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Kamusheva M, Manova M, Savova AT, Petrova GI, Mitov K, Harsányi A, Kaló Z, Márky K, Kawalec P, Angelovska B, Lakić D, Tesar T, Draganic P, Geitona M, Hatzikou M, Paveliu MS, Männik A. Comparative Analysis of Legislative Requirements About Patients' Access to Biotechnological Drugs for Rare Diseases in Central and Eastern European Countries. Front Pharmacol 2018; 9:795. [PMID: 30079023 PMCID: PMC6062647 DOI: 10.3389/fphar.2018.00795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/29/2018] [Indexed: 12/16/2022] Open
Abstract
Objectives: The aim of the study was to compare the access of patients with rare diseases (RDs) to biotechnological drugs in several Central and Eastern European countries (CEECs). We focused on the legislative pricing and reimbursement requirements, availability of biotechnological orphan medicinal products (BOMPs) for RDs, and reimbursement expenditures. Methods: A questionnaire-based survey was conducted among experts from 10 CEECs: Bulgaria, Croatia, Estonia, Greece, Hungary, Poland, Romania, Slovakia, Serbia, and Macedonia. The legal requirements for reimbursement and pricing of BOMPs were collected. All BOMPs and medicines without prior orphan designations were extracted from the European list of orphan medicinal products, 2017. The reimbursement status of these medicinal products in 2017 in the public coverage of the included CEECs as well as the share of their costs in relation to the total public pharmaceutical spending for the period from 2014 to 2016 were defined. Results: Our survey revealed that some differences in the legal requirements for pricing and reimbursement of BOMPs amongst the countries included in the study. All European Union countries have developed and implemented pharmacoeconomic guidelines with or without some specific reimbursement requirements for orphan medicinal products. Cost-effectiveness analysis, cost-utility analysis, Markov models, meta-analysis, and discount levels of costs and results were required only in Bulgaria, Poland and Hungary. The number of reimbursed BOMPs and biotechnological medicinal products for RDs without prior orphan designation was the highest in Hungary (17 and 40, respectively). Patient-based reimbursement schemes were available only in Hungary for 11 out of 17 BOMPs. Poland and Greece have the highest pharmaceutical expenditure of reimbursed BOMPs with are ~214 million and 180 million EUR, respectively in the observed period from 2014 to 2016. High proportion of the pharmaceutical expenditure on the reimbursed biotechnological medicinal products for RDs for the observed period 2014-2016 is presented in Bulgaria and Slovakia. Conclusions: The non-European Union CEECs face a significant delay in the legal implementation of pharmacoeconomic guideline for assessment of BOMPs. The access to BOMPs is similar among the observed CEECs and the countries with the best access are Hungary and Greece. The influence of BOMP expenditures on the budget in the individual countries is significant.
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Affiliation(s)
- Maria Kamusheva
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, Sofia, Bulgaria
| | - Manoela Manova
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, Sofia, Bulgaria
- National Council on Pricing and Reimbursement, Sofia, Bulgaria
| | - Alexandra T. Savova
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, Sofia, Bulgaria
- National Council on Pricing and Reimbursement, Sofia, Bulgaria
| | - Guenka I. Petrova
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, Sofia, Bulgaria
| | - Konstantin Mitov
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, Sofia, Bulgaria
| | - András Harsányi
- Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
- National Institute of Health Insurance Fund Management, Budapest, Hungary
| | - Zoltán Kaló
- Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
| | - Kristóf Márky
- National Institute of Health Insurance Fund Management, Budapest, Hungary
| | - Pawel Kawalec
- Faculty of Health Sciences, Institute of Public Health, Jagiellonian University Medical College Kraków, Kraków, Poland
| | - Bistra Angelovska
- Department of Pharmacy, Faculty of Medical Sciences, University Goce Delcev- Stip, Štip, Macedonia
| | - Dragana Lakić
- Department for Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Tomas Tesar
- Department of Organization and Management in Pharmacy, Faculty of Pharmacy, Comenius University, Bratislava, Slovakia
| | - Pero Draganic
- Croatian Agency for Medicinal Products and Medical Devices, Zagreb, Croatia
| | - Mary Geitona
- Department of Social and Educational Policy, School of Social Sciences, University of Peloponnese Tripoli, Tripoli, Greece
| | - Magdalini Hatzikou
- Department of Social and Educational Policy, School of Social Sciences, University of Peloponnese Tripoli, Tripoli, Greece
| | - Marian S. Paveliu
- Department of Pharmacology and Pharmaeconomics, Faculty of General Medicine, Titu Maiorescu University, Bucharest, Romania
| | - Agnes Männik
- Institute of Family Medicine and Public Health, University of Tartu, Tallinn, Estonia
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