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Babar ZUD. A conceptual framework to build effective medicine pricing policies for low and middle-income countries (LMICs). Res Social Adm Pharm 2024; 20:934-939. [PMID: 38908991 DOI: 10.1016/j.sapharm.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/24/2024] [Accepted: 06/19/2024] [Indexed: 06/24/2024]
Abstract
Building effective medicine pricing policies is a challenging task in all high-, middle- and low-income countries. In high-income countries have stable health systems in place, trained workforce, as well as specialised agencies to evaluate innovative drugs for reimbursement. However, in low- and middle-income countries (LMICs) the challenges are manifold. A large majority of low- and middle-income countries lack technical expertise either to evaluate new medicines or to set efficient medicine prices. The countries also lack comparator reference pricing data to set prices. Also, there are significant out-of-pocket expenditures as people pay for medicines by themselves. An effective medicine pricing policy is vital in the context that it can be used as a tool to improve access and affordability among the masses. This discussion paper presents a conceptual framework to build effective medicine pricing policies for low and middle-income countries (LMICs). The enablers to build effective medicine pricing policies are also discussed. This includes (a) data and statistics on the pharmaceutical situation of the country (b) Having a national medicine policy in the country (c) The availability of the medicine pricing data and (d) Human resources and technical capacity. WHO has recommended several strategies including External Price Referencing (EPR), Internal Reference pricing, Value-based pricing, Cost-plus pricing, and Generic medicine policies to build a pricing policy. However, this information is generic and it's a complex task for countries to tailor to their needs, hence a critical analysis is provided on these policies. The concepts related to fair medicine pricing, providing information to consumers and price transparency are also discussed.
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Fenton E, Ashton J. Pharmacological and ethical comparisons of lung cancer medicine accessibility in Australia and New Zealand. JOURNAL OF MEDICAL ETHICS 2024:jme-2023-109758. [PMID: 39209378 DOI: 10.1136/jme-2023-109758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 08/14/2024] [Indexed: 09/04/2024]
Abstract
Gaps in funded cancer medicines between New Zealand and Australia can have significant implications for patients and their families. Pharmac, the New Zealand pharmaceutical funding agency, has been criticised for not funding enough cancer medicines, and a 2022 review identified ethical concerns about its utilitarian focus on efficiency. However, as the costs of new cancer medicines rise along with public and political pressure to fund them, questions about value for money remain critical for health systems worldwide. In this paper, we compare funding for cancer medicines in New Zealand and Australia, specifically medicines for non-small cell lung cancer. We argue that the ethical imperatives on funding agencies to get value for money and provide medicines for patients with cancer underscore the importance of transparent decision-making processes, including identifying and explaining intercountry differences in funded medicines.
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Affiliation(s)
| | - John Ashton
- Department of Pharmacology and Toxicology, University of Otago, Dunedin, New Zealand
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Camejo N, Castillo C, Amarillo D, de los Santos H, Samurio G, Silva-Marquez A, Sosa F, Vera C, Xavier R, Herrera G, Alonso I, Krygier G. Efficacy of First-Line Treatment With Pertuzumab and Trastuzumab in Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer in Routine Clinical Practice. World J Oncol 2024; 15:454-462. [PMID: 38751695 PMCID: PMC11092421 DOI: 10.14740/wjon1829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/06/2024] [Indexed: 05/18/2024] Open
Abstract
Background The first-line treatment for human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer (MBC) involves a combination of trastuzumab, pertuzumab, and a taxane (TPH). This study assessed the efficacy of trastuzumab and pertuzumab (PH) in routine practice, following the treatment protocols of Uruguay's National Resources Fund (FNR), akin to clinical trials. Methods Patients with advanced MBC treated with PH between 2008 and 2022 per FNR protocols were evaluated. The Kaplan-Meyer method and log-rank test were utilized for analyzing overall survival (OS). Demographic and clinical variables, including age, menopausal status, and hormone receptors (HR), were analyzed. Results The study included 318 PH-treated patients. The median age was 56 years, with 63.2% being postmenopausal and 60.4% HR and HER-2 positive. With a median follow-up of 17.2 months, the median OS was 29 months. OS varied based on HR status and the presence of metastases at different sites, significantly lower in patients with brain, cutaneous/subcutaneous, and pulmonary metastases. Additionally, OS was higher in patients treated at private institutions compared to public ones. Conclusions This study demonstrates the disparity in oncological treatment efficacy between clinical trials and clinical reality in Uruguay, emphasizing the importance of authentic environment research for more representative and effective medicine in Latin America.
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Affiliation(s)
- Natalia Camejo
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Cecilia Castillo
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Dahiana Amarillo
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | | | - Gaston Samurio
- School of Medicine, University of Uruguay, Montevideo, Uruguay
| | | | - Franco Sosa
- School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Claudia Vera
- School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Rocio Xavier
- School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Guadalupe Herrera
- Department of Quantitative Methods, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | | | - Gabriel Krygier
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
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Wang Q, Liu S, Nie Z, Zhu Z, Fu Y, Zhang J, Wei X, Yang L, Wei X. The pan-Canadian Tiered Pricing Framework and Chinese National Volume-Based Procurement: A comparative study using Donabedian's structure-process-outcome framework. J Glob Health 2023; 13:04137. [PMID: 37947028 PMCID: PMC10636597 DOI: 10.7189/jogh.13.04137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Background Generic drugs have been seen as a potentially powerful way to alleviate the financial burden on patients and health care systems. Two strategies for achieving rational prices of generic drugs are tiered pricing framework and pooled purchasing power. We compare the pan-Canadian Tiered Pricing Framework (TPF) and the Chinese National Volume-Based Procurement (NVBP) as comparators to explore the similarities and differences between the two mechanisms and summarise lessons for other jurisdictions. Methods This comparative study applies Donabedian's structure-process-outcome framework to systematically analyse the macro contexts, procedures, and long- and short-term results of each pricing mechanism, and the interactions between them. Results Structure: TPF is an upstream initiative aimed at lowering the prices of generic drugs and increasing coverage and price consistency. NVBP is a downstream national initiative prioritised for reducing drug prices to achieve value-based purchasing. Process: By associating the number of manufacturers with price cuts, TPF leaves the choice to manufacturers to decide if they want to enter a specific market. In contrast, the Chinese government determines NVBP list and has the authority to choose manufacturer(s) with the lowest price(s). TPF provides clear price information to potential suppliers with unclear order quantity. The NVBP drug price is determined by tendering, while procurement volume is clear and massive. Outcome: The effectiveness of TPF and NVBP is similar, with both achieving a 53% price cut. Both TPF and NVBP experienced efficiency improvement since their establishment, with 98 and 86 drugs priced per year. By comparing 60 drugs covered by both programmes, the NVBP price is 57% of that of the TPF counterpart on average (1.1 to 301.6%), by purchase power parity. Conclusions The tiered pricing scheme is feasible in regions with a stable and mature pharmaceutical market, typically seen in high-income countries, while tendering is more workable in low- and middle-income countries where the pharmaceutical market is weak and unstable. Experience in the two countries shows that a coordinated pricing mechanism involves many piecemeal interactive problems, which a sophisticated system with a robust long-range plan may address better.
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Affiliation(s)
- Quan Wang
- School of Public Health, Peking University, Beijing, China
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Siqi Liu
- Center of Health System and Policy, Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Zhijie Nie
- School of Public Health, Peking University, Beijing, China
| | - Zheng Zhu
- School of Public Health, Peking University, Beijing, China
| | - Yaqun Fu
- School of Public Health, Peking University, Beijing, China
| | - Jiawei Zhang
- School of Public Health, Peking University, Beijing, China
| | - Xia Wei
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, England, UK
| | - Li Yang
- School of Public Health, Peking University, Beijing, China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Modiba WK, Katerere DR, Mncwangi NP. A desktop review of evaluation of implementation of national medicines policies in SADC countries. Heliyon 2023; 9:e22218. [PMID: 38045165 PMCID: PMC10692818 DOI: 10.1016/j.heliyon.2023.e22218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 12/05/2023] Open
Abstract
A national medicine policy (NMP), formerly referred to as a national drug policy (NDP) is a document that serves as a political commitment and guide for action by the government to provide safe, efficacious, quality assured, available, affordable and rationally used medicines. This is the first study to review the implemented components of the NMPs of the 16 South African Development Community (SADC) countries over the past ten years (2011-2021). Information published between 2011 and 2021 of each country such as pharmaceutical profiles, official government documents, WHO/HAI/World Bank datasets and research studies on the implemented components were appraised. Significant progress has been made by 16 SADC countries over the period 2011-2021 in implementing the NMP. The most commonly implemented components included the concept of essential medicines, pricing, and regulation. Though traditional and herbal medicines component is yet to be implemented by the majority. The pharmacist-patient ratio of 1:2300 was below the target for all countries, prompting the need to strengthen the pharmacy personnel in the healthcare systems. Medicine pricing, affordability, and availability studies are necessary to develop equitable pricing policies that will improve the accessibility of medicines in all countries and the SADC region. With the exception of the Republic of Tanzania, SADC countries need to urgently revise their NMPs, thus adopting progressive processes such as incorporating Health Technology Assessment (HTA) in the NMP. All SADC countries require a strong, internationalistic evaluation culture built-in their policy formulation. As the first study to investigate the implemented NMPs in the SADC region, it could serve as a springboard for the countries to address their common pharmaceutical challenges thus improving their readiness for universal health coverage (UHC). Future in-depth cross-country studies in the SADC region are necessary to comprehensively evaluate the implemented components of NMPs.
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Affiliation(s)
- William K. Modiba
- Tshwane University of Technology, Department of Pharmaceutical Sciences, Faculty of Science, Private Bag X680, Pretoria, 0001, South Africa
| | - David R. Katerere
- Tshwane University of Technology, Department of Pharmaceutical Sciences, Faculty of Science, Private Bag X680, Pretoria, 0001, South Africa
| | - Nontobeko P. Mncwangi
- Sefako Makgatho Health Sciences University, School of Pharmacy, Faculty of Medicine, Medunsa, 0204, South Africa
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Tenorio-Mucha J, Lazo-Porras M, Zafra J, Ewen M, Beran D. Using government data to understand the use and availability of medicines for hypertension and diabetes: lessons from Peru. J Pharm Policy Pract 2022; 15:86. [DOI: 10.1186/s40545-022-00481-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Regular measurement of the availability and use of key medicines for non-communicable diseases allows the tracking of progress to achieve equitable access to medicines. Using a country-level public sector monitoring system for medicine supply, we aim to evaluate the availability and use of losartan 50 mg tablets and metformin 850 mg tablets between 2015 and 2020 investigating the impact of different policy changes and the COVID-19 pandemic.
Methods
Data from the Peruvian National System of Medicine Supply were analyzed using an interrupted time series analysis with known and unknown structural breaks. The outcomes assessed were medicine use (monthly doses dispensed at facilities over time) and medicine availability (proportion of facilities that reported having the medicine available).
Results
The use of losartan and metformin at the primary level of care had a linear increasing trend over the period of analysis. In secondary and tertiary levels of care, there were no increases but some significant level and trend changes of doses dispensed at different times between 2017 to 2019, but none were related to the change of procurement procedures. At all levels of care, the COVID-19 onset in April 2020 caused an abrupt drop in doses dispensed especially at the primary level. Regarding availability, we found an increasing linear trend in the primary level of care for both medicines. In secondary and tertiary levels of care, the availability fluctuated between 40 and 95%. The onset of the COVID-19 pandemic did not significantly impact medicine availability, except for losartan in the tertiary level of care.
Conclusion
The availability and proper dispensing of first-line medicines for hypertension and diabetes is an essential factor for sustainable and equitable treatment. Health care systems need to be prepared for forecasting the increasing demand of medicines for chronic diseases, but also to maintain effective medicine supply chains during humanitarian crisis like pandemics.
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Stafinski T, Glennie J, Young A, Menon D. HTA decision-making for drugs for rare diseases: comparison of processes across countries. Orphanet J Rare Dis 2022; 17:258. [PMID: 35804398 PMCID: PMC9264608 DOI: 10.1186/s13023-022-02397-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/11/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Drugs for rare diseases (DRDs) offer important health benefits, but challenge traditional health technology assessment, reimbursement, and pricing processes due to limited effectiveness evidence. Recently, modified processes to address these challenges while improving patient access have been proposed in Canada. This review examined processes in 12 jurisdictions to develop recommendations for consideration during formal government-led multi-sectoral discussions currently taking place in Canada.
Methods (i) A scoping review of DRD reimbursement processes, (ii) key informant interviews, (iii) a case study of evaluations for and the reimbursement status of a set of 7 DRDs, and (iv) a virtual, multi-stakeholder consultation retreat were conducted. Results Only NHS England has a process specifically for DRDs, while Italy, Scotland, and Australia have modified processes for eligible DRDs. Almost all consider economic evaluations, budget impact analyses, and patient-reported outcomes; but less than half accept surrogate measures. Disease severity, lack of alternatives, therapeutic value, quality of evidence, and value for money are factors used in all decision-making process; only NICE England uses a cost-effectiveness threshold. Budget impact is considered in all jurisdictions except Sweden. In Italy, France, Germany, Spain, and the United Kingdom, specific factors are considered for DRDs. However, in all jurisdictions opportunities for clinician/patient input are the same as those for other drugs. Of the 7 DRDs included in the case study, the number that received a positive reimbursement recommendation was highest in Germany and France, followed by Spain and Italy. No relationship between recommendation type and specific elements of the pricing and reimbursement process was found. Conclusions Based on the collective findings from all components of the project, seven recommendations for possible action in Canada are proposed. These focus on defining “appropriate access”, determining when a “full” HTA may not be needed, improving coordination among stakeholder groups, developing a Canadian framework for Managed Access Plans, creating a pan-Canadian DRD/rare disease data infrastructure, genuine and continued engagement of patient groups and clinicians, and further research on different decision and financing options, including MAPs. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02397-4.
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Affiliation(s)
- Tania Stafinski
- Health Technology and Policy Unit, School of Public Health, University of Alberta, Edmonton, T6G 1C9, Canada
| | - Judith Glennie
- J. L. Glennie Consulting Inc., Knowledge Broker Consultant, PRISM Research Collaborative, Aurora, Canada
| | - Andrea Young
- Health Technology and Policy Unit, School of Public Health, University of Alberta, Edmonton, T6G 1C9, Canada
| | - Devidas Menon
- Health Technology and Policy Unit, School of Public Health, University of Alberta, Edmonton, T6G 1C9, Canada.
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Sarfraz M, Raza M, Khalid R, Liu T, Li Z, Niyomdecha L. Consumer Purchasing Behavior Toward Green Environment in the Healthcare Industry: Mediating Role of Entrepreneurial Innovation and Moderating Effect of Absorptive Capacity. Front Public Health 2022; 9:823307. [PMID: 35186878 PMCID: PMC8850387 DOI: 10.3389/fpubh.2021.823307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022] Open
Abstract
Entrepreneurial innovations lead to transformations in the existing business model, involving them integrating the new knowledge into the established entrepreneurial activities. The current study combines marketing strategies, entrepreneurial innovation, absorptive capacity, and consumer purchasing behavior in the health sector. This study investigates the impact of packaging and labeling strategies on entrepreneurial innovation and consumer purchasing behavior. Therefore, this study also investigates the mediating effect of entrepreneurial innovation between packaging and labeling strategies and consumer purchasing behavior. The study examines the moderating role of absorptive capacity between entrepreneurial innovation and consumer purchasing behavior. While using convenience sampling, this study used the consumer of medications as a sample from China. The research adopted a quantitative method to conduct the study analysis. A well-structured questionnaire with a 5-point Likert scale has used for the study analysis. The adopted questionnaires were utilized in data collection with 702 with a 70% response rate, and Smart PLS was used to analyze the data. The findings of this study indicate that packaging and labeling strategies significantly influence entrepreneurial innovation and consumer purchasing behavior. Entrepreneurial innovation significantly mediates the packaging and labeling strategies and consumer purchasing behavior. The moderating role of absorptive capacity significantly affects entrepreneurial innovation and consumer purchasing behavior. The implications of the investigated model with innovative marketing strategies give new insights for managerial, policymakers, and research perspectives.
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Affiliation(s)
| | - Mohsin Raza
- Faculty of Management Sciences, Phuket Rajabhat University, Phuket, Thailand
| | - Rimsha Khalid
- Department of Business Management, Limkokwing University of Creative Technology, Cyberjaya, Malaysia
| | - Tong Liu
- Office of Academic Affairs, Zhenjiang College, Zhenjiang, China
- *Correspondence: Tong Liu
| | - Zeyu Li
- Jingjiang College, Jiangsu University, Zhenjiang, China
| | - Lubna Niyomdecha
- Department of Human Resource Management, Faculty of Management, Phuket Rajabhat University, Phuket, Thailand
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Ziolkowski MI, Gomes GS, Piegas EM, Parisotto AJ, Bittencourt RA, Haas SE. Judicialization of health: lawsuits for access to medicines in Uruguaiana-RS. ABCS HEALTH SCIENCES 2021. [DOI: 10.7322/abcshs.2019105.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Introduction: In Brazil, the right to health has a constitutional and universal provision. However, the judicial route has been widely used to access health goods and services. Objective: To analyze the lawsuits of medicines filed by citizens of a Brazilian municipality. Methods: Quantitative and retrospective study evaluating 652 lawsuits filed in 2016 conducted in Uruguaiana, state of Rio Grande do Sul. The information was made available by the State Department of Health. Results: 55.5% of lawsuits filed were related to drugs provided by the public health system Sistema Único de Saúde (SUS). 44.5% did not fit into the guidelines of the Brazilian Policy for Pharmaceutical Services. Most of the lawsuits were filed by women over 60 years old. Regarding the therapeutic classification, the most requested drugs were for the nervous system. The most described pathological condition according to the ICD-10 (International Classification of Diseases) was Diabetes Mellitus. Conclusion: These data corroborate the situation found in other parts of the country, demonstrating the need to reorganize the Pharmaceutical Service Policy to ensure universal and equitable access to medicines, as described in the Federal Constitution.
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Yamoah L, Dragojlovic N, Smith A, Lynd LD, Marra CA. Evaluating New Zealanders' Values for Drug Coverage Decision Making: Trade-Offs between Treatments for Rare and Common Conditions. PHARMACOECONOMICS 2021; 39:109-119. [PMID: 33150565 DOI: 10.1007/s40273-020-00974-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND New Zealand's near static healthcare budget limits access to expensive medications including those for rare conditions. As such, it is necessary to know the public's priority for values in the drug funding decision-making process. OBJECTIVES The objectives of this study were to measure the relative societal importance of values of New Zealanders in informing drug funding decisions and to determine how New Zealanders trade off funding in various scenarios between common and rare diseases. METHODS An online survey was conducted between 17 April and 17 May, 2019 on a sample of 500 New Zealanders aged ≥ 18 years. Participants ranked 13 values using an analytical hierarchy process. Participants were then presented with different trade-off scenarios to measure their attitudes towards funding drugs for common and rare diseases. RESULTS The values ranked in the top five by most were potential effect on quality of life (71.8%), ability of the drug to work (57.6%), severity (57.6%), safety (57%), and potential to extend life (56%). Adherence and rarity held the lowest and second lowest ranking. Most believe that resources should be allocated towards drugs that have been proven to work and have the greatest health benefits. In trade-offs between access to an expensive drug therapy for a rare disease with uncertain benefits or receive a fixed cash payment, the overwhelming consensus was to receive the cash payment. CONCLUSIONS New Zealanders ultimately value drug-related factors (e.g. quality of life and efficacy) and disease-related factors (e.g. severity of disease and equity) the most but did not value disease rarity.
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Affiliation(s)
- Linda Yamoah
- Pharmacy Intern, Wellington, New Zealand
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Nick Dragojlovic
- Collaboration for Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Alesha Smith
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Larry D Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Carlo A Marra
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
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Zampirolli Dias C, Godman B, Gargano LP, Azevedo PS, Garcia MM, Souza Cazarim M, Pantuzza LLN, Ribeiro-Junior NG, Pereira AL, Borin MC, de Figueiredo Zuppo I, Iunes R, Pippo T, Hauegen RC, Vassalo C, Laba TL, Simoens S, Márquez S, Gomez C, Voncina L, Selke GW, Garattini L, Kwon HY, Gulbinovic J, Lipinska A, Pomorski M, McClure L, Fürst J, Gambogi R, Ortiz CH, Canuto Santos VC, Araújo DV, Araujo VE, Acurcio FDA, Alvares-Teodoro J, Guerra-Junior AA. Integrative Review of Managed Entry Agreements: Chances and Limitations. PHARMACOECONOMICS 2020; 38:1165-1185. [PMID: 32734573 DOI: 10.1007/s40273-020-00943-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Managed entry agreements (MEAs) consist of a set of instruments to reduce the uncertainty and the budget impact of new high-priced medicines; however, there are concerns. There is a need to critically appraise MEAs with their planned introduction in Brazil. Accordingly, the objective of this article is to identify and appraise key attributes and concerns with MEAs among payers and their advisers, with the findings providing critical considerations for Brazil and other high- and middle-income countries. METHODS An integrative review approach was adopted. This involved a review of MEAs across countries. The review question was 'What are the health technology MEAs that have been applied around the world?' This review was supplemented with studies not retrieved in the search known to the senior-level co-authors including key South American markets. It also involved senior-level decision makers and advisers providing guidance on the potential advantages and disadvantages of MEAs and ways forward. RESULTS Twenty-five studies were included in the review. Most MEAs included medicines (96.8%), focused on financial arrangements (43%) and included mostly antineoplastic medicines. Most countries kept key information confidential including discounts or had not published such data. Few details were found in the literature regarding South America. Our findings and inputs resulted in both advantages including reimbursement and disadvantages including concerns with data collection for outcome-based schemes. CONCLUSIONS We are likely to see a growth in MEAs with the continual launch of new high-priced and often complex treatments, coupled with increasing demands on resources. Whilst outcome-based MEAs could be an important tool to improve access to new innovative medicines, there are critical issues to address. Comparing knowledge, experiences, and practices across countries is crucial to guide high- and middle-income countries when designing their future MEAs.
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Affiliation(s)
- Carolina Zampirolli Dias
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Ludmila Peres Gargano
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Pâmela Santos Azevedo
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Marina Morgado Garcia
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Maurílio Souza Cazarim
- Department of Pharmaceutical Sciences, Pharmacy School, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Minas Gerais, Brazil
| | - Laís Lessa Neiva Pantuzza
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
| | - Nelio Gomes Ribeiro-Junior
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - André Luiz Pereira
- Gerência de Planejamento, Monitoramento e Avaliação Assistenciais Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marcus Carvalho Borin
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Isabella de Figueiredo Zuppo
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | | | - Tomas Pippo
- Pan American Health Organization (PAHO), Brasília, Brazil
| | - Renata Curi Hauegen
- National Institute of Science and Technology for Innovation on Diseases of Neglected Populations (INCT-IDPN), Center for Technological Development in Health (CDTS), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Carlos Vassalo
- Facultad de Ciencias Médicas, Universidad Nacional del Litoral, Santa Fe, Argentina
| | - Tracey-Lea Laba
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Haymarket, Sydney, NSW, Australia
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Louvain, Belgium
| | - Sergio Márquez
- Economista, Administradora de los Recursos del Sistema General de Seguridad Social en Salud (ADRES), Bogotá, Colombia
| | - Carolina Gomez
- Think Tank "Medicines, Information and Power", National University of Colombia, Bogotá, Colombia
| | | | | | - Livio Garattini
- CESAV, Centre for Health Economics, IRCCS Institute for Pharmacological Research 'Mario Negri', Ranica, Bergamo, Italy
| | - Hye-Young Kwon
- Division of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, United Kingdom
- College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Jolanta Gulbinovic
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, Vilnius, Lithuania
| | - Aneta Lipinska
- Agency for Health Technology Assessment and Tariff System (AOTMiT), Warsaw, Poland
| | - Maciej Pomorski
- Agency for Health Technology Assessment and Tariff System (AOTMiT), Warsaw, Poland
| | - Lindsay McClure
- Procurement, Commissioning and Facilities, NHS National Services Scotland, Edinburgh, UK
| | - Jurij Fürst
- Health Insurance Institute, Ljubljana, Slovenia
| | | | | | | | - Denizar Vianna Araújo
- Secretariat of Science, Technology and Strategic Inputs, Ministry of Health, Brasília, Brazil
| | - Vânia Eloisa Araujo
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- Pontifical Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Francisco de Assis Acurcio
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Juliana Alvares-Teodoro
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Augusto Afonso Guerra-Junior
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil.
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil.
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Al-Omar HA, Attuwaijri AA, Aljuffali IA. Pharmaceutical companies' views on a health technology assessment (HTA) entity in Saudi Arabia. Saudi Pharm J 2020; 28:662-668. [PMID: 32550796 PMCID: PMC7292859 DOI: 10.1016/j.jsps.2020.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/17/2020] [Indexed: 11/24/2022] Open
Abstract
Saudi Arabia is undergoing a massive healthcare transformation to fulfill its new, national "Vision 2030." To align with this objective, Saudi Arabia is establishing a new, independent and evidence-based health technology assessment (HTA) entity to help it maximize health gains through efficient use of resources. This study was designed to ascertain how pharmaceutical companies perceive the creation of such a national HTA entity in Saudi Arabia; what they think about it and expect from it. To achieve the study's aim, we held a workshop in Riyadh, Saudi Arabia, lasting four and a half hours and hosted by the Saudi Ministry of Health (MOH). We invited 16 market access directors and managers from different multinational pharmaceutical companies to discuss the establishment of a national HTA entity. The findings from the workshop were structured around three axes: vision and remit; HTA method; and implementation and practical considerations. Overall, the pharmaceutical company participants were positive about HTA's value for the Saudi healthcare system and expressed willingness to adapt to meet its future requirements.
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Affiliation(s)
- Hussain Abdulrahman Al-Omar
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia.,Advisor for the Saudi Health Technology Assessment Center, Ministry of Health, Riyadh, Saudi Arabia
| | | | - Ibrahim Abdulrahman Aljuffali
- Department of Pharmaceutics, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia.,Advisor to the Minister of Health for Pharmaceutical Sector Development; Chief Strategic Purchasing Officer, Program for Health Assurance and Purchasing of Health Services (PHAP), Ministry of Health, Riyadh, Saudi Arabia
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Dabbous M, Chachoua L, Caban A, Toumi M. Managed Entry Agreements: Policy Analysis From the European Perspective. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:425-433. [PMID: 32327159 DOI: 10.1016/j.jval.2019.12.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/05/2019] [Accepted: 12/27/2019] [Indexed: 05/05/2023]
Abstract
BACKGROUND Mounting pressures on the healthcare system, such as budget constraints and new, costly health technologies reaching the market, have pushed payers and manufacturers to engage in managed entry agreements (MEAs) to address uncertainty and facilitate market access. OBJECTIVES This study was conducted to illustrate the current landscape of MEAs in Europe and to analyze the main hurdles they face in implementation, providing a policy perspective. METHODS We conducted a health policy analysis based on a literature review and described the emergence, classification, current use, and implementation obstacles of MEAs in Europe. RESULTS Throughout Europe, uncertainty and high prices of health technologies have pushed stakeholders towards MEAs. Two main types of MEAs were applied heavily, finance-based agreements (FBAs) and performance-based agreements, including individual performance-based agreements and coverage with evidence development (CED). Service-based agreements have not been as heavily considered so far, yet are increasingly used. Many European countries are turning to CEDs to address uncertainty and facilitate market access while negotiating the pricing and reimbursement rates of products. Despite the interest in CEDs, European countries have moved toward FBAs due to the complexities and burdens associated with PBAs. CONCLUSIONS Ultimately, in Europe, with the exception of Italy, where MEAs have proven to be inefficient, MEAs are predominantly FBAs dedicated to addressing cost containment from payers' perspective and external reference pricing from the manufacturers' perspective. It has been speculated that MEAs will disappear in the medium-term as they are counterproductive for extending patient access and emergence of innovation. To inform value-based decision making and allow early access to innovative medicines, CEDs should be revisited.
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