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Bergmann F, Wulkersdorfer B, Oesterreicher Z, Bauer M, Al Jalali V, Nussbaumer-Pröll A, Wölfl-Duchek M, Jorda A, Lackner E, Reiter B, Stimpfl T, Ballarini N, König F, Zeitlinger M. Comparison of pharmacokinetics and stability of generics of cefepime, linezolid and piperacillin/tazobactam with their respective originator drugs: an intravenous bioequivalence study in healthy volunteers. J Antimicrob Chemother 2022; 77:3086-3092. [PMID: 36039038 DOI: 10.1093/jac/dkac285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The efficacy and quality of generic antibacterial drug formulations are often questioned by both healthcare specialists and patients. Therefore, the present study investigated the interchangeability of generic drugs with their originators by comparing bioequivalence parameters and stability data of generic cefepime, linezolid and piperacillin/tazobactam with their respective originator drugs. METHODS In this open-label, randomized, crossover bioequivalence study, three groups of 12 healthy volunteers each received a single intravenous infusion of either 2 g of cefepime or 4.5 g of piperacillin/tazobactam and two generic formulations, or 600 mg of linezolid and one generic formulation. Plasma sampling was performed, with a 5 day washout period between study days. Stability was tested by storing reconstituted generic and originator products according to their own storage specifications and those of the comparator products. All concentrations were measured by LC-MS. RESULTS Similar ratios of generic/originator (90% CI) Cmax were observed for Cefepime-MIP/Maxipime [93.7 (88.4-99.4)], Cefepime Sandoz/Maxipime [95.9 (89.1-103.2)], Linezolid Kabi/Zyvoxid [104.5 (91.1-119.9)], Piperacillin Kabi/Tazobac [95.9 (90.4-101.7)], Piperacillin Aurobindo/Tazobac [99.7 (84.9-104.7)], Tazobactam Kabi/Tazobac [93.4 (87.4-99.8)] and Tazobactam Aurobindo/Tazobac [97.4 (89.7-105.8)]. Accordingly, similar ratios of AUC0-t were observed for Cefepime-MIP/Maxipime [91.1 (87.6-94.8)], Cefepime Sandoz/Maxipime [97.9 (92.5-103.5)], Linezolid Kabi/Zyvoxid [99.7 (93.3-106.6)], Piperacillin Kabi/Tazobac [92.2 (88.3-96.3)], Piperacillin Aurobindo/Tazobac [99.9 (97.0-102.8)], Tazobactam Kabi/Tazobac [91.4 (86.4-96.7)] and Tazobactam Aurobindo/Tazobac [98.8 (94.3-103.6)]. Stable and similar concentrations were measured for all contiguous substances, regardless of storage conditions. CONCLUSIONS Compared with their respective originator drugs, generic cefepime, linezolid and piperacillin/tazobactam met the predetermined bioequivalence criteria. All formulations were stable under the storage conditions of their respective comparators.
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Affiliation(s)
- Felix Bergmann
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria.,Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Beatrix Wulkersdorfer
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Zoe Oesterreicher
- Medical University of Vienna, Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Martin Bauer
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Valentin Al Jalali
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Alina Nussbaumer-Pröll
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Michael Wölfl-Duchek
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Anselm Jorda
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Edith Lackner
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Birgit Reiter
- Medical University of Vienna, Clinical Institute of Laboratory Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Thomas Stimpfl
- Medical University of Vienna, Clinical Institute of Laboratory Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Nicolas Ballarini
- Medical University of Vienna, Clinical Institute of Laboratory Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Franz König
- Medical University of Vienna, Center for Medical Statistics, Informatics, and Intelligent Systems, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Markus Zeitlinger
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Abstract
The high prices of new anticancer drugs and the marginal added benefit perceived by some stakeholders have fuelled a debate on the value of anticancer drugs in the European Union, even though an agreed definition of what constitutes a drug's value does not exist. In this Perspective, we discuss the value of drugs from different viewpoints and objectives of decision makers: for regulators, assessment of the benefit-risk balance of a drug is a cornerstone for approval; payers rely on cost-effectiveness analyses carried out by health technology assessment agencies for reimbursement decisions; for patients, treatment choices are based on personal preferences and attitudes to risk; and clinicians can use several scales (such as the ESMO Magnitude of Clinical Benefit Scale (ESMO-MCBS)) that have been developed as an attempt to measure value objectively. Although a unique definition that fully captures the concept of value is unlikely to emerge, herein we discuss the importance of understanding different perspectives, and how regulators can help to inform different decision makers.
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Um SI, Sohn UD, Jung SY, You SH, Kim C, Lee S, Lee H. Longitudinal study of the impact of three major regulations on the Korean pharmaceutical industry in the last 30 years. Health Res Policy Syst 2022; 20:4. [PMID: 34991612 PMCID: PMC8734354 DOI: 10.1186/s12961-021-00797-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background The pharmaceutical industry is heavily regulated. Partly for this reason, new drugs generally take over 10 years from the product development stage to market entry. Although regulations affect the pharmaceutical industry over a long period, previous studies investigating the impact of new regulatory policies have usually focused on the short period before and after implementing that policy. Therefore, the purpose of this study is to examine whether and how significantly regulatory policies affect long-term innovation in the pharmaceutical industry in Korea. Methods This study focused on three significant regulatory policies: the introduction of the product patent system, changes in the Good Manufacturing Practice (GMP) system, and the Drug Expenditure Rationalization Plan (DERP). The study used interrupted time series (ITS) analysis to investigate the long-term impacts of the policies before and after implementation. Results Our results show that introducing the product patent system in 1987 significantly increased the number of Korean patent applications. The effect of the revised GMP policies was also statistically significant, both before and after implementation and between pre-emptive companies and non-pre-emptive ones. However, due to the companies' negotiations with the regulatory authorities or the regulatory system that links drug approval and price evaluation, the DERP did not significantly delay new drug registration in Korea. Conclusion This study showed that the policies of the product patent system, GMP policies, and DERP regulations have significantly encouraged pharmaceutical companies to strive to meet regulatory requirements and promote innovation in Korea. The study suggests that it is necessary for companies to pre-emptively respond to systemic changes in development and production strategies to deal with regulatory changes and achieve sustainable growth. Also, our study results indicate that since government policies motivate the innovative system of the pharmaceutical industry, governmental authorities, when formulating pharmaceutical policies, need to consider the impact on the long-term innovation of the industry.
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Affiliation(s)
- Seung In Um
- Korea Pharmaceutical and Bio-Pharma Manufacturers Association, Seoul, South Korea
| | - Uy Dong Sohn
- Department of Pharmacology, Chung-Ang University, Seoul, South Korea
| | - Sun-Young Jung
- College of Pharmacy, Chung-Ang University, Seoul, South Korea
| | - Seung-Hun You
- Department of Global Innovative Drugs, Chung-Ang University, Seoul, South Korea
| | - Changone Kim
- Graduate School of Global Entrepreneurship, Keimyung University, Daegu, South Korea
| | - Sora Lee
- Graduate School of Management of Technology, Sungkyunkwan University, Suwon, South Korea
| | - Heesang Lee
- Graduate School of Management of Technology, Sungkyunkwan University, Suwon, South Korea.
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Vogler S. Can we achieve affordable cancer medicine prices? Developing a pathway for change. Expert Rev Pharmacoecon Outcomes Res 2021; 21:321-325. [PMID: 33653228 DOI: 10.1080/14737167.2021.1898951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (GÖG/Austrian National Public Health Institute), Vienna, Austria
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Lavigne JE, Lagerberg T, Ambrosi JW, Chang Z. Study designs and statistical approaches to suicide and prevention research in real-world data. Suicide Life Threat Behav 2021; 51:127-136. [PMID: 33624870 DOI: 10.1111/sltb.12677] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To provide researchers, clinicians and policy makers with a primer to study designs, statistical approaches and graphical reporting methods for suicide research in real world data (RWD). METHODS Study designs, statistical method and graphical reporting standards are detailed with examples from the recently published literature. RESULTS Data sources and codes for identifying suicidal behavior are described. Study designs are described in detail for post-market surveillance, retrospective cohort studies, case control and nested case-control studies, and self-controlled (within-individual) studies including applications of marginal structural models. Graphical reporting of designs is described using an original research study. CONCLUSIONS Compared to RCTs, RWE studies offer larger sample sizes, greater generalizability, and real-world validity. However, these non-experimental data risk uncontrolled confounding and potential introduction of bias unless data, design and statistical approaches are rigorously aligned.
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Affiliation(s)
- Jill E Lavigne
- Center of Excellence for Suicide Prevention, Department of Veterans Health Affairs, 400 Fort Hill Ave, Canandaigua, 14424, USA.,Wegmans School of Pharmacy, St John Fisher College, 3690 East Ave, Rochester, NY, 14618, USA
| | | | - John W Ambrosi
- Wegmans School of Pharmacy, St John Fisher College, 3690 East Ave, Rochester, NY, 14618, USA
| | - Zheng Chang
- Karolinska Institute, 171 77 Stockholm, Solna, Sweden
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Tang S, Zhang R, Si Y, Cheng Y, Gong Y. Measurement of the Equality of the Drug Welfare Induction Level of Chinese Patients With Chronic Diseases in Gansu, Sichuan, Hebei, and Zhejiang Based on the Bivariate Theil-T Index Method. Front Public Health 2020; 8:581533. [PMID: 33194987 PMCID: PMC7655781 DOI: 10.3389/fpubh.2020.581533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/28/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives: This study aimed to measure the induction level of drug welfare in Chinese patients with chronic diseases using a bivariate Theil index. Design: The bivariate Theil-T index was used to hierarchically decompose the relevant survey data, and the contribution rate of the intragroup gap and the intergroup gap to the total gap was investigated to better understand the current drug welfare induction level of Chinese patients with chronic diseases. Setting: The study was based in Gansu, Sichuan, Hebei, and Zhejiang provinces in China. Participants: Survey data was from patients with chronic diseases in 20 hospitals in four provinces. Primary and secondary outcome measures: Data was collected through a questionnaire designed by the research team after expert consultation. Using the variables represented by the index system to decompose the Theil index from the two dimensions of the region and urban and rural areas. SPSS 22.0 was used for reliability and validity analysis and Theil index calculation. Results: The overall level of drug welfare induction in Chinese patients with chronic diseases had a high degree of equalization. The overall Theil index was 0.0003, but there were still some differences among groups. Conclusions: To improve the drug welfare equalization induction level of patients with chronic diseases in China, the government should start from western rural areas, and policy should target the provinces that were in a disadvantaged position within the region to promote the equalization of drug welfare induction level for patients with chronic diseases in China.
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Affiliation(s)
- Shaoliang Tang
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ruxia Zhang
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yinghang Si
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yan Cheng
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ying Gong
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
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Annemans L, Makady A. TRUST4RD: tool for reducing uncertainties in the evidence generation for specialised treatments for rare diseases. Orphanet J Rare Dis 2020; 15:127. [PMID: 32456653 PMCID: PMC7251888 DOI: 10.1186/s13023-020-01370-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 03/31/2020] [Indexed: 01/07/2023] Open
Abstract
Background Many treatments developed for rare diseases will have an Orphan Medicinal Product (OMP) designation, indicating that they are likely to deliver benefit in an area of high unmet need. Their approval may be based on a small or uncontrolled trial, as randomised controlled trials (RCTs) of sufficient size are often difficult to conduct, or repeat, as a result of the rarity of the condition, sparsity of patients, or for ethical reasons. Furthermore, many products are given a conditional marketing authorisation, requiring additional evidence to be collected after product launch. This is even more challenging with the advent of advanced therapeutic medicinal products, which use novel scientific approaches like gene or somatic cell therapy. Issue Given the high unmet need associated with these products, there is pressure for Health Technology Assessment (HTA)/reimbursement bodies to enable rapid access to effective treatments. However, there is often only limited evidence available for assessment. Methods TRUST4RD proposes an approach to identify uncertainties of most concern for decision-makers by developing an iterative and informed dialogue amongst stakeholders (including manufacturers, clinicians, patients, regulatory- and HTA agencies and payers), so that potential approaches to resolution can be discussed. As evidence is generated, uncertainties are reviewed and prioritised, and evidence-generation plans revised or clarified accordingly. The aim is to develop – both pre- and post HTA submission – a better understanding of evidence requirements versus evidence-generation trade-offs as an evidence base grows and the potential value of a product becomes clearer. Conclusion TRUST4RD presents guidance on defining uncertainties and evidence gaps in the assessment of value and value for money of specialised treatments for rare diseases. It also provides guidance on the potential of Real World Evidence (RWE) to help address such uncertainties, including the typology of evidence uncertainties, the importance of different uncertainties and the data sources available to address them before and after HTA submission. In making use of the guidance, authorisation and reimbursement discussions on such treatments can be embedded in an evidence-rich context, thereby ensuring value to all parties, particularly to patients.
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Affiliation(s)
- Lieven Annemans
- Dept of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, C Heymanslaan 10, 9000, Ghent, Belgium.
| | - Amr Makady
- Dept of Pharmaceutical Sciences, University of Utrecht Faculty David de Wiedbuilding, Universiteitsweg 99, 3584, Utrecht, CG, Netherlands
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8
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Patterson JA, Carroll NV. Should the United States government regulate prescription prices? A critical review. Res Social Adm Pharm 2020; 16:717-723. [DOI: 10.1016/j.sapharm.2019.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 11/24/2022]
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Abstract
Innovation has become an increasingly common topic in healthcare. Private companies, developers, payers, and regulators are devoting attention toward innovative products and processes as a crucial component of their interests in and occupation with healthcare services. Even when there is no consensus as to its definition, "innovation" -as opposed to "invention"- is broadly understood to refer turning a good idea into a practical solution. Adoption and applicability are key components of implementation that are sustained not only on innovation's attributes themselves but also in the characteristics of providers, users, and implementing organizations, as well as the external environment. Regulatory agencies often face the need to make decisions about proposed innovations with obsolete or inadequate normative frameworks and with a high degree of uncertainty about its eventual performance or its risks. Early interaction between developers and dedicated multidisciplinary teams at regulatory agencies may prove instrumental for speeding up the time required for proper evaluation and product registration, as well as the establishment of quality validation mechanisms. Community involvement both in the adoption and vigilance on innovative products and processes is crucial for completing the process of defining their roles and uses.
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Wang SV, Patterson OV, Gagne JJ, Brown JS, Ball R, Jonsson P, Wright A, Zhou L, Goettsch W, Bate A. Transparent Reporting on Research Using Unstructured Electronic Health Record Data to Generate ‘Real World’ Evidence of Comparative Effectiveness and Safety. Drug Saf 2019; 42:1297-1309. [DOI: 10.1007/s40264-019-00851-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Li DG, Najafzadeh M, Kesselheim AS, Mostaghimi A. Spending on World Health Organization essential medicines in Medicare Part D, 2011-15: retrospective cost analysis. BMJ 2019; 366:l4257. [PMID: 31315833 PMCID: PMC6635813 DOI: 10.1136/bmj.l4257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To characterize the trends, drivers, and potential modifiers of increased spending by US Medicare beneficiaries on medicines deemed essential by the World Health Organization. DESIGN Retrospective cost analysis of Medicare Part D Prescriber Public Use File, detailing annual generic and brand name drug prescribing and spending from 2011 through 2015 by Medicare Part D participants who filled prescriptions for WHO essential medicines. SETTING US Medicare System. MAIN OUTCOME MEASURES Total and per beneficiary Medicare spending, total and per beneficiary out-of-pocket patient spending, cumulative beneficiary count, claim count, and per unit drug cost. All spending measures were adjusted for inflation and reported in 2015 US dollars. RESULTS Medicare Part D expenditures on 265 WHO essential medicines between 2011 and 2015 was $87.2bn (£68.4bn; €76.5bn), with annual spending increasing from $11.9bn in 2011 to $25.8bn in 2015 (116%). Patients' out-of-pocket spending for essential medicines over the same period was $12.1bn. Total annual out-of-pocket spending increased from $2.0bn to $2.9bn (47%), and annual per beneficiary out-of-pocket spending on these drugs increased from $20.42 to $21.17 (4%). Total prescription count increased from 376.1m to 498.9m (33%), and cumulative beneficiary count grew from 95.9m to 135.8m (42%). Of the essential medicines included in the study, the per unit cost of 133 (50%) agents increased faster than the average inflation rate during this period. Overall, approximately 58% of the increase in total spending during this period can be attributed to the introduction of novel agents. CONCLUSIONS Spending associated with essential medicines grew substantially from 2011 to 2015, driven largely by the increased use of two expensive novel drugs used in treating hepatitis C. Approximately 22% of increased total spending during this period can be attributed to increases in per unit cost of existing drugs. These trends may limit patients' access to essential drugs while also increasing healthcare system costs.
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Affiliation(s)
- David G Li
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Mehdi Najafzadeh
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital Boston, MA, USA
| | - Aaron S Kesselheim
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital Boston, MA, USA
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Designing trials for new cystic fibrosis modulators. THE LANCET RESPIRATORY MEDICINE 2018; 6:484-486. [PMID: 29859920 DOI: 10.1016/s2213-2600(18)30195-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 05/01/2018] [Indexed: 12/30/2022]
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14
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Natsis Y. The top 5 issues in EU medicines policy for 2018. MEDICINE ACCESS @ POINT OF CARE 2018. [DOI: 10.1177/2399202618774510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Yannis Natsis
- European Public Health Alliance (EPHA) AISBL, Brussels, Belgium
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15
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Wang SV, Schneeweiss S, Berger ML, Brown J, de Vries F, Douglas I, Gagne JJ, Gini R, Klungel O, Mullins CD, Nguyen MD, Rassen JA, Smeeth L, Sturkenboom M. Reporting to Improve Reproducibility and Facilitate Validity Assessment for Healthcare Database Studies V1.0. Pharmacoepidemiol Drug Saf 2018; 26:1018-1032. [PMID: 28913963 PMCID: PMC5639362 DOI: 10.1002/pds.4295] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 07/25/2017] [Accepted: 07/25/2017] [Indexed: 12/28/2022]
Abstract
Purpose Defining a study population and creating an analytic dataset from longitudinal healthcare databases involves many decisions. Our objective was to catalogue scientific decisions underpinning study execution that should be reported to facilitate replication and enable assessment of validity of studies conducted in large healthcare databases. Methods We reviewed key investigator decisions required to operate a sample of macros and software tools designed to create and analyze analytic cohorts from longitudinal streams of healthcare data. A panel of academic, regulatory, and industry experts in healthcare database analytics discussed and added to this list. Conclusion Evidence generated from large healthcare encounter and reimbursement databases is increasingly being sought by decision‐makers. Varied terminology is used around the world for the same concepts. Agreeing on terminology and which parameters from a large catalogue are the most essential to report for replicable research would improve transparency and facilitate assessment of validity. At a minimum, reporting for a database study should provide clarity regarding operational definitions for key temporal anchors and their relation to each other when creating the analytic dataset, accompanied by an attrition table and a design diagram. A substantial improvement in reproducibility, rigor and confidence in real world evidence generated from healthcare databases could be achieved with greater transparency about operational study parameters used to create analytic datasets from longitudinal healthcare databases.
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Affiliation(s)
- Shirley V Wang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, MA, USA.,Department of Medicine, Harvard Medical School, MA, USA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, MA, USA.,Department of Medicine, Harvard Medical School, MA, USA
| | | | - Jeffrey Brown
- Department of Population Medicine, Harvard Medical School, MA, USA
| | - Frank de Vries
- Department of Clinical Pharmacy, Maastricht UMC+, The Netherlands
| | - Ian Douglas
- London School of Hygiene and Tropical Medicine, England, UK
| | - Joshua J Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, MA, USA.,Department of Medicine, Harvard Medical School, MA, USA
| | - Rosa Gini
- Agenzia regionale di sanità della Toscana, Florence, Italy
| | - Olaf Klungel
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, Netherlands
| | - C Daniel Mullins
- Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, MA, USA
| | | | | | - Liam Smeeth
- London School of Hygiene and Tropical Medicine, England, UK
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Alaei S, Alhani F, Navipour H. The financial transaction between counseling and nursing care service centers (CNCSCs) and their clients: a qualitative study. BMC Health Serv Res 2018; 18:282. [PMID: 29649999 PMCID: PMC5898021 DOI: 10.1186/s12913-018-2934-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 02/12/2018] [Indexed: 11/10/2022] Open
Abstract
Background Community-oriented nursing care is an important model of nursing care. Counseling and Nursing Care Service Centers (CNCSCs) have been providing these private services to the Iranian community for nearly two decades. Resource management, cost-benefit analysis and affordability are important steps in providing these services. The present study was conducted to explore the challenges of financial transactions between CNCSCs and their clients. Methods This study has a qualitative design and was conducted on a total of 30 participants, consisting of CNCSC managers, staff, physicians and clients who were selected through purposive theoretical sampling. Data were collected through in-depth interviews and direct observations and were analyzed using conventional qualitative content analysis. Results The analysis of the data led to the extraction of three main categories, including the flaunted atmosphere due to direct financial transaction, instability in determining tariffs for nursing services and the use of strategies for cost-effective services and client satisfaction. Conclusion To increase affordability and satisfaction and expand private community-based nursing. Services, appropriate financial policies should be designed and applied that can lead to transparent and simple financial transactions with the clients by way of indirect monetary exchanges. These policies should be designed in a systematic manner with integrity, facilitate inter-sectorial cooperation in the health sector and be cost-effective for the clients, insurance companies and the health system. Electronic supplementary material The online version of this article (10.1186/s12913-018-2934-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sefollah Alaei
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Jalal Al-Ahmad, P.O. Box 14115-331, Tehran, Iran
| | - Fatemeh Alhani
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Jalal Al-Ahmad, P.O. Box 14115-331, Tehran, Iran.
| | - Hassan Navipour
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Jalal Al-Ahmad, P.O. Box 14115-331, Tehran, Iran
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Bonertz A, Roberts GC, Hoefnagel M, Timon M, Slater JE, Rabin RL, Bridgewater J, Pini C, Pfaar O, Akdis C, Goldstein J, Poulsen LK, van Ree R, Rhyner C, Barber D, Palomares O, Sheikh A, Pawankar R, Hamerlijnk D, Klimek L, Agache I, Angier E, Casale T, Fernandez‐Rivas M, Halken S, Jutel M, Lau S, Pajno G, Sturm G, Varga EM, Gerth van Wijk R, Bonini S, Muraro A, Vieths S. Challenges in the implementation of EAACI guidelines on allergen immunotherapy: A global perspective on the regulation of allergen products. Allergy 2018; 73:64-76. [PMID: 28771830 DOI: 10.1111/all.13266] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2017] [Indexed: 11/30/2022]
Abstract
Regulatory approaches for allergen immunotherapy (AIT) products and the availability of high-quality AIT products are inherently linked to each other. While allergen products are available in many countries across the globe, their regulation is very heterogeneous. First, we describe the regulatory systems applicable for AIT products in the European Union (EU) and in the United States (US). For Europe, a depiction of the different types of relevant procedures, as well as the committees involved, is provided and the fundamental role of national agencies of the EU member states in this complex and unique network is highlighted. Furthermore, the regulatory agencies from Australia, Canada, Japan, Russia, and Switzerland provided information on the system implemented in their countries for the regulation of allergen products. While AIT products are commonly classified as biological medicinal products, they are made available by varying types of procedures, most commonly either by obtaining a marketing authorization or by being distributed as named patient products. Exemptions from marketing authorizations in exceptional cases, as well as import of allergen products from other countries, are additional tools applied by countries to ensure availability of needed AIT products. Several challenges for AIT products are apparent from this analysis and will require further consideration.
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Affiliation(s)
| | - G. C. Roberts
- University of Southampton Southampton UK
- University Hospital Southampton NHS Foundation Trust Southampton UK
- David Hide Asthma and Allergy Research Centre Newport Isle of Wight UK
| | - M. Hoefnagel
- CBG‐MEB (Medicines Evaluation Board) Utrecht The Netherlands
| | - M. Timon
- Division of Biological Products, Advanced Therapies and Biotechnology Agencia Española de Medicamentos y Productos Sanitarios (AEMPS) Madrid Spain
| | - J. E. Slater
- US Food and Drug Administration Silver Spring MD USA
| | - R. L. Rabin
- US Food and Drug Administration Silver Spring MD USA
| | | | - C. Pini
- Istituto Superiore di Sanità Rome Italy
| | - O. Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Medical Faculty Mannheim Universitätsmedizin Mannheim, Heidelberg University Mannheim Germany
- Center for Rhinology and Allergology Wiesbaden Germany
| | - C. Akdis
- Swiss Institute of Allergy and Asthma Research University Zurich Davos Switzerland
| | - J. Goldstein
- Division of Allergy, Immunology and Transplantation National Institute of Allergy and Infectious Diseases National Institutes of Health Bethesda MD USA
| | - L. K. Poulsen
- Allergy Clinic Copenhagen University Hospital at Gentofte Copenhagen Denmark
| | - R. van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology Academic Medical Center University of Amsterdam Amsterdam The Netherlands
| | | | - D. Barber
- Universidad CEU San Pablo Madrid Spain
| | - O. Palomares
- Department of Biochemistry and Molecular Biology School of Chemistry Complutense University of Madrid (UCM) Madrid Spain
| | - A. Sheikh
- The University of Edinburgh Scotland UK
| | | | - D. Hamerlijnk
- Patient Advocacy Group Dutch Lung Foundation Amersfoort The Netherlands
| | - L. Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - I. Agache
- Department of Allergy and Clinical Immunology Faculty of Medicine Transylvania University Brasov Brasov Romania
| | - E. Angier
- Sheffield Teaching Hospital Sheffield UK
| | - T. Casale
- University of South Florida Tampa FL USA
| | | | - S. Halken
- Hans Christian Andersen Childrens Hospital Odense University Hospital Odense Denmark
| | - M. Jutel
- Poland and ALL‐MED Medical Research Institute Wroclaw Medical University Wrocław Poland
| | - S. Lau
- Department for Pediatric Pneumology and Immunology Charité Universitätsmedizin Berlin Germany
| | - G. Pajno
- Department of Pediatrics and Allergy Unit University of Messina Messina Italy
| | - G. Sturm
- Department of Dermatology and Venerology Medical University of Graz Austria
- Outpatient Allergy Clinic Reumannplatz Vienna Austria
| | | | | | - S. Bonini
- University of Campania Luigi Vanvitelli, IFT‐CNR Naples, Rome Italy
| | - A. Muraro
- Padua University Hospital Padua Italy
| | - S. Vieths
- Paul‐Ehrlich‐Institut Langen Germany
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18
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Horgan D. Treatment Is Worth a Lot - But Just How Much. Biomed Hub 2017; 2:202-211. [PMID: 31988950 PMCID: PMC6945954 DOI: 10.1159/000481616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 09/19/2017] [Indexed: 11/23/2022] Open
Abstract
More than at any other time in history, science offers enormous potential to transform the prevention, diagnosis and treatment of many diseases. However, patients are urgently awaiting new therapies - and too often not getting them. And researchers and companies also face significant development obstacles as only one in ten drugs entering clinical trials ever makes it over the finish line. This article looks at the issues involved in bringing innovation into healthcare systems from a political and policy level. It takes a close look at Health Technology Assessment (HTA) across Member States, how it is working and, more to the point, how it isn't, and how it often serves to stymie the introduction of new medicines by undermining the European Medicines Agency (EMA). The article argues that the EU could strengthen HTA cooperation via a common framework, and promote higher quality and fairer assessments; while joint work could reduce duplication of efforts, and promote better synergies as well as better use of Member States' resources. The author also takes an in-depth look into criticism of private-sector pricing of innovative medicines in the light of discussions about what constitutes “value” in the context of new treatments - a discussion that shows no signs of abating - while advocating enhanced contact and the need for compromise between all stakeholders in the great value debate.
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Affiliation(s)
- Denis Horgan
- European Alliance for Personalised Medicine, Brussels, Belgium
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19
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Wang SV, Schneeweiss S, Berger ML, Brown J, de Vries F, Douglas I, Gagne JJ, Gini R, Klungel O, Mullins CD, Nguyen MD, Rassen JA, Smeeth L, Sturkenboom M. Reporting to Improve Reproducibility and Facilitate Validity Assessment for Healthcare Database Studies V1.0. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:1009-1022. [PMID: 28964431 DOI: 10.1016/j.jval.2017.08.3018] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE Defining a study population and creating an analytic dataset from longitudinal healthcare databases involves many decisions. Our objective was to catalogue scientific decisions underpinning study execution that should be reported to facilitate replication and enable assessment of validity of studies conducted in large healthcare databases. METHODS We reviewed key investigator decisions required to operate a sample of macros and software tools designed to create and analyze analytic cohorts from longitudinal streams of healthcare data. A panel of academic, regulatory, and industry experts in healthcare database analytics discussed and added to this list. CONCLUSION Evidence generated from large healthcare encounter and reimbursement databases is increasingly being sought by decision-makers. Varied terminology is used around the world for the same concepts. Agreeing on terminology and which parameters from a large catalogue are the most essential to report for replicable research would improve transparency and facilitate assessment of validity. At a minimum, reporting for a database study should provide clarity regarding operational definitions for key temporal anchors and their relation to each other when creating the analytic dataset, accompanied by an attrition table and a design diagram. A substantial improvement in reproducibility, rigor and confidence in real world evidence generated from healthcare databases could be achieved with greater transparency about operational study parameters used to create analytic datasets from longitudinal healthcare databases.
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Affiliation(s)
- Shirley V Wang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, MA, USA; Department of Medicine, Harvard Medical School, MA, USA.
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, MA, USA; Department of Medicine, Harvard Medical School, MA, USA
| | | | - Jeffrey Brown
- Department of Population Medicine, Harvard Medical School, MA, USA
| | - Frank de Vries
- Department of Clinical Pharmacy, Maastricht UMC+, The Netherlands
| | - Ian Douglas
- London School of Hygiene and Tropical Medicine, England, UK
| | - Joshua J Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, MA, USA; Department of Medicine, Harvard Medical School, MA, USA
| | - Rosa Gini
- Agenzia regionale di sanità della Toscana, Florence, Italy
| | - Olaf Klungel
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, Netherlands
| | - C Daniel Mullins
- Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, MA, USA
| | | | | | - Liam Smeeth
- London School of Hygiene and Tropical Medicine, England, UK
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20
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van der Gronde T, Uyl-de Groot CA, Pieters T. Addressing the challenge of high-priced prescription drugs in the era of precision medicine: A systematic review of drug life cycles, therapeutic drug markets and regulatory frameworks. PLoS One 2017; 12:e0182613. [PMID: 28813502 PMCID: PMC5559086 DOI: 10.1371/journal.pone.0182613] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
CONTEXT Recent public outcry has highlighted the rising cost of prescription drugs worldwide, which in several disease areas outpaces other health care expenditures and results in a suboptimal global availability of essential medicines. METHOD A systematic review of Pubmed, the Financial Times, the New York Times, the Wall Street Journal and the Guardian was performed to identify articles related to the pricing of medicines. FINDINGS Changes in drug life cycles have dramatically affected patent medicine markets, which have long been considered a self-evident and self-sustainable source of income for highly profitable drug companies. Market failure in combination with high merger and acquisition activity in the sector have allowed price increases for even off-patent drugs. With market interventions and the introduction of QALY measures in health care, governments have tried to influence drug prices, but often encounter unintended consequences. Patent reform legislation, reference pricing, outcome-based pricing and incentivizing physicians and pharmacists to prescribe low-cost drugs are among the most promising short-term policy options. Due to the lack of systematic research on the effectiveness of policy measures, an increasing number of ad hoc decisions have been made with counterproductive effects on the availability of essential drugs. Future challenges demand new policies, for which recommendations are offered. CONCLUSION A fertile ground for high-priced drugs has been created by changes in drug life-cycle dynamics, the unintended effects of patent legislation, government policy measures and orphan drug programs. There is an urgent need for regulatory reform to curtail prices and safeguard equitable access to innovative medicines.
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Affiliation(s)
- Toon van der Gronde
- Department of Pharmaceutical Sciences, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - Carin A. Uyl-de Groot
- Institute for Medical Technology Assessment, Department of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
| | - Toine Pieters
- Department of Pharmaceutical Sciences, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
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21
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Rathi VK, Gadkaree SK, Ross JS, Kozin ED, Sethi RK, Naunheim MR, Puram SV, Gray ST. US Food and Drug Administration Clearance of Moderate-Risk Otolaryngologic Devices via the 510(k) Process, 1997-2016. Otolaryngol Head Neck Surg 2017; 157:608-617. [PMID: 28786317 DOI: 10.1177/0194599817721689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The US Food and Drug Administration (FDA) clears moderate-risk devices via the 510(k) process based on substantial equivalence to previously cleared devices; evidence of safety and effectiveness is not required. We characterized the premarket evidence supporting FDA clearance of otolaryngologic devices. Study Design Retrospective cross-sectional analysis. Setting Publicly available FDA documents. Subjects and Methods Recently cleared (1997-2016) moderate-risk otolaryngologic devices were categorized by type (diagnostic/therapeutic), subspecialty, implantable designation (yes/no), and recall history (yes/no). Supporting evidence was categorized by type (clinical/nonclinical/none; nonclinical and clinical mutually inclusive) and public availability of nonclinical and clinical performance data (available/not provided/not applicable). Results Between 1997 and 2016, the FDA cleared 377 moderate-risk otolaryngologic devices. The majority were therapeutic (n = 240/377 [63.7%]) and otologic (n = 311/377 [82.5%]); roughly one-third (n = 121/377 [32.1%]) were implantable. Few (n = 10/377 [2.7%]) devices were subject to recall. FDA documents summarizing premarket evidence were accessible for two-thirds (n = 247/377 [65.5%]) of devices. Among these devices, one-quarter (n = 66/247 [26.7%]) were supported by clinical evidence. The majority (n = 177/247 [71.7%]) were supported by nonclinical evidence, although nearly one-quarter (n = 58/247 [23.5%]) were cleared without supporting evidence. Therapeutic devices were more often cleared without supporting evidence (therapeutic: n = 53/170 [31.2%]; diagnostic: n = 5/77 [6.5%]; P < .0001). Nonclinical and clinical performance data were rarely available (nonclinical: n = 49/247 [19.8%]; clinical: n = 32/247 [13.0%]) within public summaries. Conclusion The FDA cleared most moderate-risk otolaryngologic devices for marketing via the 510(k) process without clinical evidence of safety and effectiveness. Otolaryngologists should be aware of limitations in premarket evidence when considering the adoption of new devices into clinical practice.
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Affiliation(s)
- Vinay K Rathi
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Shekhar K Gadkaree
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph S Ross
- 3 Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, Connecticut.,4 Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut.,5 Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Elliott D Kozin
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Rosh K Sethi
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew R Naunheim
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Sidharth V Puram
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Stacey T Gray
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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22
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Li J, Feng XL. Health care-seeking behaviours and health expenditures in adults aged 45 years and older in China, 2011-2013. Trop Med Int Health 2017; 22:638-654. [PMID: 28278358 DOI: 10.1111/tmi.12865] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To provide an assessment of China's progress to universal health coverage (UHC) from the perspective of people-centred care. METHODS We obtained data on 28 103 participants from the China Health and Retirement Longitudinal Study (CHALRS) during 2011-2013. We used logistic regressions and generalised linear models to analyse care-seeking behaviours and medical expenditures. RESULTS We found that 95.5% of the subjects were covered by social health insurance in 2013, and nearly 60% subjects in need of medical care were self-medicated. Health insurance was a strong predictor for the access to outpatient care. Use of pure and mixed self-medication increased by 15% and 32% respectively, while use of pure outpatient care fell by 10% between 2011 and 2013, after adjusting for predisposing, service needs and enabling factors. Such trends were particularly evident for the Urban Resident Basic Medical Insurance and the New Cooperative Medical Scheme, which covered more than 80%. The monthly out-of-pocket medical expenditures and the probability of encountering catastrophic health expenditures for outpatient care were four times larger than that for self-medication. Between 2011 and 2013, outpatient care medical costs rose by nearly 50%, whereas there was no such obvious trend for self-medication. People with insurance schemes offering lower cost sharing incurred consistently higher out-of-pocket outpatient payments. CONCLUSIONS The monitoring of global progress to UHC should incorporate self-medication. In China, it seems that the current reform and the huge government investment have not resulted in access to affordable quality care. To achieve UHC, not only universal insurance, but system-level efforts are needed.
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Affiliation(s)
- Jiasen Li
- School of Public Health, Peking University, Beijing, China
| | - Xing Lin Feng
- School of Public Health, Peking University, Beijing, China
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23
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Nicod E, Annemans L, Bucsics A, Lee A, Upadhyaya S, Facey K. HTA programme response to the challenges of dealing with orphan medicinal products: Process evaluation in selected European countries. Health Policy 2017; 123:140-151. [PMID: 28400128 DOI: 10.1016/j.healthpol.2017.03.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 12/21/2016] [Accepted: 03/20/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Challenges commonly encountered in HTA of orphan medicinal products (OMPs) were identified in Advance-HTA. Since then, new initiatives have been developed to specifically address issues related to HTA of OMPs. OBJECTIVE AND METHODS This study aimed to understand why these new HTA initiatives in England, Scotland and at European-level were established and whether they resolve the challenges of OMPs. The work of Advance-HTA was updated with a literature review and a conceptual framework of clinical, regulatory and economic challenges for OMPs was developed. The new HTA programmes were critiqued against the conceptual framework and outstanding challenges identified. RESULTS The new programmes in England and Scotland recognise the challenges identified in demonstrating the value of ultra-OMPs (and OMPs) and that they require a different process to standard HTA approaches. Wider considerations of disease and treatment experiences from a multi-stakeholder standpoint are needed, combined with other measures to deal with uncertainty (e.g. managed entry agreements). While approaches to assessing this new view of value of OMPs, extending beyond cost/QALY frameworks, differ, their criteria are similar. These are complemented by a European initiative that fosters multi-stakeholder dialogue and consensus about value determinants throughout the life-cycle of an OMP. CONCLUSION New HTA programmes specific to OMPs have been developed but questions remain about whether they sufficiently capture value and manage uncertainty in clinical practice.
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Affiliation(s)
- Elena Nicod
- Centre for Research on Health and Social Care Management, Bocconi University, Via Roentgen 1, 20126 Milan, Italy; Department of Social Policy, London School of Economics and Political Science, Houghton Street, WC2A 2AE, London, United Kingdom.
| | - Lieven Annemans
- Department of Public Health, Ghent University, De Pintelaan 185, 4K3, 9000 Gent, Belgium.
| | - Anna Bucsics
- Department of Finance, University of Vienna, Oskar-Morgenstern-Platz 1 (6th floor), 1090 Vienna, Austria.
| | - Anne Lee
- Scottish Medicines Consortium, Delta House (8th floor), 50 West Nile Street, G1 2NP Glasgow, Scotland, United Kingdom.
| | - Sheela Upadhyaya
- Centre for Health Technology Evaluation, National Institute for Health and Care Excellence, 10 Spring Gardens, SW1A 2BU London, United Kingdom.
| | - Karen Facey
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Nine Edinburgh BioQuarter, 9 Little France Road, EH16 4UX Edinburgh, Scotland, United Kingdom.
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24
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Cowie MR, Filippatos GS, Alonso Garcia MDLA, Anker SD, Baczynska A, Bloomfield DM, Borentain M, Bruins Slot K, Cronin M, Doevendans PA, El-Gazayerly A, Gimpelewicz C, Honarpour N, Janmohamed S, Janssen H, Kim AM, Lautsch D, Laws I, Lefkowitz M, Lopez-Sendon J, Lyon AR, Malik FI, McMurray JJV, Metra M, Figueroa Perez S, Pfeffer MA, Pocock SJ, Ponikowski P, Prasad K, Richard-Lordereau I, Roessig L, Rosano GMC, Sherman W, Stough WG, Swedberg K, Tyl B, Zannad F, Boulton C, De Graeff P. New medicinal products for chronic heart failure: advances in clinical trial design and efficacy assessment. Eur J Heart Fail 2017; 19:718-727. [PMID: 28345190 DOI: 10.1002/ejhf.809] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/30/2017] [Accepted: 02/07/2017] [Indexed: 12/13/2022] Open
Abstract
Despite the availability of a number of different classes of therapeutic agents with proven efficacy in heart failure, the clinical course of heart failure patients is characterized by a reduction in life expectancy, a progressive decline in health-related quality of life and functional status, as well as a high risk of hospitalization. New approaches are needed to address the unmet medical needs of this patient population. The European Medicines Agency (EMA) is undertaking a revision of its Guideline on Clinical Investigation of Medicinal Products for the Treatment of Chronic Heart Failure. The draft version of the Guideline was released for public consultation in January 2016. The Cardiovascular Round Table of the European Society of Cardiology (ESC), in partnership with the Heart Failure Association of the ESC, convened a dedicated two-day workshop to discuss three main topic areas of major interest in the field and addressed in this draft EMA guideline: (i) assessment of efficacy (i.e. endpoint selection and statistical analysis); (ii) clinical trial design (i.e. issues pertaining to patient population, optimal medical therapy, run-in period); and (iii) research approaches for testing novel therapeutic principles (i.e. cell therapy). This paper summarizes the key outputs from the workshop, reviews areas of expert consensus, and identifies gaps that require further research or discussion. Collaboration between regulators, industry, clinical trialists, cardiologists, health technology assessment bodies, payers, and patient organizations is critical to address the ongoing challenge of heart failure and to ensure the development and market access of new therapeutics in a scientifically robust, practical and safe way.
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Affiliation(s)
- Martin R Cowie
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, Sydney Street, London, SW3 6HP, UK
| | - Gerasimos S Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Athens University Hospital Attikon, Athens, Greece
| | - Maria de Los Angeles Alonso Garcia
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, Sydney Street, London, SW3 6HP, UK.,Scientific Advice Working Party European Medicines Agency, Medical Assessor Medicines and Healthcare Products Regulatory Agency (MHRA), London, UK
| | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Centre Göttingen (UMG), Göttingen, Germany.,Division of Homeostasis Research, Dept of Cardiology, Charité Campus CVK, Berlin, Germany
| | | | | | | | | | | | - Pieter A Doevendans
- European Medicines Agency Committee for Advanced Therapy, London, UK.,UMC, Utrecht, the Netherlands
| | | | | | | | | | | | | | | | | | - Martin Lefkowitz
- Novartis Pharmaceuticals, East Hanover, New Jersey, United States
| | - Jose Lopez-Sendon
- Cardiology Department, Hospital Universitario La Paz; IdiPaz, CIBER-CV, Madrid, Spain
| | - Alexander R Lyon
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, Sydney Street, London, SW3 6HP, UK
| | | | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK
| | - Marco Metra
- Cardiology, University of Brescia, Brescia, Italy
| | | | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Piotr Ponikowski
- Department of Heart Diseases, Medical University, Military Hospital, Wroclaw, Poland
| | - Krishna Prasad
- United Kingdom Medicines and Healthcare Products Regulatory Agency, London, UK
| | | | | | - Giuseppe M C Rosano
- IRCCS San Raffaele Hospital Roma, Rome, Italy.,Cardiovascular Clinical Academic Group, St George's Hospitals NHS Trust, University of London, London, UK
| | | | | | - Karl Swedberg
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, Sydney Street, London, SW3 6HP, UK.,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Faiez Zannad
- INSERM, Centre d'Investigation Clinique 1433 and Unité 1116, Université de Lorraine and CHU, Nancy, France
| | | | - Pieter De Graeff
- Dutch Medicines Evaluation Board (CBG-MEB), Utrecht, the Netherlands.,Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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25
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Rathi VK, Wang B, Ross JS, Downing NS, Kesselheim AS, Gray ST. Clinical Evidence Supporting US Food and Drug Administration Approval of Otolaryngologic Prescription Drug Indications, 2005-2014. Otolaryngol Head Neck Surg 2017; 156:683-692. [PMID: 28116974 DOI: 10.1177/0194599816689666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The US Food and Drug Administration (FDA) approves indications for prescription drugs based on premarket pivotal clinical studies designed to demonstrate safety and efficacy. We characterized the pivotal studies supporting FDA approval of otolaryngologic prescription drug indications. Study Design Retrospective cross-sectional analysis. Setting Publicly available FDA documents. Subjects Recently approved (2005-2014) prescription drug indications for conditions treated by otolaryngologists or their multidisciplinary teams. Drugs could be authorized for treatment of otolaryngologic disease upon initial approval (original indications) or thereafter via supplemental applications (supplemental indications). Methods Pivotal studies were categorized by enrollment, randomization, blinding, comparator type, and primary endpoint. Results Between 2005 and 2014, the FDA approved 48 otolaryngologic prescription drug indications based on 64 pivotal studies, including 21 original indications (19 drugs, 31 studies) and 27 supplemental indications (18 drugs, 33 studies). Median enrollment was 299 patients (interquartile range, 198-613) for original indications and 197 patients (interquartile range, 64-442) for supplemental indications. Most indications were supported by ≥1 randomized study (original: 20/21 [95%], supplemental: 21/27 [78%]) and ≥1 double-blinded study (original: 14/21 [67%], supplemental: 17/27 [63%]). About half of original indications (9/21 [43%]) and one-quarter of supplemental indications (7/27 [26%]) were supported by ≥1 active-controlled study. Nearly half (original: 8/21 [38%], supplemental: 14/27 [52%]) of all indications were approved based exclusively on studies using surrogate markers as primary endpoints. Conclusion The quality of clinical evidence supporting FDA approval of otolaryngologic prescription drug indications varied widely. Otolaryngologists should consider limitations in premarket evidence when helping patients make informed treatment decisions about newly approved drugs.
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Affiliation(s)
- Vinay K Rathi
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Bo Wang
- 3 Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Joseph S Ross
- 4 Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, Connecticut, USA.,5 Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA.,6 Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Nicholas S Downing
- 7 Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Aaron S Kesselheim
- 8 Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stacey T Gray
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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Integrating health technology assessment requirements in the clinical development of medicines: the experience from NICE scientific advice. Eur J Clin Pharmacol 2016; 73:297-305. [DOI: 10.1007/s00228-016-2174-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/02/2016] [Indexed: 10/20/2022]
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Antoñanzas F, Terkola R, Postma M. The Value of Medicines: A Crucial but Vague Concept. PHARMACOECONOMICS 2016; 34:1227-1239. [PMID: 27444306 DOI: 10.1007/s40273-016-0434-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Health Technology Assessment is increasingly used to evaluate the value of healthcare products and to prioritize resources; however, defining exactly what value is and how it should be measured remains a challenge. In this article, we report the results of a literature review, focusing on nine European countries, with the aim of investigating how value is defined from the perspective of different stakeholders, how definitions of value are used, and how value is incorporated into decision making. Only three articles were identified that presented definitions of value, and there was no single shared definition of value in healthcare, which appears to be a highly subjective concept. The majority of the countries investigated combine clinical assessment with economic evaluation to make reimbursement recommendations; the quality-adjusted life-year is the most commonly used measure of value but does not capture broader aspects of value that may be important to patients and healthcare systems. We describe the use of value-based pricing and multi-criteria decision analysis, two approaches to the incorporation of broader aspects of value into decision making. Overall, we have identified considerable variation in how a product's value is defined by different stakeholders. Although a universal understanding of value in healthcare is important, it is clear that current definitions are insufficient, potentially leading to inconsistent reimbursement decisions. Ultimately, the establishment of clearer policies for defining and measuring value in healthcare is needed, and is likely to lead to improvements in the consistency of decision making.
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Affiliation(s)
| | - Robert Terkola
- College of Pharmacy, University of Florida, Gainesville, FL, USA
- University of Groningen, Groningen, The Netherlands
| | - Maarten Postma
- Unit of Pharmacotherapy, Epidemiology and Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
- Institute of Science in Healthy Aging and healthcaRE (SHARE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Enzmann H, Meyer R, Broich K. The new EU regulation on in vitro diagnostics: potential issues at the interface of medicines and companion diagnostics. Biomark Med 2016; 10:1261-1268. [DOI: 10.2217/bmm-2016-0233] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Zhao M, Wu J. Impacts of regulated competition on pricing in Chinese pharmaceutical market under urban employee basic medical insurance. Expert Rev Pharmacoecon Outcomes Res 2016; 17:311-320. [DOI: 10.1080/14737167.2017.1251318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Mingyue Zhao
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
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Breckenridge A, Eichler HG, Jarow JP. Precision medicine and the changing role of regulatory agencies. Nat Rev Drug Discov 2016; 15:805-806. [DOI: 10.1038/nrd.2016.206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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New trends and challenges in the European regulation of innovative medicines. Regul Toxicol Pharmacol 2016; 80:314-20. [DOI: 10.1016/j.yrtph.2016.05.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/24/2016] [Indexed: 01/02/2023]
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Ermisch M, Bucsics A, Vella Bonanno P, Arickx F, Bybau A, Bochenek T, van de Casteele M, Diogene E, Fürst J, Garuolienė K, van der Graaff M, Gulbinovič J, Haycox A, Jones J, Joppi R, Laius O, Langner I, Martin AP, Markovic-Pekovic V, McCullagh L, Magnusson E, Nilsen E, Selke G, Sermet C, Simoens S, Sauermann R, Schuurman A, Ramos R, Vlahovic-Palcevski V, Zara C, Godman B. Payers' Views of the Changes Arising through the Possible Adoption of Adaptive Pathways. Front Pharmacol 2016; 7:305. [PMID: 27733828 PMCID: PMC5039228 DOI: 10.3389/fphar.2016.00305] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/26/2016] [Indexed: 12/29/2022] Open
Abstract
Payers are a major stakeholder in any considerations and initiatives concerning adaptive licensing of new medicinal products, also referred to as Medicines Adaptive Pathways to patients (MAPPs). Firstly, the scope and necessity of MAPPs need further scrutiny, especially with regard to the definition of unmet need. Conditional approval pathways already exist for new medicines for seriously debilitating or life-threatening diseases and only a limited number of new medicines are innovative. Secondly, MAPPs will result in new medicines on the market with limited evidence about their effectiveness and safety. Additional data are to be collected after approval. Consequently, adaptive pathways may increase the risk of exposing patients to ineffective or unsafe medicines. We have already seen medicines approved conventionally that subsequently proved ineffective or unsafe amongst a wider, more co-morbid population as well as medicines that could have been considered for approval under MAPPs but subsequently proved ineffective or unsafe in Phase III trials and were never licensed. Thirdly, MAPPs also put high demands on payers. Routine collection of patient level data is difficult with high transaction costs. It is not clear who will fund these. Other challenges for payers include shifts in the risk governance framework, implications for evaluation and HTA, increased complexity of setting prices, difficulty with ensuring equity in the allocation of resources, definition of responsibility and liability and implementation of stratified use. Exit strategies also need to be agreed in advance, including price reductions, rebates, or reimbursement withdrawals when price premiums are not justified. These issues and concerns will be discussed in detail including potential ways forward.
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Affiliation(s)
- Michael Ermisch
- Pharmaceuticals Department, National Association of Statutory Health Insurance Funds Berlin, Germany
| | - Anna Bucsics
- Department of Finance, University of Vienna Vienna, Austria
| | | | - Francis Arickx
- National Institute for Health and Disability Insurance Bruxelles, Belgium
| | | | - Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College Krakow, Poland
| | | | - Eduardo Diogene
- Clinical Pharmacology Service, Vall d'Hebron University Hospital, Fundació Institut Català de Farmacologia Barcelona, Spain
| | - Jurij Fürst
- Medicinal Products Department, Health Insurance Institute of Slovenia Ljubljana, Slovenia
| | - Kristina Garuolienė
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius UniversityVilnius, Lithuania; Medicines Reimbursement Department, National Health Insurance FundVilnius, Lithuania
| | | | - Jolanta Gulbinovič
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius UniversityVilnius, Lithuania; State Medicines Control AgencyVilnius, Lithuania
| | - Alan Haycox
- Health Economics Centre, University of Liverpool Management School Liverpool, UK
| | - Jan Jones
- Scottish Medicines Consortium Glasgow, UK
| | - Roberta Joppi
- Pharmaceutical Drug Department, Azienda Sanitaria Locale of Verona Verona, Italy
| | - Ott Laius
- State Agency of Medicines Tartu, Estonia
| | - Irene Langner
- Wissenschaftliches Institut der AOK (WIdO) Berlin, Germany
| | - Antony P Martin
- Health Economics Centre, University of Liverpool Management School Liverpool, UK
| | - Vanda Markovic-Pekovic
- Ministry of Health and Social WelfareBanja Luka, Bosnia and Herzegovina; Department of Social Pharmacy, Medical Faculty, University Banja LukaBanja Luka, Bosnia and Herzegovina
| | - Laura McCullagh
- Pharmacoeconomics and Health Technology Assessment, Department of Pharmacology and Therapeutics, Trinity College Dublin, Ireland
| | - Einar Magnusson
- Department of Health Services, Ministry of Health Reykjavík, Iceland
| | | | - Gisbert Selke
- Wissenschaftliches Institut der AOK (WIdO) Berlin, Germany
| | - Catherine Sermet
- Institut de Recherche et Documentation en Economie de la Santé (IRDES) Paris, France
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven Leuven, Belgium
| | - Robert Sauermann
- Department of Pharmaceutical Affairs, Main Association of Austrian Social Insurance Institutions Vienna, Austria
| | - Ad Schuurman
- National Health Care Institute Diemen, Netherlands
| | - Ricardo Ramos
- Health Technology Assessment, Prices and Reimbursement Department, INFARMED - National Authority of Medicines and Health Products, I. P., Parque de Saúde de Lisboa Lisbon, Portugal
| | | | - Corinne Zara
- Barcelona Health Region, Catalan Health Service Barcelona, Spain
| | - Brian Godman
- Health Economics Centre, University of Liverpool Management SchoolLiverpool, UK; Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of StrathclydeGlasgow, UK; Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital HuddingeStockholm, Sweden
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