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Bergh N, Lindmark K, Lissdaniels J, Lanne G, Käck O, Cowie MR. Estimating the clinical and budgetary impact of using angiotensin receptor neprilysin inhibitor as first line therapy in patients with HFrEF. ESC Heart Fail 2024; 11:1153-1162. [PMID: 38279516 DOI: 10.1002/ehf2.14551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 08/30/2023] [Accepted: 09/21/2023] [Indexed: 01/28/2024] Open
Abstract
AIMS Recent updates of international treatment guidelines for heart failure with reduced ejection fraction (HFrEF) differ regarding the use of angiotensin receptor neprilysin inhibitor (ARNI) as first-line treatment. The American Heart Association/American College of Cardiology/Heart Failure Society of America (AHA/ACC/HFSA) 2022 guidelines gives ARNI a Class IA recommendation for HFrEF patients while the European Society of Cardiology's guidelines are less clear when ARNI could be considered as first line treatment option in de novo patients. This study aimed to model the clinical and budgetary outcomes of implementing these guidelines, comparing conservative ARNI prescription patterns with less conservative in Sweden and in the United Kingdom. METHODS AND RESULTS A health economic model was developed to compare different treatment patterns for HFrEF. Incident cohorts were included on an annual basis and followed over 10 years. The model included treatment specific all-cause mortality and hospitalization rates, as well as drug acquisition, monitoring, and hospitalization costs. Increasing the use of ARNI could lead to about 7000-12 300 life years gained and 2600-4600 hospitalizations prevented in Sweden. These health benefits come with an additional cost of 112-195 million euros. Similar results were estimated for the United Kingdom, albeit on a larger population. CONCLUSIONS Increasing the proportion of patients receiving ARNI instead of angiotensin converting enzyme inhibitors as first-line treatment of HFrEF will lead to a considerable number of additional life years gained and prevented hospitalizations but with additional cost in terms of health care expenditure in Sweden and in the United Kingdom.
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Affiliation(s)
- Nicklas Bergh
- Department of Clinical and Molecular Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Krister Lindmark
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | | | | | - Oskar Käck
- Novartis Innovative Medicines, Kista, Sweden
| | - Martin R Cowie
- School of Cardiovascular Medicine, Faculty of Lifesciences & Medicine, King's College London (Royal Brompton Hospital, Guy's & St Thomas' NHS Foundation Trust), London, UK
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Son KB. Does the first generic exclusivity system provide an economic incentive for early generic entrance under the patent linkage system? Front Public Health 2023; 11:1120729. [PMID: 37601172 PMCID: PMC10435867 DOI: 10.3389/fpubh.2023.1120729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction A period of exclusivity for the first generics, as part of the patent linkage system, was established in South Korea to provide an economic incentive for early generic entry. This study describes the dynamics of generic penetration and assesses the first mover market share advantages under the patent linkage system. Methods Pairs of originators and their corresponding generics granted the first generic exclusivity from 2015 to 2020 were identified. We categorized generics into first movers and latecomers, described the penetration curves of generics, and estimated the saturated market share of generics, first movers, and latecomers. Volume-based monthly prescriptions were used to describe the generics' penetration curves. A logistic growth model was adopted to estimate the saturated market shares of generics. Results We identified 28 pairs of originators and generics, presented penetration curves, and estimated generics market shares. The saturated market share of generics was 30%, and the time to saturation was approximately 33 months. The shapes of penetration varied by nationality, route, and number of generics. The existence of latecomers was associated with the decreased penetration speed over time and decreased market share of generics. However, the first mover market share advantages or latecomers' disadvantages were consistently observed. Conclusion The generic uptake in South Korea is delayed, limited, and context-dependent. However, first generics' market share advantage suggests that a period of exclusivity, as part of the patent linkage system, could provide an economic incentive for early generic entrance.
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Affiliation(s)
- Kyung-Bok Son
- College of Pharmacy, Hanyang University, Ansan, Gyeonggi-do, Republic of Korea
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Perna S, Cangini A, Marini R, Guerrizio MA, Da Cas R, Traversa G, Trotta F. Dynamics of price competition in Italian pharmaceutical off-patent market. Front Med (Lausanne) 2022; 9:1045374. [DOI: 10.3389/fmed.2022.1045374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/04/2022] [Indexed: 11/30/2022] Open
Abstract
IntroductionThe aim of the study was to evaluate, in a regulated generics market, the effect of the number of manufacturers of generic drugs on the amplitude of off-patent products price reduction and the price evolution of originators and generics after the patent expiry of pharmaceuticals dispensed by community pharmacies and reimbursed by the Italian National Health Service (INHS).MethodsThe AIFA “transparency list” was utilized to select unbranded and branded off-patent drug dispensed by community pharmacies and reimbursed by the Italian National Health Service between 2012 and 2018. The unbranded drug entry in the transparency list database was considered as a proxy of its patent expiry.ResultsA total of 42 different active ingredients were included in the analysis. The relative price per dose at time t of unbranded and branded drugs, considering as common denominator the price per dose a year before the patent expiry, (t-1) decreased with the increase of unbranded manufacturers. At the time of the patent expiry, the price of unbranded drugs was almost 50% less than that of branded drugs at t-1 and the price of branded drugs started to decrease before the first unbranded entry.ConclusionAn inverse relation between the number of generic drug entrants and the price of generics and originators was detected. The patent expiry determines a price decline, more concentrated in the first year of patent expiry.
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Kovács B, Darida M, Simon J. Drugs Becoming Generics-The Impact of Genericization on the Market Performance of Antihypertensive Active Pharmaceutical Ingredients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189429. [PMID: 34574353 PMCID: PMC8465659 DOI: 10.3390/ijerph18189429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/31/2021] [Indexed: 11/24/2022]
Abstract
To explore long-term changes in intra and inter-class choices between generic compounds, this paper investigates the market trends of two antihypertensive drug classes that have closely related pharmacological mechanisms—angiotensin convertase enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). We analysed the development of ACEI and ARB markets between 2001 and 2016 in nine European countries, covering the genericization transition periods of both therapeutic groups. The analysis was undertaken on the level of the active pharmaceutical ingredients (API) and focused on international and country-specific diffusion patterns. Comparison of ARB and ACEI therapies shows that although ARBs became off-patent during the observed period, and have a clinical advantage in terms of the adverse event profile over ACEIs, the increasing dominance of ARBs cannot be identified. One explanation is that ACEI therapies became generics earlier, relocating competition to the level of brands, while competition among ARBs remained at the level of the APIs. As for intra-class drug preferences, it was observed that the long-term trends show that ramipril outperformed its ACEI competitors, even though the kinetics and the rank order of preferred active compounds were inconsistent among markets. The diffusion of clinically preferable therapies seems to be ultimately supported by generic entries. In Eastern European countries, the emergence of generic markets has not only improved access to ACE inhibitors and ARBs, but has been a prerequisite for changing preferences. In contrast, genericization resulted in the relative anchoring of prior, branded era-based preferences in some Western European countries, which may be attributed to the role of the cessation of promotion and the fixity of prescription behaviour.
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Affiliation(s)
- Bence Kovács
- Institute of Marketing, Corvinus University of Budapest, 1093 Budapest, Hungary;
- Global Pipeline and Portfolio Project Management Department, Gedeon Richter Plc., 1103 Budapest, Hungary
- Correspondence:
| | - Miklós Darida
- Medical Division, Gedeon Richter Plc.,1103 Budapest, Hungary;
| | - Judit Simon
- Institute of Marketing, Corvinus University of Budapest, 1093 Budapest, Hungary;
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Attitude and Purchase Intention to Generic Drugs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094579. [PMID: 33925923 PMCID: PMC8123425 DOI: 10.3390/ijerph18094579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/28/2022]
Abstract
Generic drugs were instituted in 1984 in the United States. Since that time, many studies have been conducted in several countries into consumer attitude and behavior when purchasing generic drugs. Understanding the factors that can influence attitude and purchasing intention in this segment has been a challenge. Thus, this paper aims to present a mapping of the literature on the attitude toward and intention to purchase generic drugs and capture insights that can help define and improve promotional strategies for the use of these products. To identify articles related to the theme, we selected the Web of Science, Science Direct, Scopus, Lilacs, Pubmed Central, Springer, and Embase databases time limited to June 2020, using the keywords “generic drug”, “purchase intention”, and “attitude”. The results indicate that this topic is relatively new, with publications in the leading journals in the area demonstrating its importance. Analysis revealed five strategic insights and showed that the research theme could be grouped into three clusters: (i) consumer attitude and behavior, (ii) perspective of patients and health professionals, and (iii) assessment of the risks associated with generic medications to determine which factors can influence purchase intention, providing decision makers with a broader view with regard to directing public policy strategies in healthcare.
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AlRuthia Y, Aljohani B, Alsharif WR, Alrasheed HH, Alghamdi BM, Asiri S, Alarfaj M, Almuaythir GS, Almazrou S, Almazroo O, Alaofi A, Alenazi R. Prospects of Establishing a Saudi Version of the United States Food and Drug Administration Orange Book. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2020.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Serra-Sastre V, Bianchi S, Mestre-Ferrandiz J, O'Neill P. Does NICE influence the adoption and uptake of generics in the UK? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:229-242. [PMID: 33284426 PMCID: PMC7881963 DOI: 10.1007/s10198-020-01245-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 11/09/2020] [Indexed: 06/12/2023]
Abstract
The aim of this paper is to examine generic competition in the UK, with a special focus on the role of Health Technology Assessment (HTA) on generic market entry and diffusion. In the UK, where no direct price regulation on pharmaceuticals exists, HTA has a leading role for recommending the use of medicines providing a non-regulatory aspect that may influence the dynamics in the generic market. The paper focuses on the role of Technology Appraisals issued by the National Institute for Health and Care Excellence (NICE). We follow a two-step approach. First, we examine the probability of generic entry. Second, conditional on generic entry, we examine the determinants of generic market share. We use data from IQVIA British Pharmaceutical Index (BPI) for the primary care market for 60 products that lost patent between 2003 and 2012. Our results suggest that market size remains one of the main drivers of generic entry. After controlling for market size, intermolecular substitution and difficulty of manufacturing increase the likelihood of generic entry. After generic entry, our estimates suggest that generic market share is highly state dependent. Our findings also suggest that while NICE recommendations do influence generic uptake, there is only marginal evidence they affect generic entry.
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Affiliation(s)
- Victoria Serra-Sastre
- Department of Economics, City, University of London, London, UK.
- Department of Health Policy, London School of Economics and Political Science, London, UK.
- Association of the British Pharmaceutical Industry, London, UK.
| | - Simona Bianchi
- Association of the British Pharmaceutical Industry, London, UK
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Mills M, Kanavos P. Do pharmaceutical budgets deliver financial sustainability in healthcare? Evidence from Europe. Health Policy 2020; 124:239-251. [DOI: 10.1016/j.healthpol.2019.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/25/2019] [Accepted: 12/06/2019] [Indexed: 11/25/2022]
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Souliotis K, Golna C, Kani C, Markantonis S. Exploring knowledge and perceptions on generic drugs of final year pharmacy school students in Greece. Expert Rev Pharmacoecon Outcomes Res 2019; 19:569-574. [PMID: 30658041 DOI: 10.1080/14737167.2019.1571412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: The economic crisis in Greece has triggered an extensive public debate about the use of generic drugs (generics). Despite their cost-saving potential, generic market penetration remains very low. This raises questions on awareness of, perception on and preference for generics by health-care professionals and patients. This is a descriptive study on the level of knowledge and attitudes towards generics of final year pharmacy school students in Greece. Methods: An electronic questionnaire was distributed to 173 senior pharmacy school students in three Universities in Greece. Responses were submitted electronically. Results: The majority of students knew that generics contain the same active ingredient as the originator products and are cheaper. Students were somehow concerned with safety and efficacy of generics. The majority of students agreed that pharmacists should probably recommend the use of generics, and indicated that prescribing and dispensing practices would largely depend on the profit margin. Despite more than half of the students expressing a positive attitude towards generics, they were inadequately educated on their features. Conclusion: It is critical to improve knowledge of and preference for generics amongst health-care professionals from early on if to build the trust required to increase generic market penetration and achieve measurable savings in pharmaceutical expenditure.
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Affiliation(s)
- Kyriakos Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese , Corinth , Greece.,Health Policy Institute , Athens , Greece
| | | | - Chara Kani
- Faculty of Social and Political Sciences, University of Peloponnese , Corinth , Greece
| | - Sophia Markantonis
- Department of Pharmacy, National and Kapodistrian University of Athens , Athens , Greece
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Domeyer PJ, Katsari V, Sarafis P, Aletras V, Niakas D. Greek students' attitudes, perception and knowledge regarding generic medicines in times of economic crisis: a cross-sectional study. BMC MEDICAL EDUCATION 2018; 18:262. [PMID: 30442145 PMCID: PMC6238271 DOI: 10.1186/s12909-018-1379-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 11/02/2018] [Indexed: 05/09/2023]
Abstract
BACKGROUND The penetration of generic medicines in the pharmaceutical market is influenced, among others, by the consumer's attitude upon them. The attitude of students in health management and recent alumni is particularly important, as they constitute tomorrow's policymakers. The aim of our study was to assess their attitude, perception and knowledge towards generic medicines. METHODS A cross-sectional study was undertaken, involving students in Health Management and recent alumni. The ATtitude TOwards GENerics (ATTOGEN) validated questionnaire was used, which consists of 18 items, yielding 6 scales (trust, state audit, knowledge, drug quality, drug substitution and fiscal impact), with all item responses expressed on a 5-point Likert scale and higher scores denoting greater disagreement. Correlation coefficients were computed and independent sample tests were performed using non-parametrical statistical methods. RESULTS A total of 1402 students were interviewed, with a female predominance (62.88%). The mean (SD) scores for the six scales of the ATTOGEN questionnaire were: Trust: 2.877 (0.940), State audit: 3.251 (0.967), Knowledge: 1.537 (0.688), Drug quality: 2.708 (0.971), Drug substitution: 3.828 (1.127) and Fiscal impact: 2.299 (0.860). Trust over generics was statistically significantly associated with all ATTOGEN scales (all p < 0.001). In addition, the increased level of knowledge about generics was associated with recognition of the generic medicines' quality equivalence (p < 0.001) and positive fiscal impact (p = 0.018). Pharmacists declared having a superior knowledge of generic medicines, being more satisfied with the information they receive about them and strongly believing in drug substitution (p < 0.001). Comparatively to other professionals, pharmacists also indicated substantial differences between branded and generic medicines more often (p < 0.001). They also argued to a greater extent that generic medicines were invented and promoted to resolve the financial crisis of social security institutions at the expense of citizens (p < 0.001). CONCLUSIONS This study demonstrated a mixed attitude of students regarding generic medicines. Trust and knowledge emerged as key factors shaping the students' attitude towards generics. Among students, pharmacists exhibited a distinct response pattern. This study underlines the importance of addressing and correcting health management students' misbeliefs about generics' quality and utility.
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Affiliation(s)
| | - Vasiliki Katsari
- School of Social Sciences, Hellenic Open University, Patras, Greece
| | - Pavlos Sarafis
- Nursing Department, Cyprus University of Technology, Limassol, Cyprus
| | - Vassilis Aletras
- Department of Business Administration, University of Macedonia, Thessaloniki, Greece
| | - Dimitris Niakas
- School of Social Sciences, Hellenic Open University, Patras, Greece
- Μedical School, National and Kapodistrian University of Athens, Athens, Greece
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Guan X, Tian Y, Ross-Degnan D, Man C, Shi L. Interrupted time-series analysis of the impact of generic market entry of antineoplastic products in China. BMJ Open 2018; 8:e022328. [PMID: 30012792 PMCID: PMC6082476 DOI: 10.1136/bmjopen-2018-022328] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The rapid growth of pharmaceutical costs is a major healthcare issue all over the world. The high prices of new drugs, especially those for cancer, are also a concern for stakeholders. Generic drugs are a major price-reducing opportunity and provide more societal value. The aim of this research is to analyse the impact of generic entry on the volume and cost of antineoplastic agents in China. METHODS An interrupted time-series design examined monthly sales of three antineoplastic drugs (capecitabine, decitabine, imatinib) from 699 public hospitals during January 2011 to June 2016. The first generic entry times (December 2013, December 2012, August 2013, respectively) were regarded as the intervention time points. We estimated changes in volume and cost following the generic entry. RESULTS We found that generic entry was associated with increases in the volume of three antineoplastic agents and decreases in their costs. In terms of volume, generic entry was associated with increases in use of capecitabine, decitabine and imatinib by 815.0 (95% CI -66.5 to 1696.5, p>0.05), 11.0 (95% CI 3.7 to 18.3, p=0.004) and 2145.5 (95% CI 1784.1 to 2506.9, p<0.001) units. The entry of generic antineoplastic drugs reduced the monthly cost trend of three agents by ¥3.1 (95% CI -¥3.6 to -¥2.6, p<0.001), ¥84.7 (95% CI -¥104.7 to -¥64.6, p<0.001) and ¥21.3 (95% CI -¥24.2 to -¥18.4, p<0.001), respectively. The entry of generic drugs attenuated the upward trend in volume of three brand-name drugs and even triggered reductions in the volume of brand-name capecitabine. The entry of generics was accompanied by significant increase of ¥2.6 in monthly brand-name decitabine cost (95% CI ¥0.2 to ¥5.1, p=0.04). CONCLUSION Our findings suggested that entry of generic drugs impacted use and cost of antineoplastic medicines in China. Generic drugs may improve the availability and the affordability of antineoplastic agents, which would benefit more patients.
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Affiliation(s)
- Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Ye Tian
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Chunxia Man
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
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Kumru S, Top M. Pricing and reimbursement of generic pharmaceuticals in Turkey: Evaluation of hypertension drugs from 2007 to 2013. HEALTH POLICY AND TECHNOLOGY 2018. [DOI: 10.1016/j.hlpt.2018.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Busse R, van Ginneken E. Cross-country comparative research – Lessons from advancing health system and policy research on the occasion of the European Observatory on Health Systems and Policies’ 20th anniversary. Health Policy 2018; 122:453-456. [DOI: 10.1016/j.healthpol.2018.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Xanthopoulou SS, Katsaliaki K. Policies and perceptions on generic drugs: The case of Greece. Health Serv Manage Res 2018; 32:49-56. [PMID: 29376411 DOI: 10.1177/0951484817752630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The increase in the consumption of generic drugs to reduce pharmaceutical expenditure is a challenge for many countries, especially during the economic crisis. The purpose of the present study is to review the Greek market of generic drugs and the decisions that shape it, to determine the factors that affect Greek patients' and doctors' attitudes about generic substitution and present a set of measures for all stakeholders based on the findings of the secondary and primary analysis. The study includes (a) an analysis of international and national reports and legislation on drugs policies and (b) a questionnaire survey of 242 hospital patients and 85 doctors regarding their perceptions on generics. A small increase in the volume of generics is recorded, yet not followed by sales value, over the recent years that the measures for promoting generics prescription took effect. Distrust from both patients and doctors was observed toward generics' effectiveness and toward the appropriateness of the regulatory authorities' quality controls. The study presents a structured set of viable measures, applicable to many countries, for promoting generic drug consumption that can lead to economic efficiency without degrading the health care quality.
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WOUTERS OLIVIERJ, KANAVOS PANOSG, McKEE MARTIN. Comparing Generic Drug Markets in Europe and the United States: Prices, Volumes, and Spending. Milbank Q 2017; 95:554-601. [PMID: 28895227 PMCID: PMC5594322 DOI: 10.1111/1468-0009.12279] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Policy Points: Our study indicates that there are opportunities for cost savings in generic drug markets in Europe and the United States. Regulators should make it easier for generic drugs to reach the market. Regulators and payers should apply measures to stimulate price competition among generic drugmakers and to increase generic drug use. To meaningfully evaluate policy options, it is important to analyze historical context and understand why similar initiatives failed previously. CONTEXT Rising drug prices are putting pressure on health care budgets. Policymakers are assessing how they can save money through generic drugs. METHODS We compared generic drug prices and market shares in 13 European countries, using data from 2013, to assess the amount of variation that exists between countries. To place these results in context, we reviewed evidence from recent studies on the prices and use of generics in Europe and the United States. We also surveyed peer-reviewed studies, gray literature, and books published since 2000 to (1) outline existing generic drug policies in European countries and the United States; (2) identify ways to increase generic drug use and to promote price competition among generic drug companies; and (3) explore barriers to implementing reform of generic drug policies, using a historical example from the United States as a case study. FINDINGS The prices and market shares of generics vary widely across Europe. For example, prices charged by manufacturers in Switzerland are, on average, more than 2.5 times those in Germany and more than 6 times those in the United Kingdom, based on the results of a commonly used price index. The proportion of prescriptions filled with generics ranges from 17% in Switzerland to 83% in the United Kingdom. By comparison, the United States has historically had low generic drug prices and high rates of generic drug use (84% in 2013), but has in recent years experienced sharp price increases for some off-patent products. There are policy solutions to address issues in Europe and the United States, such as streamlining the generic drug approval process and requiring generic prescribing and substitution where such policies are not yet in place. The history of substitution laws in the United States provides insights into the economic, political, and cultural issues influencing the adoption of generic drug policies. CONCLUSIONS Governments should apply coherent supply- and demand-side policies in generic drug markets. An immediate priority is to convince more physicians, pharmacists, and patients that generic drugs are bioequivalent to branded products. Special-interest groups continue to obstruct reform in Europe and the United States.
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Elek P, Harsányi A, Zelei T, Csetneki K, Kaló Z. Policy objective of generic medicines from the investment perspective: The case of clopidogrel. Health Policy 2017; 121:558-565. [DOI: 10.1016/j.healthpol.2017.02.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 12/23/2016] [Accepted: 02/24/2017] [Indexed: 10/20/2022]
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Wouters OJ, Kanavos PG. A comparison of generic drug prices in seven European countries: a methodological analysis. BMC Health Serv Res 2017; 17:242. [PMID: 28359273 PMCID: PMC5374620 DOI: 10.1186/s12913-017-2184-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 03/23/2017] [Indexed: 11/10/2022] Open
Abstract
Background Policymakers and researchers frequently compare the prices of medicines between countries. Such comparisons often serve as barometers of how pricing and reimbursement policies are performing. The aim of this study was to examine methodological challenges to comparing generic drug prices. Methods We calculated all commonly used price indices based on 2013 IMS Health data on sales of 3156 generic drugs in seven European countries. Results There were large differences in generic drug prices between countries. However, the results varied depending on the choice of index, base country, unit of volume, method of currency conversion, and therapeutic category. The results also differed depending on whether one looked at the prices charged by manufacturers or those charged by pharmacists. Conclusions Price indices are a useful statistical approach for comparing drug prices across countries, but researchers and policymakers should interpret price indices with caution given their limitations. Price-index results are highly sensitive to the choice of method and sample. More research is needed to determine the drivers of price differences between countries. The data suggest that some governments should aim to reduce distribution costs for generic drugs. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2184-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Olivier J Wouters
- LSE Health, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | - Panos G Kanavos
- LSE Health, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
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Zhang W, Sun H, Guh D, Anis AH. The impact of price-cap regulations on market entry by generic pharmaceutical firms. Expert Rev Pharmacoecon Outcomes Res 2016; 17:231-238. [PMID: 27936981 DOI: 10.1080/14737167.2017.1271717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND In 1998, the province of Ontario, Canada implemented price-cap '70/90' regulations: the first generic must be priced at ≤70% of the associated brand-name price and subsequent generics must be priced at ≤90% of the first generics' price. The price-cap was further lowered to 50% in 2006 and 25% in 2010 for all generic drugs regardless of the first or subsequent generic entrants. This study assessed the impact of such price-cap regulations on market entry by generic firms using the formulary database from 9 provinces (January 2004-March 2013). METHODS A logistic regression was estimated to compare the probability of entry during the three policy periods in Ontario ('70/90', '25', versus '50'). Since different price-caps were subsequently introduced in other provinces, Alberta, British Columbia, New Brunswick and Saskatchewan, difference-in-differences was used to compare market entry. RESULTS In Ontario, compared with the period '50', generic firms were 76% and 63% less likely to enter markets in the periods '25' and '70/90', respectively. The difference-in-differences showed that the entry probability decreased the most in Ontario during the '25' period from the '50' period. CONCLUSION Lowering the price-cap level to 25% leads to a significantly lower probability of market entry by generic firms.
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Affiliation(s)
- Wei Zhang
- a Centre for Health Evaluation and Outcome Sciences , St. Paul's Hospital, 588-1081 Burrard Street, Vancouver , BC , Canada.,b School of Population and Public Health , University of British Columbia , Vancouver , BC , Canada
| | - Huiying Sun
- a Centre for Health Evaluation and Outcome Sciences , St. Paul's Hospital, 588-1081 Burrard Street, Vancouver , BC , Canada
| | - Daphne Guh
- a Centre for Health Evaluation and Outcome Sciences , St. Paul's Hospital, 588-1081 Burrard Street, Vancouver , BC , Canada
| | - Aslam H Anis
- a Centre for Health Evaluation and Outcome Sciences , St. Paul's Hospital, 588-1081 Burrard Street, Vancouver , BC , Canada.,b School of Population and Public Health , University of British Columbia , Vancouver , BC , Canada
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Abstract
BACKGROUND In 1998, the Province of Ontario in Canada adopted price-cap "70/90" regulations whereby the first generic entrant was required to be priced at ≤70% of the associated brand-name product and subsequent generics were priced at ≤90% of the first generic price. The price-caps were further lowered to 50% in 2006 and 25% in 2010. This study assessed the impact of such price-cap regulations on exit by generic drug firms. METHODS Formulary (2003-2012) listings of prescription drugs covered under the Ontario Drug Benefit program were used. The formulary tracks the "status" (on formulary, discontinued by manufacturer, and delisted for other reasons) for each drug. Markets were defined based on unique active ingredient and form within Ontario. Firm exit occurred when a manufacturer discontinued all its generic drugs within a market. The exit rate was defined as the number of generic firm-market exits divided by total generic firm-market follow-up years. Poisson regression was used to compare the exit rates during the 3 policy periods ("25," "50," and "70/90"). RESULTS A total of 1126 generic manufacturers paired with 290 markets were identified. The exit rate ratio during the 25% price-cap period compared with the 70%/90% period was 2.42 (95% confidence interval, 1.56-3.77). A small manufacturer or a manufacturer in a market with ≥3 competitors or in an older market was more likely to exit. CONCLUSIONS Lowering the price-cap level is associated with a higher incidence of generic firm exit from markets. Continuously reducing price-caps may have the unintended consequence of forcing generic firms to exit.
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Labiris G, Fanariotis M, Kastanioti C, Alexias G, Protopapas A, Karampitsakos T, Niakas D. Greek Physicians' Perceptions on Generic Drugs in the Era of Austerity. SCIENTIFICA 2015; 2015:251792. [PMID: 26457225 PMCID: PMC4589622 DOI: 10.1155/2015/251792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/24/2015] [Indexed: 05/24/2023]
Abstract
Purpose. To assess the beliefs and preferences of Greek physicians, regarding generic drugs, in the years of financial crisis. Setting. Multicentered, nationwide survey. Material and Methods. A custom questionnaire based on former similar studies was developed and administered to Greek physicians. The variable "perception on generics" was constructed after an exploratory study and the instrument was validated by conventional and Rasch analysis methods. 22 items formed 5 subscales that constructed the variable in question. Results. 908 physicians successfully participated in the study (response rate: 80%). Mean total scores to the instrument were 60.63 ± 12.12 for men and significantly less (58.24 ± 11.73) for women (p = 0.04). Greek physicians were not persuaded on the potential economic gain (45.79 ± 10.53); moreover they identified that Greek authorities cannot address the increased pharmacovigilance mandates. Physicians working in Athens and those working in surgical units demonstrated significantly worse scores than their colleagues from the rest of Greece and those working in Internal Medicine wards (p = 0.03). Conclusion. Our results suggest an overall poor acceptance of the national initiative on generic drugs by Greek physicians. This trial is registered with Clinicaltrials.gov identifier: NCT01855802.
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Affiliation(s)
- Georgios Labiris
- Medical School, Democritus University Medical Campus, 1st Building, 68100 Alexandroupolis, Greece
| | - Michael Fanariotis
- Medical School, Democritus University Medical Campus, 1st Building, 68100 Alexandroupolis, Greece
| | | | - Georgios Alexias
- Faculty of Social Sciences, Hellenic Open University, 26335 Patras, Greece
| | - Adonis Protopapas
- Medical School, Democritus University Medical Campus, 1st Building, 68100 Alexandroupolis, Greece
| | - Theodoros Karampitsakos
- Medical School, Democritus University Medical Campus, 1st Building, 68100 Alexandroupolis, Greece
| | - Dimitris Niakas
- Faculty of Social Sciences, Hellenic Open University, 26335 Patras, Greece
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Wouters OJ, Kanavos PG. Transitioning to a national health system in Cyprus: a stakeholder analysis of pharmaceutical policy reform. Bull World Health Organ 2015; 93:606-13. [PMID: 26478624 PMCID: PMC4581641 DOI: 10.2471/blt.14.148742] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 05/11/2015] [Accepted: 05/11/2015] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To review the pharmaceutical sector in Cyprus in terms of the availability and affordability of medicines and to explore pharmaceutical policy options for the national health system finance reform expected to be introduced in 2016. METHODS We conducted semi-structured interviews in April 2014 with senior representatives from seven key national organizations involved in pharmaceutical care. The captured data were coded and analysed using the predetermined themes of pricing, reimbursement, prescribing, dispensing and cost sharing. We also examined secondary data provided by the Cypriot Ministry of Health; these data included the prices and volumes of prescription medicines in 2013. FINDINGS We identified several key issues, including high medicine prices, underuse of generic medicines and high out-of-pocket drug spending. Most stakeholders recommended that the national government review existing pricing policies to ensure medicines within the forthcoming national health system are affordable and available, introduce a national reimbursement system and incentivize the prescribing and dispensing of generic medicines. There were disagreements over how to (i) allocate responsibilities to governmental agencies in the national health system, (ii) reconcile differences in opinion between stakeholders and (iii) raise awareness among patients, physicians and pharmacists about the benefits of greater generic drug use. CONCLUSION In Cyprus, if the national health system is going to provide universal health coverage in a sustainable fashion, then the national government must address the current issues in the pharmaceutical sector. Importantly, the country will need to increase the market share of generic medicines to contain drug spending.
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Affiliation(s)
- Olivier J Wouters
- LSE Health and Social Care, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, England
| | - Panos G Kanavos
- LSE Health and Social Care, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, England
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Kaló Z, Holtorf AP, Alfonso-Cristancho R, Shen J, Ágh T, Inotai A, Brixner D. Need for multicriteria evaluation of generic drug policies. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:346-51. [PMID: 25773570 DOI: 10.1016/j.jval.2014.12.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 10/26/2014] [Accepted: 12/10/2014] [Indexed: 05/16/2023]
Abstract
Policymakers tend to focus on improving patented drug policies because they are under pressure from patients, physicians, and manufacturers to increase access to novel therapies. The success of pharmaceutical innovation over the last few decades has led to the availability of many off-patent drugs to treat disease areas with the greatest public health need. Therefore, the success of public health programs in improving the health status of the total population is highly dependent on the efficiency of generic drug policies. The objective of this article was to explore factors influencing the true efficiency of generic prescription drug policies in supporting public health initiatives in the developed world. Health care decision makers often assess the efficiency of generic drug policies by the level of price erosion and market share of generics. Drug quality, bioequivalence, in some cases drug formulations, supply reliability, medical adherence and persistence, health outcomes, and nondrug costs, however, are also attributes of success for generic drug policies. Further methodological research is needed to measure and improve the efficiency of generic drug policies. This also requires extension of the evidence base of the impact of generic drugs, partly based on real-world evidence. Multicriteria decision analysis may assist policymakers and researchers to evaluate the true value of generic drugs.
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Affiliation(s)
- Zoltán Kaló
- Faculty of Social Sciences, Department of Health Policy and Health Economics, Eötvös Loránd University (ELTE), Budapest, Hungary; Syreon Research Institute, Budapest, Hungary.
| | - Anke-Peggy Holtorf
- Health Outcomes Strategies, Basel, Switzerland; Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | | | - Jie Shen
- Abbott Products Operations AG, Allschwil, Switzerland
| | - Tamás Ágh
- Syreon Research Institute, Budapest, Hungary
| | | | - Diana Brixner
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
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