDL-C level reduction were considered only in a few studies. The place in therapy of the new class of biologic should be considered a kind of 'third line' for cholesterol-lowering, after patients have failed with restricted dietary regimens and then with current drug therapies. Otherwise they could result in hardly sustainable expenses even for developed countries.
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Garattini L, Padula A. Why EMA should provide clearer guidance on the authorization of NBCDs in generic and hybrid applications. Expert Rev Clin Pharmacol 2016; 10:243-245. [PMID: 27997812 DOI: 10.1080/17512433.2017.1274652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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73
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Garattini L, Curto A, Padula A. Reimbursable drug classes and ceilings in Italy: why not only one? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:923-926. [PMID: 27255742 DOI: 10.1007/s10198-016-0808-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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74
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Garattini L, Curto A. Performance-Based Agreements in Italy: 'Trendy Outcomes' or Mere Illusions? PHARMACOECONOMICS 2016; 34:967-969. [PMID: 27260615 DOI: 10.1007/s40273-016-0420-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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75
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Garattini L, Curto A. European Medicines Agency: leave the UK but remain the same. J R Soc Med 2016; 109:324-5. [PMID: 27609795 DOI: 10.1177/0141076816663559] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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76
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Garattini L, Curto A, Freemantle N. Vaccination planning in Italy: increasing vaccines while reducing coverage? Expert Rev Pharmacoecon Outcomes Res 2016; 16:547-548. [DOI: 10.1080/14737167.2016.1215918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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77
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Tediosi F, Bertolini G, Parazzini F, Mecca G, Garattini L. Cost analysis of dialysis modalities in Italy. Health Serv Manage Res 2016. [DOI: 10.1258/0951484011912483] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study analyses management and costs of dialysis in the Italian National Health Service (NHS). Information on efficacy and health-related quality of life (HRQOL) based on the existing literature also is presented. The clinical differences between the dialysis modalities seem to be related to their appropriateness to specific patient groups. Efficacy rates are similar and the only differences are in complications and HRQOL. Traditional haemodialysis (THD) can be done by Italian patients in dialysis centres or in hospital. High-flux haemodialysis (HFHD) is generally only done in hospital. Peritoneal dialysis (PD) is usually done at home. The cost analysis was performed on a sample of Italian dialysis centres and hospitals, according to the full cost method. As expected, HFHD was more expensive than THD and PD, but no marked differences emerged among the different HFHD modalities. THD modalities in dialysis centres were less costly than in hospitals. Automated PD (APD) was much more expensive (almost twice) than continuous ambulatory PD (CAPD), the cheapest method in absolute terms. This study confirms that dialysis is costly and that it is very difficult to assess the cost-effectiveness of the different approaches. Although this study has limits, it should provide sufficient analytical information to local healthcare managers for more rational allocation of financial resources to dialysis services.
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Garattini L, Curto A, Freemantle N. Pharmaceutical Price Schemes in Europe: Time for a 'Continental' One? PHARMACOECONOMICS 2016; 34:423-6. [PMID: 26820147 DOI: 10.1007/s40273-015-0377-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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79
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Garattini L, Curto A, Freemantle N. Access to primary care in Italy: time for a shake-up? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:113-6. [PMID: 26416216 DOI: 10.1007/s10198-015-0732-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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80
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Garattini L, Padula A, Da Costa MR. Economic Evidence of Pneumococcal Vaccination in Older Adults: Uncertain Modelling or Competitive Tendering? PHARMACOECONOMICS 2016; 34:221-224. [PMID: 26518294 DOI: 10.1007/s40273-015-0341-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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81
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Garattini L, Ghislandi F, Padula A. Older anti-TNF-α agents: why not group them for common indications in the EU? Expert Rev Pharmacoecon Outcomes Res 2016; 16:1-4. [PMID: 26751100 DOI: 10.1586/14737167.2016.1140576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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82
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Garattini L, Ghislandi F, Da Costa MR. Cost-Effectiveness Modeling in Multiple Sclerosis: Playing Around with Non-Healthcare Costs? PHARMACOECONOMICS 2015; 33:1241-1244. [PMID: 26293887 DOI: 10.1007/s40273-015-0322-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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83
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Garattini L, Curto A, van de Vooren K. Western European markets for biosimilar and generic drugs: worth differentiating. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2015; 16:683-687. [PMID: 25791078 DOI: 10.1007/s10198-015-0684-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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84
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Garattini L, Curto A, Freemantle N. Personalized medicine and economic evaluation in oncology: all theory and no practice? Expert Rev Pharmacoecon Outcomes Res 2015; 15:733-8. [PMID: 26289733 DOI: 10.1586/14737167.2015.1078239] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The clinical definition of personalized medicine (PM) is closely related to that of pharmacogenomics. Ideally, PM could lead the pharmaceutical industry to differentiate products by subgroups of patients with the same pathology and find new gene targets for drug discovery. Here, we focus on the potential impact of PM on the design of clinical trials and economic evaluations limited to oncology (its first and main field of application). Then, we assess the European economic evaluations focused on trastuzumab and cetuximab, the two drugs usually mentioned as emblematic examples of targeted therapies. Clinical results of PM in oncology have not been as encouraging as hoped so far. Of course, economic evaluations on targeted therapies cannot help overcome the lack of clinical evidence for most of them. The two paradigmatic examples of cetuximab and trastuzumab indicate that the methodological implications on economic evaluations debated in the literature are more theoretical than practical.
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Garattini L, van de Vooren K. Safety and Quality of Generic Drugs: A Never Ending Debate Fostered by Economic Interests? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2015; 13 Suppl 1:S3-S4. [PMID: 26091711 PMCID: PMC4519587 DOI: 10.1007/s40258-015-0156-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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86
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van de Vooren K, Curto A, Garattini L. Pricing of forthcoming therapies for hepatitis C in Europe: beyond cost-effectiveness? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2015; 16:341-345. [PMID: 25407841 DOI: 10.1007/s10198-014-0653-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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87
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van de Vooren K, Curto A, Freemantle N, Garattini L. Market-access agreements for anti-cancer drugs. J R Soc Med 2015; 108:166-70. [PMID: 25488094 PMCID: PMC4484207 DOI: 10.1177/0141076814559626] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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88
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van de Vooren K, Curto A, Garattini L. Biosimilar versus generic drugs: same but different? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2015; 13:125-127. [PMID: 25652151 DOI: 10.1007/s40258-015-0154-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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89
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Garattini L, Curto A, van de Vooren K. Long-term modeling on HPV vaccination: do we really need any more? Expert Rev Pharmacoecon Outcomes Res 2015; 15:191-4. [DOI: 10.1586/14737167.2015.1023297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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90
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Garattini L, Curto A, van de Vooren K. Do the current performance-based schemes in Italy really work? "Success fee": a novel measure for cost-containment of drug expenditure. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:352. [PMID: 25773571 DOI: 10.1016/j.jval.2014.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 12/08/2014] [Indexed: 06/04/2023]
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91
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Garattini L, Curto A, van de Vooren K. Italian risk-sharing agreements on drugs: are they worthwhile? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2015; 16:1-3. [PMID: 24728513 DOI: 10.1007/s10198-014-0585-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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92
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Curto A, Duranti S, Van de Vooren K, Garattini L. Vaccination planning and vaccine prices in a decentralizing country - Italy. Expert Rev Pharmacoecon Outcomes Res 2014; 14:195-202. [PMID: 24625038 DOI: 10.1586/14737167.2014.898565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper gives an overview, in the era of regionalization, of vaccination planning and vaccine price management in the Italian National Health Service. In particular, we analyse the current National Vaccination Plan (NVP) and end with two "case studies" of the latest entries in the Italian vaccination calendar, comparing HPV and PCV vaccines, the most expensive ones in Italy at present. The present NVP put an end to the long period without official documents for vaccination planning, mainly reflecting the controversial relationships between the national and regional tiers. However, this document is not really useful for planning from the health professionals' point of view, lacking epidemiological information. Thorough systematic assessment of the new, expensive vaccines is becoming a real priority in the light of current financial difficulties. In this perspective, the two examples discussed have given different results so far, starting from a heterogeneous situation of potential market competition.
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Garattini L, van de Vooren K, Curto A. Cost-effectiveness of trastuzumab in metastatic breast cancer: mainly a matter of price in the EU? Health Policy 2014; 119:212-6. [PMID: 25523144 DOI: 10.1016/j.healthpol.2014.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 11/19/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
Abstract
Trastuzumab (TR), a monoclonal antibody approved by EMA in 2000 and one of the first examples of "targeted therapy", is indicated to treat human epidermal growth factor receptor 2 (HER2) positive breast cancer. TR, whose patent will expire in 2015 in Europe, has been judged positively for reimbursement by most public authorities in the EU. Here we critically review the existing evidence on TR in metastatic breast cancer (MBC), in line with the multidisciplinary health technology assessment (HTA) approach, to assess whether the existing evidence supports TR positive reimbursement decisions taken in MBC by EU health authorities. We did a literature search for the main HTA topics (efficacy, quality of life and ethics) on the PubMed international database (2000-2013). Then, we did a specific literature search to select the full economic evaluations (FEEs) conducted in EU countries focused on TR as first-line innovative therapy in MBC. We retrieved scant evidence in the literature to support TR reimbursement in MBC. We found only two clinical trials and their results were unclear because of the large proportion of patients who crossed over. Moreover, the quality of methods was poor in all four European FEEs selected. This example of HTA exercise on a mature monoclonal antibody in a specific indication casts doubts on how often the reimbursement decisions taken by EU health authorities in emotional pathologies like cancer are rational. These decisions should at least be reconsidered periodically on the basis of the latest evidence.
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Curto A, Garattini L. Comment on: "Current status and trends in performance-based risk-sharing arrangements between healthcare payers and medical product manufacturers". APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2014; 12:565. [PMID: 25124262 DOI: 10.1007/s40258-014-0118-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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95
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Garattini L, van de Vooren K. Are high prices a barrier to human papillomavirus vaccination in the United States? Not in Italy. JAMA Pediatr 2014; 168:584. [PMID: 24886804 DOI: 10.1001/jamapediatrics.2014.49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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96
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Curto S, Ghislandi S, van de Vooren K, Duranti S, Garattini L. Regional tenders on biosimilars in Italy: An empirical analysis of awarded prices. Health Policy 2014; 116:182-7. [DOI: 10.1016/j.healthpol.2014.02.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 02/05/2014] [Accepted: 02/08/2014] [Indexed: 10/25/2022]
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97
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Garattini L, Van de Vooren K, Freemantle N. Tendering and value-based pricing: lessons from Italy on human papilloma virus vaccines. J R Soc Med 2014; 107:4-5. [PMID: 24399770 DOI: 10.1177/0141076813512122] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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98
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van de Vooren K, Duranti S, Curto A, Garattini L. A critical systematic review of budget impact analyses on drugs in the EU countries. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2014; 12:33-40. [PMID: 24158922 DOI: 10.1007/s40258-013-0064-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Budget impact analysis (BIA) is a relatively recent technique that is supposed to be complementary to more established economic evaluations (EEs). OBJECTIVE We reviewed the BIAs published on drugs in the EU since December 2008, to assess whether these studies have improved in quality in the last few years. METHODS We conducted a literature search on the international databases PubMed and EMBASE. The selected articles were screened using a two-step approach to assess (1) their main methodological characteristics and (2) the level of adherence to the latest BIA definition. The assessment was made by two independent reviewers and any disagreement was resolved through discussion. RESULTS Eventually, 17 articles were reviewed. Thirteen referred to a stand-alone BIA not accompanying a full EE, only nine focussed on a new treatment, 15 were sponsored by the manufacturer of the drug of reference, all but one claiming savings for healthcare budgets. The quality of methods was poor in many of the studies, and only a few of them attempted to estimate real local costs in a credible way. Therefore, the crucial items that in theory make a BIA different from other types of EEs were often the major points of weakness of the studies reviewed. CONCLUSIONS Our review confirmed that the BIA is not yet a well-established technique in the literature and many published studies still fail to reach an acceptable quality. In particular, BIAs funded by pharmaceutical companies appear to be tailored to show short-term savings induced by new, highly priced products.
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van de Vooren K, Duranti S, Curto A, Garattini L. Cost effectiveness of the new pneumococcal vaccines: a systematic review of European studies. PHARMACOECONOMICS 2014; 32:29-45. [PMID: 24288207 DOI: 10.1007/s40273-013-0113-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Diseases caused by Streptococcus pneumoniae (pneumococcus) are a major global public health problem. Despite their importance, information on the burden of the different pneumococcal diseases is limited and estimates vary widely. OBJECTIVE AND METHODS We critically reviewed the full economic evaluations (FEEs) on the new pneumococcal conjugate vaccines (PCVs) conducted in the European Union (EU) to assess their potential contribution to public decision making. We selected the FEEs focussed on PCV-10 and PCV-13 and published in English from January 2007 until June 2013. We screened the selected articles to assess their main methodological features using a common checklist composed of epidemiological, clinical and economic items. RESULTS All the ten studies selected were based on modelling and the time horizon was always long term. Two studies focused on adults, the remaining eight on infants. Only one study based herd immunity on national data, eight used foreign data or modelling and the last did not consider it. National prices and tariffs were claimed to be sources for unit costs in all studies; however, half of them assumed price parity when one vaccine was not yet marketed, and the figures varied within the countries where more than one study was conducted. Conclusions supported the economic utility of pneumococcal vaccination in all studies, raising some concern only in (i) the independent study, which found that PCV-13 was borderline cost effective, and (ii) the study sponsored by both manufacturers, which estimated an incremental ratio slightly above the national threshold for both PCV-10 and PCV-13. CONCLUSION The European studies we analysed are mostly based on weak sources of data. Because of the limited information on vaccine effectiveness and lack of epidemiological and economic data, the need for extensive recourse to assumptions leads to great within- and between-study variability generated by authors' choices.
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Garattini L, van de Vooren K. Could co-payments on drugs help to make EU health care systems less open to political influence? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2013; 14:709-713. [PMID: 22961231 DOI: 10.1007/s10198-012-0428-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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