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Lim H, Sanci L, Webster S, Wilson AN, Lau P. 'No-Frills Prils': GPs' views on drug costs and therapeutic interchange of angiotensin-converting enzyme inhibitors: a qualitative study. Aust J Prim Health 2021; 27:152-157. [PMID: 33685577 DOI: 10.1071/py20208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/02/2020] [Indexed: 11/23/2022]
Abstract
Medications form a significant portion of spending in primary health care. Angiotensin-converting enzyme inhibitors (ACE-Is) are among the most prescribed blood pressure medications in general practice. Medications within this class are considered therapeutically equivalent, but the cost of each ACE-I varies. Our aim was to explore cost and other factors that influence general practitioners (GPs) to prescribe a specific ACE-I and understand their views on therapeutic interchange within this drug class. We conducted a qualitative study of Australian GPs using thematic analysis. We found that GPs were aware of therapeutic equivalency within the ACE-I class, but unaware of the cost differences. Although GPs tended to adopt a prescribing preference, they were open to fewer prescribing options if there was a decreased cost to patients and the PBS, or potential to minimise prescribing error. Our findings have immediate relevance for national prescribing policies and the Pharmaceutical Benefits Scheme (PBS). The wide selection of ACE-Is that are available results in diverse prescribing patterns and may not be cost-effective for patients or the PBS. Restricting the number of drug options within the ACE-I class in primary care appears to be an acceptable drug cost-containment strategy according to our sample of GPs.
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Affiliation(s)
- Hok Lim
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Level 3, 780 Elizabeth Street, Melbourne, Vic. 3010, Australia; and Corresponding author
| | - Lena Sanci
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Level 3, 780 Elizabeth Street, Melbourne, Vic. 3010, Australia
| | - Susan Webster
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Level 3, 780 Elizabeth Street, Melbourne, Vic. 3010, Australia
| | - Alyce N Wilson
- International Development, Burnet Institute, 85 Commercial Road, Prahran, Vic. 3181, Australia
| | - Phyllis Lau
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Level 3, 780 Elizabeth Street, Melbourne, Vic. 3010, Australia
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Cappello B, Moja L, Figueras A, Magrini N. The "Square Box": Therapeutic Equivalence as a Foundation of the WHO Model List of Essential Medicines. Front Pharmacol 2020; 11:578000. [PMID: 33071791 PMCID: PMC7533616 DOI: 10.3389/fphar.2020.578000] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/26/2020] [Indexed: 12/02/2022] Open
Abstract
Every two years, the World Health Organization (WHO) updates its Model List of Essential Medicines, intended as a guide for countries to adopt or adapt in accordance with local priorities and treatment guidelines, for the development of national essential medicines lists. When more than one therapeutic option is available for a given indication, the WHO Model List often includes a single medicine as representative of a group of equivalent and interchangeable medicines. The representative medicine of that group is listed with an accompanying ‘square box’ symbol. The intended purpose of the square box is to highlight pharmacological classes or groups of medicines for which countries, institutions and health professionals can assume homogeneous therapeutic efficacy and safety and select the most appropriate single medicine based on price, local availability, and acceptability. Though this concept of therapeutic equivalence within a therapeutic class has been endorsed by most authoritative textbooks of pharmacology since Goodman & Gilman’s The Pharmacological Basis of Therapeutics and evidence-based guidelines, marketing forces have often made claims on individual drugs to distinguish them beyond relevant differences shown by reliable evidence: this has generated the concept of “me-too drugs” with its double meaning—i.e., market latecomers differing minimally from products preceding them and whose marketing budgets have significant opportunity costs, or medicines which may be useful to substitute for equivalent products in the event of shortages. The square box concept is applied in the context of a comprehensive list: therapeutic equivalence or interchangeability cannot always be easily established. Different interpretations have been applied to different groups of medicines over the 40+ year history of the Model List. This paper presents the concept of the square box, provides key examples and guidance on how square box listings should be practically interpreted in the development and implementation of national essential medicine lists, considers the applicability of a square box listing concept to biologic medicines and proposes that an updated review of the square box concept and listings is warranted.
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Affiliation(s)
- Bernadette Cappello
- Department of Health Products Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Lorenzo Moja
- Department of Health Products Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Albert Figueras
- Department of Health Products Policy and Standards, World Health Organization, Geneva, Switzerland.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
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3
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Santos AS, Guerra-Junior AA, Noronha KVMDS, Andrade MV, Ruas CM. The Price of Substitute Technologies. Value Health Reg Issues 2019; 20:154-158. [PMID: 31561148 DOI: 10.1016/j.vhri.2019.08.474] [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: 03/15/2019] [Revised: 08/02/2019] [Accepted: 08/06/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Only a small share of new drugs is truly innovative; 85% to 90% of all new health technologies have little or no advantage over existing therapeutic alternatives. Health economic evaluations can be used to induce acceptable prices for new technologies through threshold pricing. OBJECTIVE This work discusses a cost-effectiveness threshold (λ) to be applied to the price regulation of substitute technologies. METHODS Considering that substitute technologies add only small marginal benefits in terms of innovation or ethical considerations to the system, it does not make sense to allow a loss of efficiency to list them. It has been postulated that the threshold calculated from opportunity costs (κ) represents its maximum possible value and that there must be a threshold (β) that maximizes consumer surplus. For a substitute technology to be listed, the cost of treatment associated with it must be lower than the cost of treatment of the incumbent technology added to the difference in effectiveness priced at the threshold. RESULTS There is no reason for us to believe that the oligopolistic pharmaceutical market is currently charging prices at the cost of production. That way, the cost-effectiveness ratio of the incumbent technology, when lower than κ, is shown through a deductive process to be a plausible estimate for λ that fulfills the objective of maximizing consumer benefit, granting producers a part of the combined surplus to stimulate research and development; that is, it would be between β and κ. CONCLUSION In conclusion, the price of substitute technologies should be limited by the cost-effectiveness ratio of the incumbent technology.
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Affiliation(s)
- André Soares Santos
- Department of Social Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Núcleo de Avaliação de Tecnologias em Saúde do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Department of Economical Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | - Augusto Afonso Guerra-Junior
- Department of Social Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; SUS Collaborating Centre for Technology Assessment and Excelence Health Excellence, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Mônica Viegas Andrade
- Department of Economical Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Cristina Mariano Ruas
- Department of Social Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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4
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Lanthier ML, Kerr KW, Miller KL. An Analysis of Follow-On Development in New Drug Classes, January 1986-June 2018. Clin Pharmacol Ther 2019; 106:1125-1132. [PMID: 31206617 DOI: 10.1002/cpt.1554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/13/2019] [Indexed: 11/11/2022]
Abstract
Follow-on drugs-new medicines approved within an established drug class-provide incremental treatment improvements, additional choices for clinicians and patients, and potential price competition. We examine the timing, quantity, and product characteristics of within-class drug approvals for new drug classes approved by the US Food and Drug Administration since January 1986. We find that nearly two-thirds of first-in-class drugs do not face a subsequent follow-on product. Follow-on innovation within a drug class was more common and occurred more rapidly in the 1990s than during the 2000s. We also find that fewer drug classes have multiple competitors entering the market during the 2000s. First-in-class drugs treating rare disorders experienced lower rates of follow-on entry than drugs treating common medical conditions. The decreased pace of follow-on development likely results from greater industry focus on rare diseases and increasing reimbursement pressure on products lacking clear advantages over existing products.
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Affiliation(s)
- Michael L Lanthier
- Office of the Commissioner, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Kirk W Kerr
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Kathleen L Miller
- Office of the Commissioner, US Food and Drug Administration, Silver Spring, Maryland, USA
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5
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Schotten C, Leist LGT, Semrau AL, Browne DL. A machine-assisted approach for the preparation of follow-on pharmaceutical compound libraries. REACT CHEM ENG 2018. [DOI: 10.1039/c8re00010g] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Coupling of a continuous flow process to a robotic microwave device has led to a simple platform for the preparation of compound libraries, specifically the anti-migraine compound Zolmitriptan and several unknown analogues.
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Affiliation(s)
| | | | - A. Lisa Semrau
- School of Chemistry
- Cardiff University Main Building
- Cardiff
- UK
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6
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Undurraga J, Baldessarini RJ. Tricyclic and selective serotonin-reuptake-inhibitor antidepressants compared with placebo in randomized trials for acute major depression. J Psychopharmacol 2017; 31:1624-1625. [PMID: 29182075 DOI: 10.1177/0269881117731294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Juan Undurraga
- 1 International Consortium for Mood and Psychotic Disorder Research, Mailman Research Center, McLean Hospital, Belmont, USA.,2 Department of Neurology and Psychiatry, Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Santiago, Chile.,3 Early Intervention Program, J Horwitz-Barak Psychiatric Institute, Santiago, Chile
| | - Ross J Baldessarini
- 1 International Consortium for Mood and Psychotic Disorder Research, Mailman Research Center, McLean Hospital, Belmont, USA.,4 Department of Psychiatry, Harvard Medical School, Boston, USA
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7
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DiMasi JA, Chakravarthy R. Competitive Development in Pharmacologic Classes: Market Entry and the Timing of Development. Clin Pharmacol Ther 2016; 100:754-760. [DOI: 10.1002/cpt.502] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/30/2016] [Accepted: 08/31/2016] [Indexed: 11/07/2022]
Affiliation(s)
- JA DiMasi
- Tufts Center for the Study of Drug Development; Tufts University; Boston Massachusetts USA
| | - R Chakravarthy
- Tufts Center for the Study of Drug Development; Tufts University; Boston Massachusetts USA
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8
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Poorhoseini HR, Kassaian SE, Hoseini K, Saroukhani S, Salarifar M, Alidoosti M, Nematipour E, Haji-Zeinali AM, Amirzadegan A, Seyyed Mohammadzadeh MH, Khadem Vatan K, Aghajani H, Sheikh Fathollahi M, Farrokh-Eslamlou H. Comparing clinical outcomes for a twelve-month trial of zotarolimus- and everolimus-eluting stents in patients with coronary artery disease: data from the THCRIC registry. Ther Adv Cardiovasc Dis 2016; 10:206-13. [PMID: 26857928 DOI: 10.1177/1753944716629868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES New-generation coronary stents including zotarolimus- and everolimus-eluting stents (ZES and EES) have been shown to decrease the risk of restenosis. The purpose of this study was to compare the safety and efficacy of ZES and EES over a 12-month clinical follow up, in routine clinical practice. METHODS This is an observational study in which 1029 consecutive patients treated with ZES (n = 669) or EES (n = 360) were enrolled. The study endpoint was major adverse cardiac events (MACE), defined as cardiac death, nonfatal myocardial infarction (MI), and target lesion or vessel revascularization at 12 months. RESULTS Follow up was completed among 94.9% of the patients. The overall MACE occurred in 4 (0.6%) and 7 (2.0%) patients in the ZES and EES group, respectively. The occurrence of other cardiac events including nonfatal MI and target vessel or lesion revascularization was 1 (0.2%) versus 1 (0.3%) and 7 (1.1%) versus 5 (1.4%), respectively, in the ZES and EES groups of patients. Despite a slightly lower rate of MACE and cardiac death in the ZES group, the difference between these two groups was not significant (n = 0.064 for overall MACE, p = 0.129 for cardiac mortality, n = 0.999 for nonfatal MI, n = 0.468 for target vessel and n = 0.999 for target lesion revascularization). CONCLUSIONS According to our results, it could be concluded that the difference in the rate of MACE between the ZES and EES groups was not statistically significant at 12-month follow up.
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Affiliation(s)
- Hamid Reza Poorhoseini
- Interventional Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ebrahim Kassaian
- Interventional Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kianoosh Hoseini
- Interventional Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Saroukhani
- Clinical Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Interventional Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Alidoosti
- Interventional Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Nematipour
- Interventional Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Mohammad Haji-Zeinali
- Interventional Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Amirzadegan
- Interventional Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mir Hossein Seyyed Mohammadzadeh
- Associate Professor of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, PO Box: 1411713138, Tehran, Iran
| | - Kamal Khadem Vatan
- Cardiology Department, Urmia University of Medical Sciences, Urmia, Iran
| | - Hassan Aghajani
- Interventional Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmood Sheikh Fathollahi
- Clinical Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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9
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Hostenkamp G. Do follow-on therapeutic substitutes induce price competition between hospital medicines? Evidence from the Danish hospital sector. Health Policy 2013; 111:68-77. [DOI: 10.1016/j.healthpol.2013.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 03/07/2013] [Accepted: 03/11/2013] [Indexed: 11/30/2022]
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10
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Grabner M, Johnson W, Abdulhalim AM, Kuznik A, Mullins CD. The Value of Atorvastatin Over the Product Life Cycle in the United States. Clin Ther 2011; 33:1433-43. [DOI: 10.1016/j.clinthera.2011.08.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 08/25/2011] [Accepted: 08/31/2011] [Indexed: 10/17/2022]
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11
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Follow-on drugs: How far should chemists look? Drug Discov Today 2011; 16:722-32. [DOI: 10.1016/j.drudis.2011.05.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Revised: 04/08/2011] [Accepted: 05/20/2011] [Indexed: 01/27/2023]
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12
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Gandjour A, Chernyak N. A new prize system for drug innovation. Health Policy 2011; 102:170-7. [PMID: 21724290 DOI: 10.1016/j.healthpol.2011.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 06/01/2011] [Accepted: 06/06/2011] [Indexed: 11/16/2022]
Abstract
We propose a new prize (reward) system for drug innovation which pays a price based on the value of health benefits accrued over time. Willingness to pay for a unit of health benefit is determined based on the cost-effectiveness ratio of palliative/nursing care. We solve the problem of limited information on the value of health benefits by mathematically relating reward size to the uncertainty of information including information on potential drug overuse. The proposed prize system offers optimal incentives to invest in research and development because it rewards the innovator for the social value of drug innovation. The proposal is envisaged as a non-voluntary alternative to the current patent system and reduces excessive marketing of innovators and generic drug producers.
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Affiliation(s)
- Afschin Gandjour
- Department of Public Health, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
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13
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Doloresco F, Fominaya C, Schumock GT, Vermeulen LC, Matusiak L, Hunkler RJ, Shah ND, Hoffman JM. Projecting future drug expenditures—2011. Am J Health Syst Pharm 2011; 68:921-32. [DOI: 10.2146/ajhp100712] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Fred Doloresco
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, and Research Assistant Professor, Department of Social and Preventive Medicine, School of Public Health and Health Professions
| | - Cory Fominaya
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY
| | - Glen T. Schumock
- Department of Pharmacy Practice, and Director, Center for Pharmacoeconomic Research, College of Pharmacy, University of Illinois—Chicago, Chicago
| | - Lee C. Vermeulen
- Center for Clinical Knowledge Management, University of Wisconsin Health, Madison, and Clinical Professor, School of Pharmacy, University of Wisconsin—Madison, Madison
| | - Linda Matusiak
- Professional Relations, IMS Health, Plymouth Meeting, PA
| | | | - Nilay D. Shah
- Division of Health Care Policy and Research, Mayo Clinic College of Medicine, Rochester, MN, and Senior Associate Consultant, Mayo Clinic, Rochester
| | - James M. Hoffman
- Pharmaceutical Department, St. Jude Children’s Research Hospital, Memphis, TN, and Associate Professor of Clinical Pharmacy, College of Pharmacy, University of Tennessee Health Science Center, Memphis
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14
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Lukkari P. Merger: institutional interplay with customer relationship management. MANAGEMENT RESEARCH REVIEW 2011. [DOI: 10.1108/01409171111096450] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Impact of generic competition on market share and prices of cardiovascular medicines on the Bulgarian pharmaceutical market. J Public Health (Oxf) 2010. [DOI: 10.1007/s10389-010-0352-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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17
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Hoffman JM, Doloresco F, Vermeulen LC, Shah ND, Matusiak L, Hunkler RJ, Schumock GT. Projecting future drug expenditures—2010. Am J Health Syst Pharm 2010; 67:919-28. [DOI: 10.2146/ajhp100068] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- James M. Hoffman
- Pharmaceutical Department, St. Jude Children’s Research Hospital, Memphis, TN, and Assistant Professor, Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee Health Science Center, Memphis
| | - Fred Doloresco
- Department of Pharmacy Practice, School of Pharmacy, and Research Assistant Professor HS, Department of Social and Preventive Medicine, School of Public Health and Health Professions, University of Buffalo, Buffalo, NY
| | - Lee C. Vermeulen
- Center for Drug Policy, University of Wisconsin Hospital and Clinics, Madison, and Clinical Professor, School of Pharmacy, University of Wisconsin—Madison, Madison
| | - Nilay D. Shah
- Division of Health Care Policy and Research, Mayo Clinic College of Medicine, Rochester, MN, and Associate Consultant, Mayo Clinic, Rochester
| | - Linda Matusiak
- Professional Relations, IMS Health, Plymouth Meeting, PA
| | | | - Glen T. Schumock
- Department of Pharmacy Practice, and Director, Center for Pharmacoeconomic Research, College of Pharmacy, University of Illinois—Chicago, Chicago
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18
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Stone GW, Rizvi A, Newman W, Mastali K, Wang JC, Caputo R, Doostzadeh J, Cao S, Simonton CA, Sudhir K, Lansky AJ, Cutlip DE, Kereiakes DJ. Everolimus-eluting versus paclitaxel-eluting stents in coronary artery disease. N Engl J Med 2010; 362:1663-74. [PMID: 20445180 DOI: 10.1056/nejmoa0910496] [Citation(s) in RCA: 675] [Impact Index Per Article: 48.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Previous studies have established the superiority of coronary everolimus-eluting stents over paclitaxel-eluting stents with respect to angiographic findings. However, these trials were not powered for superiority in clinical end points. METHODS We randomly assigned 3687 patients at 66 U.S. sites to receive everolimus-eluting stents or paclitaxel-eluting stents without routine follow-up angiography. The primary end point was the 1-year composite rate of target-lesion failure (defined as cardiac death, target-vessel myocardial infarction, or ischemia-driven target-lesion revascularization). RESULTS Everolimus-eluting stents were superior to paclitaxel-eluting stents with respect to the primary end point of target-lesion failure (4.2% vs. 6.8%; relative risk, 0.62; 95% confidence interval, 0.46 to 0.82; P=0.001). Everolimus-eluting stents were also superior with respect to the major secondary end point of the 1-year rate of ischemia-driven target-lesion revascularization (P=0.001) and were noninferior with respect to the major secondary end point of the 1-year composite rate of cardiac death or target-vessel myocardial infarction (P<0.001 for noninferiority; P=0.09 for superiority). The 1-year rates of myocardial infarction and stent thrombosis were also lower with everolimus-eluting stents than with paclitaxel-eluting stents (1.9% vs. 3.1%, P=0.02 for myocardial infarction; 0.17% vs. 0.85%, P=0.004 for stent thrombosis). Target-lesion failure was consistently reduced with everolimus-eluting stents as compared with paclitaxel-eluting stents in 12 prespecified subgroups, except in the subgroup of patients with diabetes (6.4% vs. 6.9%, P=0.80). CONCLUSIONS Everolimus-eluting stents, as compared with paclitaxel-eluting stents, resulted in reduced rates of target-lesion failure at 1 year, results that were consistent in all patients except those with diabetes, in whom the results were nonsignificantly different. (ClinicalTrials.gov number, NCT00307047.)
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Affiliation(s)
- Gregg W Stone
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY 10022, USA.
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Hoffman JM, Shah ND, Vermeulen LC, Doloresco F, Martin PK, Blake S, Matusiak L, Hunkler RJ, Schumock GT. Projecting future drug expenditures--2009. Am J Health Syst Pharm 2009; 66:237-57. [PMID: 19179637 DOI: 10.2146/ajhp080636] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Drug expenditure trends in 2007 and 2008, projected drug expenditures for 2009, and factors likely to influence drug expenditures are discussed. SUMMARY Various factors are likely to influence drug expenditures in 2009, including drugs in development, the diffusion of new drugs, drug safety concerns, generic drugs, Medicare Part D, and changes in the drug supply chain. The increasing availability of important generic drugs and drug safety concerns continue to moderate growth in drug expenditures. The drug supply chain remains dynamic and may influence drug expenditures, particularly in specialized therapeutic areas. Initial data suggest that the Medicare Part D benefit has influenced drug expenditures, but the ultimate impact of the benefit on drug expenditures remains unclear. From 2006 to 2007, total U.S. drug expenditures increased by 4.0%, with total spending rising from $276 billion to $287 billion. Drug expenditures in clinics continue to grow more rapidly than in other settings, with a 9.9% increase from 2006 to 2007. Hospital drug expenditures increased at a moderate rate of only 1.6% from 2006 to 2007; through the first nine months of 2008, hospital drug expenditures increased by only 2.8% compared with the same period in 2007. CONCLUSION In 2009, we project a 0-2% increase in drug expenditures in outpatient settings, a 1-3% increase in expenditures for clinic-administered drugs, and a 1-3% increase in hospital drug expenditures.
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Affiliation(s)
- James M Hoffman
- Pharmaceutical Department, St. Jude Children's Research Hospital, Memphis, TN, USA
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20
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Serrao E, Odde S, Ramkumar K, Neamati N. Raltegravir, elvitegravir, and metoogravir: the birth of "me-too" HIV-1 integrase inhibitors. Retrovirology 2009; 6:25. [PMID: 19265512 PMCID: PMC2660292 DOI: 10.1186/1742-4690-6-25] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 03/05/2009] [Indexed: 11/10/2022] Open
Abstract
Merck's MK-0518, known as raltegravir, has recently become the first FDA-approved HIV-1 integrase (IN) inhibitor and has since risen to blockbuster drug status. Much research has in turn been conducted over the last few years aimed at recreating but optimizing the compound's interactions with the protein. Resulting me-too drugs have shown favorable pharmacokinetic properties and appear drug-like but, as expected, most have a highly similar interaction with IN to that of raltegravir. We propose that, based upon conclusions drawn from our docking studies illustrated herein, most of these me-too MK-0518 analogues may experience a low success rate against raltegravir-resistant HIV strains. As HIV has a very high mutational competence, the development of drugs with new mechanisms of inhibitory action and/or new active substituents may be a more successful route to take in the development of second- and third-generation IN inhibitors.
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Affiliation(s)
- Erik Serrao
- Department of Pharmacology and Pharmaceutical Sciences, University of Southern California, School of Pharmacy, Los Angeles, CA 90089, USA.
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Doctors' attitudes about prescribing and knowledge of the costs of common medications. Ir J Med Sci 2009; 178:277-80. [PMID: 19221833 DOI: 10.1007/s11845-009-0276-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Accepted: 01/06/2009] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Compliance with medical therapy may be compromised because of the affordability of medications. Inadequate physician knowledge of drug costs may unwittingly contribute to this problem. METHODS We measured attitudes about prescribing and knowledge of medication costs by written survey of medical and surgical non consultant hospital doctors and consultants in two University teaching hospitals (n = 102). Sixty-eight percent felt the cost of medicines was an important consideration in the prescribing decision, however, 88% often felt unaware of the actual costs. Only 33% had easy access to drug cost data, and only 3% had been formally educated about drug costs. Doctors' estimates of the cost of a supply of ten commonly used medications were accurate in only 12% of cases, too low for 50%, and too high for 38%. CONCLUSIONS Interventions are needed to educate doctors about drug costs and provide them with reliable, easily accessible cost information in real-world practice.
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Abstract
Critics of me-too innovation often argue that follow-on drugs offer little incremental clinical value over existing pioneer products, while at the same time increasing health care costs. We examine whether consumers view follow-on and pioneer drugs as close substitutes or distinct clinical therapies. For five major classes of drugs, we find that large reductions in the price of pioneer molecules after patent expiration-which would typically lead to decreased consumption of strong substitutes-have no effect on the trend in demand for follow-on drugs. Our findings are likely unaffected by health insurance, competitive pricing of me-toos, marketing, and switching costs.
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Hoffman JM, Shah ND, Vermeulen LC, Doloresco F, Grim P, Hunkler RJ, Hontz KM, Schumock GT. Projecting future drug expenditures—2008. Am J Health Syst Pharm 2008; 65:234-53. [DOI: 10.2146/ajhp070629] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- James M. Hoffman
- Pharmaceutical Department, St. Jude Children’s Research Hospital, and Assistant Professor, Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee Health Science Center, Memphis
| | - Nilay D. Shah
- Division of Health Care Policy and Research, Mayo Clinic College of Medicine, Rochester, MN
| | - Lee C. Vermeulen
- Center for Drug. Policy, University of Wisconsin Hospital and Clinics (UWHC), Madison, and Clinical Associate Professor, School of Pharmacy, University of Wisconsin—Madison, Madison
| | | | | | | | | | - Glen T. Schumock
- Center for Pharmacoeconomic Research, College of Pharmacy, University of Illinois—Chicago, Chicago
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24
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Abstract
BACKGROUND Pharmaceutical costs are the fastest-growing health-care expense in most developed countries. Higher drug costs have been shown to negatively impact patient outcomes. Studies suggest that doctors have a poor understanding of pharmaceutical costs, but the data are variable and there is no consistent pattern in awareness. We designed this systematic review to investigate doctors' knowledge of the relative and absolute costs of medications and to determine the factors that influence awareness. METHODS AND FINDINGS Our search strategy included The Cochrane Library, EconoLit, EMBASE, and MEDLINE as well as reference lists and contact with authors who had published two or more articles on the topic or who had published within 10 y of the commencement of our review. Studies were included if: either doctors, trainees (interns or residents), or medical students were surveyed; there were more than ten survey respondents; cost of pharmaceuticals was estimated; results were expressed quantitatively; there was a clear description of how authors defined "accurate estimates"; and there was a description of how the true cost was determined. Two authors reviewed each article for eligibility and extracted data independently. Cost accuracy outcomes were summarized, but data were not combined in meta-analysis because of extensive heterogeneity. Qualitative data related to physicians and drug costs were also extracted. The final analysis included 24 articles. Cost accuracy was low; 31% of estimates were within 20% or 25% of the true cost, and fewer than 50% were accurate by any definition of cost accuracy. Methodological weaknesses were common, and studies of low methodological quality showed better cost awareness. The most important factor influencing the pattern and accuracy of estimation was the true cost of therapy. High-cost drugs were estimated more accurately than inexpensive ones (74% versus 31%, Chi-square p < 0.001). Doctors consistently overestimated the cost of inexpensive products and underestimated the cost of expensive ones (binomial test, 89/101, p < 0.001). When asked, doctors indicated that they want cost information and feel it would improve their prescribing but that it is not accessible. CONCLUSIONS Doctors' ignorance of costs, combined with their tendency to underestimate the price of expensive drugs and overestimate the price of inexpensive ones, demonstrate a lack of appreciation of the large difference in cost between inexpensive and expensive drugs. This discrepancy in turn could have profound implications for overall drug expenditures. Much more focus is required in the education of physicians about costs and the access to cost information. Future research should focus on the accessibility and reliability of medical cost information and whether the provision of this information is used by doctors and makes a difference to physician prescribing. Additionally, future work should strive for higher methodological standards to avoid the biases we found in the current literature, including attention to the method of assessing accuracy that allows larger absolute estimation ranges for expensive drugs.
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Affiliation(s)
- G. Michael Allan
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
- Institute of Health Economics, Edmonton, Alberta, Canada
- * To whom correspondence should be addressed. E-mail:
| | - Joel Lexchin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Natasha Wiebe
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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25
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Hoffman JM, Shah ND, Vermeulen LC, Schumock GT, Grim P, Hunkler RJ, Hontz KM. Projecting future drug expenditures—2007. Am J Health Syst Pharm 2007; 64:298-314. [PMID: 17244880 DOI: 10.2146/ajhp060545] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Drug expenditure trends in 2005 and 2006, projected drug expenditures for 2007, and factors likely to influence drug costs are discussed. SUMMARY Various factors are likely to affect drug costs, including drug prices, drugs in development, and generic drugs. In 2005, there was a continued moderation of the increase in drug expenditures. Total prescription drug expenditures increased by 5.5% from 2004 to 2005, with total spending rising from $239 billion to $252 billion. Through the first nine months of 2006, hospital drug expenditures increased by only 3% compared with 2005. This moderation of the growth of prescription drug expenditures can be attributed to three major factors: availability of major prescription drugs in generic form, continued increase in cost sharing for employees in employer-sponsored health plans, and decreased use due to safety concerns. It is expected that expenditures in 2007 will be influenced by similar factors, with few costly new products reaching the market, increased concern over product safety reducing the use of older agents and slowing the diffusion of newer agents that do reach the market, and several important patent expirations, leading to slower growth in expenditures. CONCLUSION In 2007, we project a 5-7% increase in drug expenditures in outpatient settings, a 14-16% increase in clinics, and a 4-6% increase in hospitals.
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Affiliation(s)
- James M Hoffman
- Pharmaceutical Department, St. Jude Children's Research Hospital, Memphis, TN, USA
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26
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Blöchl-Daum B. ["Me-too drugs" and the concept of a class effect]. Wien Med Wochenschr 2007; 156:494-7. [PMID: 17041805 DOI: 10.1007/s10354-006-0333-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Accepted: 05/02/2006] [Indexed: 11/28/2022]
Abstract
A distinction between "Breakthrough-drug" and "Me-too-drug" within one therapeutic class of medication is usually not clinically relevant. The concept of a class effect, which would mean, that one "Me-too drug" could be substituted with another one from the same therapeutic class, is only proven for very few drug classes. Usually an individual risk/benefit assessment has to be performed for each specific drug. Even if a class effect has been established, doctors should not be forced to switch their patients to the cheapest drug within the same class. Patient specific factors such as compliance have to be considered first. However at the onset of a new therapy regimen, the drug with the lowest price should be used.
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Affiliation(s)
- Brigitte Blöchl-Daum
- Universitätsklinik für Klinische Pharmakologie, Medizinische Universität Wien, Wien, Austria.
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27
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Wolpe P, Sahl M, Howard J. Bioethical Issues in Medicinal Chemistry and Drug Treatment. COMPREHENSIVE MEDICINAL CHEMISTRY II 2007. [PMCID: PMC7152255 DOI: 10.1016/b0-08-045044-x/00025-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of drugs to treat human disease is a pursuit that extends back into our evolutionary ancestors. Drugs are powerful substances with a great capacity to cause harm if misused or overused. Even when used correctly, pharmaceuticals can elicit disputes about their relative harms and benefits in specific situations. The establishment of modern intermediaries – physicians or pharmacists – in the allocation of the most powerful drugs increases the potential for conflict between those who control the resource and those who desire access to it. The size and influence of the pharmaceutical–industrial complex places disproportionate power in those whose interests lie in promoting and expanding pharmaceutical use in society. The expense of certain drugs complicates equitable allocation, and the concentration of pharmaceutical power in Western, industrialized countries promotes research and drug discovery disproportionately for diseases that are prevalent in the wealthier nations. The increasing sophistication of drug action challenges the traditional model of using drugs as a means to treat pathological conditions and processes, and raises the specter of lifestyle and enhancement uses of pharmaceuticals. New means of drug discovery – such as the use of stem cells – have elicited debate about the relative values placed on the status of the embryo and the potential treatment for intractable conditions that could result from stem cell research. Finally, the overall emphasis on drugs as the first line defense against what ails us has provoked some societal soul-searching. In this chapter, we review some of the ethical issues attendant to drug production and distribution, including issues of safety, justice, economic inequality, and the changing demands for drugs that exceed therapeutic uses. Suggestions are made to make pharmaceutical companies more responsive to these issues and to make oversight bodies more responsible for their roles.
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28
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Müller M. Editorial: Klinische Arzneimitteltherapie. Wien Med Wochenschr 2006; 156:471. [PMID: 17041801 DOI: 10.1007/s10354-006-0329-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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29
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Affiliation(s)
- Henry Mintzberg
- International Masters for Health Leadership, Desautels Faculty of Management, McGill University, Montréal, Que.
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30
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Austin PC, Mamdani MM, Juurlink DN. How many "Me-Too" drugs are enough? The case of physician preferences for specific statins. Ann Pharmacother 2006; 40:1047-51. [PMID: 16705028 DOI: 10.1345/aph.1g654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The increasing availability of "Me-Too" drugs has provided considerable treatment options for clinicians. However, the number of such drugs within a class that are actually used by clinicians has not been well studied. OBJECTIVE To determine the number of different statins that individual physicians use in practice. METHODS The Ontario Drug Benefit database was used to identify physicians who issued at least 10 incident statin prescriptions between October 2001 and May 2003 for patients aged 66 years and older. A preferred statin was defined for each physician, and the proportion of each physician's incident prescriptions written for that agent was determined. We then determined the number of different statins required to fill each physician's incident prescribing needs. RESULTS A total of 3426 physicians wrote 73,571 incident statin prescriptions. The mean percentage of prescriptions written for each physician's preferred statin formulation was 73.7%. Repeat analysis to examine the proportion of prescriptions filled using each physician's top 2 statin formulations found that the average physician wrote the vast majority of his or her incident prescriptions (94.9%) for only 1 or 2 statins. Half of all physicians used, at most, 2 different statins for all incident prescribing, while 91.3% of physicians used, at most, 3 different statins for all of their incident prescribing. CONCLUSIONS A high proportion of Ontario physicians issued the majority of their incident statin prescriptions for the same statin formulation. Most physicians required, at most, 3 different statins for all incident statin prescribing.
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Affiliation(s)
- Peter C Austin
- Institute for Clinical Evaluative Sciences, Toronto, Canada.
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31
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Lexchin J. Do manufacturers of brand-name drugs engage in price competition? An analysis of introductory prices. CMAJ 2006; 174:1120-1. [PMID: 16606961 PMCID: PMC1421463 DOI: 10.1503/cmaj.051687] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Joel Lexchin
- School of Health Policy and Management, York University, Toronto, Ont.
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32
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Hoffman JM, Shah ND, Vermeulen LC, Schumock GT, Grim P, Hunkler RJ, Hontz KM. Projecting future drug expenditures—2006. Am J Health Syst Pharm 2006; 63:123-38. [PMID: 16390926 DOI: 10.2146/ajhp050446] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Drug expenditure trends in 2004 and 2005, projected drug expenditures for 2006, and factors likely to influence drug costs are discussed. SUMMARY Various factors are likely to affect drug costs, including drug prices, drugs in development, and generic drugs. In 2004 there was a continued moderation of the increase in drug expenditures. Drug expenditures increased by 8.7% from 2003 to 2004. Through the first nine months of 2005, expenditures increased by only 8.1% compared with 2004. This moderation can be attributed to several factors, including the continued trend toward higher prescription drug cost sharing for insured consumers, growing availability of generic drugs, and lack of "blockbuster" new drugs in recent years. Drug expenditures in 2006 will likely be influenced by similar factors, with few costly new products reaching the market, increased concern over product safety slowing the diffusion of those new agents that do reach the market, and several important patent expirations, leading to slower growth in expenditures. CONCLUSION Forecasting and managing rising drug expenditures remains a challenge. Pharmacy managers must remain vigilant in monitoring drug costs in their health system and take a proactive role in pursuing efficient drug utilization. The dynamic health policy environment further complicates drug budgeting and must be considered, especially in integrated health systems responsible for managing inpatient, outpatient, and clinic drug costs. The comparison of health-system-specific data and trends with the national information presented in this article may provide a useful context when presenting institutional drug costs to senior management.
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Affiliation(s)
- James M Hoffman
- Pharmaceutical Department, St. Jude Children's Research Hospital, Memphis, TN, USA
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33
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Crigger NJ. Pharmaceutical promotions and conflict of interest in nurse practitioner's decision making: The undiscovered country. ACTA ACUST UNITED AC 2005; 17:207-12. [PMID: 15924562 DOI: 10.1111/j.1041-2972.2005.00034.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To increase nurse practitioners' (NPs) awareness of the conflict of interest that exists between the NPs' primary goal of making the best medication choices for patients and the potentially negative impact that the pharmaceutical industry's marketing strategies have on these choices. DATA SOURCES Selected healthcare professional, philosophical, and bioethical literature was reviewed. CONCLUSIONS Healthcare professionals are given gifts, dinners, and other inducements in the drug industry's effort to increase consumerism and drug sales. The current method of drug promotion increases sales but also increases healthcare expenses. Research also indicates that the pharmaceutical marketing strategies influence the judgments that NPs and other healthcare professionals make about patient care and drug prescriptions. IMPLICATIONS Guidelines are presented that can reduce the likelihood that any conflict of interest that exists will influence NPs' decisions about patient care.
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Abstract
Not paying for a drug unless it works sounds great for patients and healthcare funders, but it could also benefit manufacturers.
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Affiliation(s)
- Claus Møldrup
- Department of Social Pharmacy, Danish University of Pharmaceutical Sciences, Universitetsparken 2, DK-2100 Copenhagen Ø, Denmark.
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35
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Hoffman JM, Shah ND, Vermeulen LC, Hunkler RJ, Hontz KM. Projecting future drug expenditures—2005. Am J Health Syst Pharm 2005; 62:149-67. [PMID: 15700889 DOI: 10.1093/ajhp/62.2.149] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Drug expenditure trends in 2003 and 2004 and projected drug expenditures for 2005 are discussed. SUMMARY Various factors are likely to affect drug costs, including drug prices, drugs in development, and generic drugs. In 2003 there was a continued moderation of the increase in drug expenditures. Drug expenditures increased by 11.4% from 2002 to 2003. Through the first nine months of 2004, expenditures increased by only 8.7% compared with 2003. This moderation can be attributed to many factors, particularly patent expirations, prescription-to-nonprescription conversions and a continued slowdown in new drug approvals. Higher cost sharing for consumers and continued weaknesses in several sectors of the U.S. economy affecting employment levels and insurance coverage also contributed to this smaller increase in drug utilization. It is expected that 2005 drug expenditure growth will out-pace the growth in overall health care expenditures and growth in the economy. CONCLUSION In 2005, there should be a 10-12% increase in drug expenditures in outpatient settings, a 12-15% increase in clinics, and a 6-9% increase in hospitals.
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Affiliation(s)
- James M Hoffman
- Pharmaceutical Department, St. Jude Children's Research Hospital, Memphis, TN, USA
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36
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Daikos GK. Ethical dilemmas encountered during clinical drug trials. Int J Antimicrob Agents 2004; 24:24-31. [PMID: 15225856 DOI: 10.1016/j.ijantimicag.2004.03.004] [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: 11/28/2022]
Abstract
Ethical standards have a basis in antiquity and changes in practice need to be measured by moral considerations that are slower to change. This paper considers present day ethical problems in clinical trials--especially in infection, conflict of interest, financing of scientific studies and publishing (or non-publishing) of the results.
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Affiliation(s)
- George K Daikos
- Aphiareion Foundation for Chemotherapeutic Studies, Athens University School of Medicine, 12 Stratiotikou Syndesmou Street, GR 10676 Athens, Greece.
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37
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38
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DiMasi JA, Paquette C. The economics of follow-on drug research and development: trends in entry rates and the timing of development. PHARMACOECONOMICS 2004; 22:1-14. [PMID: 15660473 DOI: 10.2165/00019053-200422002-00002] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES The development of so-called 'me-too', or 'follow-on', drugs by the pharmaceutical industry has been viewed by some as duplicative and wasteful, while others have argued that these drugs often provide needed therapeutic options and inject some price competition into the marketplace. This study examines data on the trends in the speed with which competitive entry has occurred in the pharmaceutical marketplace and the competitive nature of the industry's development of these drugs. DATA AND METHODS We examined data on the entry rates of drugs in a large number of therapeutic classes over time, as well as detailed survey information on the relative timing of the development of drugs in the classes. Classes were defined according to chemical structure or pharmacologic mode of action and similarity of clinical use. We determined average times to initial and subsequent entry in drug classes by period and examined the timing of development milestones achieved by what have turned out to be follow-on drugs in relation to the development and approval of the first drug in a class to be approved. RESULTS We found that the period of marketing exclusivity that the breakthrough drug in a new class enjoys has fallen dramatically over time (a median of 10.2 years in the 1970s to 1.2 years for the late 1990 s). Approximately one-third of follow-on new drugs received a priority rating from the US FDA. The vast majority of the follow-on drugs for drug classes that were created in the last decade were in clinical development prior to the approval of the class breakthrough drug. CONCLUSIONS The data suggest that entry barriers have fallen over time for new drug introductions. The increased competitiveness of the pharmaceutical marketplace was likely fueled by changes over time on both the supply and demand sides. The development histories of entrants to new drug classes suggest that development races better characterise new drug development than does a model of post hoc imitation. Thus, the usual distinctions drawn between breakthrough and 'me-too' drugs may not be very meaningful.
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Affiliation(s)
- Joseph A DiMasi
- Tufts Center for the Study of Drug Development, Tufts University, Boston, Massachusetts 02111, USA.
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39
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Lasjaunias PL. "From operative morbidity to risk management". Interv Neuroradiol 2003; 9:335-7. [PMID: 20591312 PMCID: PMC3547374 DOI: 10.1177/159101990300900402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2003] [Accepted: 10/10/2003] [Indexed: 03/23/2024] Open
Affiliation(s)
- P L Lasjaunias
- Service de Neuroradiologie Diagnostique et Thérapeutique Hôpital de Bicêtre, Le Kremlin, Bicêtre; France
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