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Babar ZUD, Dulal S, Dhakal NP, Upadhyaya MK, Trap B. Developing Nepal's medicines pricing policy: evidence synthesis and stakeholders' consultation. J Pharm Policy Pract 2024; 17:2346222. [PMID: 38690551 PMCID: PMC11060005 DOI: 10.1080/20523211.2024.2346222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Objectives The objectives of this paper are to (a) explore stakeholders' opinions regarding Nepal's existing medicines pricing practices/situation and (b) build and present a set of medicines pricing policies for Nepal. Methods A review of the literature and field visits to community retail pharmacies, hospital pharmacies, wholesalers, and distributor outlets in Kathmandu were conducted to assess the medicines pricing situation. Following the literature review, preliminary meetings with stakeholders and field visits were held and a draft interview guide was prepared. Consultative sessions subsequently were undertaken in Kathmandu, Nepal, in January 2023 with representatives from the Department of Drug Administration, Ministry of Health and Population, Association of Pharmaceutical Producers of Nepal, consumer groups, Transparency International, Medicines Importers Association of Nepal/ Pharmaceutical Distributors Association of Nepal, Nepal Chemist and Druggist Association, and Nepal Pharmaceutical Association. Notes were taken during these meetings regarding issues and concerns raised as well as experiences and recommendations for the future, as outlined in the interview guide. Results The stakeholders in general stated that they do not have any objection to price regulation; however, they believe such regulation should be subject to periodic review. Both the importers and the Ministry of Health and Population have the view that an independent body/authority should be charged with regulating the prices of medicines. A set of policy options to be considered for use in Nepal include cost-plus pricing, external price referencing, internal reference pricing, and mark-up regulations. Conclusion Key issues related to pricing were identified and suggest that a set of pricing policies and updated regulations need to be considered to establish changes that are transparent, rational, and acceptable to the related stakeholders. Hence, suggestions made in this paper could be useful to inform a rational and fair pricing structure and to improve access to medicines.
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Affiliation(s)
| | - Santosh Dulal
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kathmandu, Nepal
| | - Narayan Prasad Dhakal
- Department of Drug Administration, Ministry of Health and Population, Kathmandu, Nepal
| | - Madan Kumar Upadhyaya
- Quality Standard and Regulation Division, Ministry of Health and Population, Kathmandu, Nepal
| | - Birna Trap
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kathmandu, Nepal
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Zhou J, Lan T, Lu H, Pan J. Price negotiation and pricing of anticancer drugs in China: An observational study. PLoS Med 2024; 21:e1004332. [PMID: 38166148 DOI: 10.1371/journal.pmed.1004332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/17/2024] [Accepted: 12/13/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND While China has implemented reimbursement-linked drug price negotiation annually since 2017, emphasizing value-based pricing to achieve a value-based strategic purchase of medical insurance, whether drug prices became better aligned with clinical value after price negotiation has not been sufficiently established. This study aimed to assess the changes in prices and their relationship with the clinical value of anticancer drugs after the implementation of price negotiations in China. METHODS AND FINDINGS In this observational study, anticancer drug indications that were negotiated successfully between 2017 and 2022 were identified through National Reimbursement Drug Lists (NRDL) of China. We excluded extensions of indications for drugs already listed in the NRDL, indications for pediatric use, and indications lacking corresponding clinical trials. We identified pivotal clinical trials for included indications by consulting review reports or drug labels issued by the Center for Drug Evaluation, National Medical Products Administration. We calculated treatment costs as outcome measures based on publicly available prices and collected data on clinical value including safety, survival, quality of life, and overall response rate (ORR) from publications of pivotal clinical trials. The associations between drug costs and clinical value, both before and after negotiation, were analyzed using regression analyses. We also examined whether price negotiation has led to a reduction in the variation of treatment costs for a given value. We included 103 anticancer drug indications, primarily for the treatment of blood cancer, lung cancer, and breast cancer, with 76 supported by randomized controlled trials and 27 supported by single-arm clinical trials. The median treatment costs over the entire sample have been reduced from US$34,460.72 (interquartile range (IQR): 19,990.49 to 55,441.66) to US$13,688.79 (IQR: 7,746.97 to 21,750.97) after price negotiation (P < 0.001). Before price negotiation, each additional month of survival gained was associated with an increase in treatment costs of 3.4% (95% confidence interval (CI) [2.1, 4.8], P < 0.001) for indications supported by randomized controlled trials, and a 10% increase in ORR was associated with a 6.0% (95% CI [1.6, 10.3], P = 0.009) increase in treatment costs for indications supported by single-arm clinical trials. After price negotiation, the associations between costs and clinical value may not have changed significantly, but the variation of drug costs for a given value was reduced. Study limitations include the lack of transparency in official data, missing data on clinical value, and a limited sample size. CONCLUSIONS In this study, we found that the implementation of price negotiation in China has led to drug pricing better aligned with clinical value for anticancer drugs even after substantial price reductions. The achievements made in China could shed light on the price regulation in other countries, particularly those with limited resources and increasing drug expenditures.
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Affiliation(s)
- Jing Zhou
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Tianjiao Lan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Hao Lu
- School of Public Health, Imperial College London, London, United Kingdom
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- School of Public Administration, Sichuan University, Chengdu, China
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Mavela NH, Couchman IMS, Mgwaba T, Nxumalo CT. A qualitative study of pharmacists' perceptions and awareness of homoeopathic medicines in Durban, South Africa. S Afr Fam Pract (2004) 2023; 65:e1-e10. [PMID: 38197691 PMCID: PMC10784278 DOI: 10.4102/safp.v65i1.5698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND There is growing interest in the demand for and use of homoeopathic medicines by the public; however, little is known about the perspectives of pharmacists regarding the use of these medicines, particularly in the South African private health context. METHODS A qualitative approach using an exploratory cross-sectional descriptive design was used. Data were collected from a purposive sample of 15 participants comprising pharmacy managers, pharmacists and pharmacy assistants from six different conveniently selected private pharmacy retail outlets. Data were collected using individual interviews utilising a semi-structured interview guide. An audiotape was used to record the data which were transcribed verbatim and analysed thematically, following Tech's steps of data analysis. Ethical approval to conduct the study was obtained from the Durban University of Technology's Institutional Research Ethics Committee. RESULTS The findings of this study revealed four superordinate themes related to pharmacists' perceptions and self-reported awareness regarding homoeopathic medicines. These are (1) negative perceptions regarding homoeopathic medicines, (2) perceived benefits of homoeopathic medicines, (3) poor knowledge and awareness of homoeopathic medicines and (4) capacity development and curriculum aspects. CONCLUSION The findings highlight the need for an educational intervention on homoeopathic medicines targeting pre-service and in-service pharmacy practitioners, to enable them to provide effective education regarding all types of medicines as the demand for homoeopathic medicines increases.Contribution: The study findings provide evidence to support advocacy for an educational intervention to improve awareness and knowledge of pharmacists to enable provision of effective health education for patients. More research, however, is required to inform the contents of this training intervention for pharmacists.
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Affiliation(s)
- Nokuthula H Mavela
- Centre for Excellence in Learning and Teaching, Durban University of Technology, Durban.
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Wang Q, Liu S, Nie Z, Zhu Z, Fu Y, Zhang J, Wei X, Yang L, Wei X. The pan-Canadian Tiered Pricing Framework and Chinese National Volume-Based Procurement: A comparative study using Donabedian's structure-process-outcome framework. J Glob Health 2023; 13:04137. [PMID: 37947028 PMCID: PMC10636597 DOI: 10.7189/jogh.13.04137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Background Generic drugs have been seen as a potentially powerful way to alleviate the financial burden on patients and health care systems. Two strategies for achieving rational prices of generic drugs are tiered pricing framework and pooled purchasing power. We compare the pan-Canadian Tiered Pricing Framework (TPF) and the Chinese National Volume-Based Procurement (NVBP) as comparators to explore the similarities and differences between the two mechanisms and summarise lessons for other jurisdictions. Methods This comparative study applies Donabedian's structure-process-outcome framework to systematically analyse the macro contexts, procedures, and long- and short-term results of each pricing mechanism, and the interactions between them. Results Structure: TPF is an upstream initiative aimed at lowering the prices of generic drugs and increasing coverage and price consistency. NVBP is a downstream national initiative prioritised for reducing drug prices to achieve value-based purchasing. Process: By associating the number of manufacturers with price cuts, TPF leaves the choice to manufacturers to decide if they want to enter a specific market. In contrast, the Chinese government determines NVBP list and has the authority to choose manufacturer(s) with the lowest price(s). TPF provides clear price information to potential suppliers with unclear order quantity. The NVBP drug price is determined by tendering, while procurement volume is clear and massive. Outcome: The effectiveness of TPF and NVBP is similar, with both achieving a 53% price cut. Both TPF and NVBP experienced efficiency improvement since their establishment, with 98 and 86 drugs priced per year. By comparing 60 drugs covered by both programmes, the NVBP price is 57% of that of the TPF counterpart on average (1.1 to 301.6%), by purchase power parity. Conclusions The tiered pricing scheme is feasible in regions with a stable and mature pharmaceutical market, typically seen in high-income countries, while tendering is more workable in low- and middle-income countries where the pharmaceutical market is weak and unstable. Experience in the two countries shows that a coordinated pricing mechanism involves many piecemeal interactive problems, which a sophisticated system with a robust long-range plan may address better.
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Affiliation(s)
- Quan Wang
- School of Public Health, Peking University, Beijing, China
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Siqi Liu
- Center of Health System and Policy, Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Zhijie Nie
- School of Public Health, Peking University, Beijing, China
| | - Zheng Zhu
- School of Public Health, Peking University, Beijing, China
| | - Yaqun Fu
- School of Public Health, Peking University, Beijing, China
| | - Jiawei Zhang
- School of Public Health, Peking University, Beijing, China
| | - Xia Wei
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, England, UK
| | - Li Yang
- School of Public Health, Peking University, Beijing, China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Espinosa O, Bejarano V, Sanabria C, Rodríguez J, Basto S, Rodríguez-Lesmes P, Robayo A. Detecting unexpected growths in health technologies expenditures: the case of MIPRES in Colombia. BMC Health Serv Res 2023; 23:1153. [PMID: 37880691 PMCID: PMC10601102 DOI: 10.1186/s12913-023-10155-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023] Open
Abstract
We developed an algorithm to explore unexpected growth in the usage and costs of health technologies. We exploit data from the expenditures on technologies funded by the Colombian government under the compulsory insurance system, where all prescriptions for technologies not included in an explicit list must be registered in a centralized information system, covering the period from 2017 to 2022. The algorithm consists of two steps: an outlier detection method based on the density of the expenditures for selecting a first set of technologies to consider (39 technologies out of 106,957), and two anomaly detection models for time series to determine which insurance companies, health providers, and regions have the most notorious increases. We have found that most medicines associated with atypical behavior and significant monetary growth could be linked to the use of recently introduced drugs in the market. These drugs have valid patents and very specific clinical indications, often involving high-cost pharmacological treatments. The most relevant case is the Burosumab, approved in 2018 to treat a rare genetic disorder affecting skeletal growth. Secondly, there is clear evidence of anomalous increasing trend evolutions in the identified enteral nutritional support supplements or Food for Special Medical Purposes. The health system did not purchase these products before July 2021, but in 2022 they represented more than 500,000 USD per month.
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Affiliation(s)
- Oscar Espinosa
- Directorate of Analytical, Economic and Actuarial Studies in Health, Instituto de Evaluación Tecnológica en Salud (IETS), Bogotá, D.C, Colombia.
- Economic Models and Quantitative Methods Research Group, Centro de Investigaciones para el Desarrollo, Universidad Nacional de Colombia, Bogotá, D.C, Colombia.
| | - Valeria Bejarano
- Directorate of Analytical, Economic and Actuarial Studies in Health, Instituto de Evaluación Tecnológica en Salud (IETS), Bogotá, D.C, Colombia
- Economic Models and Quantitative Methods Research Group, Centro de Investigaciones para el Desarrollo, Universidad Nacional de Colombia, Bogotá, D.C, Colombia
| | - Cristian Sanabria
- Directorate of Analytical, Economic and Actuarial Studies in Health, Instituto de Evaluación Tecnológica en Salud (IETS), Bogotá, D.C, Colombia
| | - Jhonathan Rodríguez
- Directorate of Analytical, Economic and Actuarial Studies in Health, Instituto de Evaluación Tecnológica en Salud (IETS), Bogotá, D.C, Colombia
- Economic Models and Quantitative Methods Research Group, Centro de Investigaciones para el Desarrollo, Universidad Nacional de Colombia, Bogotá, D.C, Colombia
| | - Sergio Basto
- Directorate of Analytical, Economic and Actuarial Studies in Health, Instituto de Evaluación Tecnológica en Salud (IETS), Bogotá, D.C, Colombia
| | - Paul Rodríguez-Lesmes
- Directorate of Analytical, Economic and Actuarial Studies in Health, Instituto de Evaluación Tecnológica en Salud (IETS), Bogotá, D.C, Colombia
- School of Economics, Universidad del Rosario, Bogotá, D.C, Colombia
| | - Adriana Robayo
- Executive Directorate, Instituto de Evaluación Tecnológica en Salud (IETS), Bogotá, D.C, Colombia
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Wang X, Huang H, Sun Y, Zhu Z, Jiang B, Yang L. Effects of volume-based procurement policy on the usage and expenditure of first-generation targeted drugs for non-small cell lung cancer with EGFR mutation in China: an interrupted time series study. BMJ Open 2023; 13:e064199. [PMID: 37407064 DOI: 10.1136/bmjopen-2022-064199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES In December 2018, China launched national volume-based procurement (NVBP) to negotiate drug prices with manufacturers. Gefitinib was one of the 25 pilot drugs, which is used for treatment of non-small cell lung cancer. Lung cancer is the most common type of cancer in China and targeted drugs like gefitinib have been proven to provide clinical benefits to patients. This study aims to explore the impact of NVBP policy on the usage and expenditure of anticancer drugs. METHODS Gefitinib and alternative drugs (icotinib and erlotinib) were used as objects of study. Quarterly data from the China Hospital Pharmaceutical Audit database in 9454 hospitals in China were used for analysis. Descriptive analysis was conducted using purchase volume and expenditure as variables. Interrupted time-series (ITS) analysis was applied to further analyse the effect of NVBP policy on the medicines under study. RESULTS During the 12-month period before (2018Q2-2019Q1) and after (2019Q2-2020Q1) the NVBP policy, the total purchase volume of medicines rose from 4.48 million defined daily dose (DDD) to 7.02 million DDD, with an increase of 56.66%. Purchase volume of gefitinib and alternative drugs increased 100.61% and 14.88%, respectively. After the implementation of NVBP policy, procurement volume of alternative drugs decreased by 72 051 DDD (p value=0.044) and trend change decreased by 56 738 DDD (p value<0.01). The overall expenditure reduction was 14.7%, with the expenditure of gefitinib reducing by 38.47% and alternative drugs increasing by 10.70%. ITS analysis indicated statistically significant differences in level and trend changes for expenditure of total drugs and gefitinib. CONCLUSIONS The evidence provided in this study indicated that the implementation of NVBP policy was related to the expenditure reduction of the first generation of anti-EGFR lung cancer drugs. The policy effectively controlled the increase in expenditures for corresponding drugs while ensuring the use of drugs.
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Affiliation(s)
- Xiaoyang Wang
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Huang Huang
- Public Policy Research Center, Peking University, Beijing, China
| | - Yan Sun
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zheng Zhu
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Bin Jiang
- Public Policy Research Center, Peking University, Beijing, China
- School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Li Yang
- School of Public Health, Peking University Health Science Center, Beijing, China
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7
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Zhu Z, Wang Q, Sun Q, Lexchin J, Yang L. Improving access to medicines and beyond: the national volume-based procurement policy in China. BMJ Glob Health 2023; 8:e011535. [PMID: 37463786 PMCID: PMC10577736 DOI: 10.1136/bmjgh-2022-011535] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/28/2023] [Indexed: 07/20/2023] Open
Abstract
Since 2019, the Chinese central government has taken significant steps to centralize national purchasing power and has implemented a pooled procurement system. In this paper, we provide an in-depth analysis of China's National Volume-Based Procurement (NVBP) policy, which represents a unique approach to pooled procurement within the pharmaceutical sector. The primary objectives of the NVBP are to reduce drug prices, enhance access to affordable medications, and improve the overall functioning of the pharmaceutical industry in China. Our analysis delves into the key features of the NVBP, including its centralized procurement system, volume-based procurement approach, and the guaranteed procurement volumes allocated to winning bidders. We also address the challenges and implications associated with the NVBP, such as its impact on the pharmaceutical industry, the sustainability of price reductions, and the importance of striking a balance between price reduction and industry sustainability. Through a comparative analysis, we shed light on the distinct characteristics of China's approach to pooled procurement and its potential ramifications for healthcare policies and practices. By examining the NVBP within the broader context of China's evolving healthcare landscape, we aim to contribute to a deeper understanding of the implications and effectiveness of this unique policy initiative.
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Affiliation(s)
- Zheng Zhu
- Department of Health Policy and Management, Peking University School of Public Health, Beijing, China
| | - Quan Wang
- Department of Health Policy and Management, Peking University School of Public Health, Beijing, China
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Qiang Sun
- Shandong University School of Public Health, Jinan, Shandong, China
| | - Joel Lexchin
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Li Yang
- Department of Health Policy and Management, Peking University School of Public Health, Beijing, China
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Peng K, Blais JE, Pratt NL, Guo JJ, Hillen JB, Stanford T, Ward M, Lai ECC, Shin JY, Tong X, Fan M, Cheng FWT, Wu J, Yeung WWY, Lau CS, Leung WK, Wong ICK, Li X. Impact of Introducing Infliximab Biosimilars on Total Infliximab Consumption and Originator Infliximab Prices in Eight Regions: An Interrupted Time-Series Analysis. BioDrugs 2023; 37:409-420. [PMID: 36952213 DOI: 10.1007/s40259-023-00589-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE We aimed to assess whether the introduction of the first infliximab biosimilar was associated with changes in overall infliximab consumption (originator and biosimilars) and price changes to the originator infliximab. METHODS An interrupted time series analysis using infliximab sales data from 2010 to 2020 from the IQVIA Multinational Integrated Data Analysis System for eight selected regions: Australia, Canada, Hong Kong, Korea, India, Japan, the UK, and the USA. Quarterly measures of infliximab consumption and list prices were respectively defined as the number of standard units (SU)/1000 inhabitants and as 2020 USA dollars (USD)/SU. RESULTS Following the introduction of infliximab biosimilars, overall infliximab consumption increased in Australia [immediate change: 0.145 SU/1000 inhabitants (P = 0.014); long-term change: 0.022 SU/1000 inhabitants per quarter (P < 0.001)], Canada [immediate change 0.415 (P = 0.008)], the UK [long-term change 0.024 (P < 0.001)], and Hong Kong [immediate change: 0.042 (P < 0.001)]. The list price of originator infliximab also decreased following biosimilar introduction in Australia [immediate change: - 187.84 USD/SU (P < 0.001); long-term change - 6.46 USD/SU per quarter (P = 0.043)], Canada [immediate change: - 145.58 (P < 0.001)], the UK [immediate change: - 34.95 (P = 0.010); long-term change: - 4.77 (P < 0.001)], and Hong Kong [long-term change: - 4.065 (P = 0.046)]. Consumption and price changes were inconsistent in India, Japan, Korea, and the USA. CONCLUSIONS Introduction of the first infliximab biosimilar was not consistently associated with increased consumption across regions. Additional policy and healthcare system interventions to support biosimilar infliximab adoption are needed.
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Affiliation(s)
- Kuan Peng
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Joseph E Blais
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Nicole L Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Jeff Jianfei Guo
- James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
| | - Jodie B Hillen
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Tyman Stanford
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
- Pharmacy Education, Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Michael Ward
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ju-Young Shin
- Department of Biohealth Regulatory Science, School of Pharmacy, Sungkyunkwan University, Seoul, South Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Xinning Tong
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Min Fan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Franco W T Cheng
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Winnie W Y Yeung
- Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, Pok Fu Lam, Hong Kong SAR, China
| | - Chak-Sing Lau
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, Pok Fu Lam, Hong Kong SAR, China
| | - Wai Keung Leung
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China.
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pak Shek Kok, Hong Kong SAR, China.
- Aston Pharmacy School, Aston University, Birmingham, UK.
| | - Xue Li
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China.
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pak Shek Kok, Hong Kong SAR, China.
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Otieku E, Fenny AP, Labi AK, Owusu-Ofori AK, Kurtzhals J, Enemark U. Knowledge, attitudes and practices regarding antimicrobial use and resistance among healthcare seekers in two tertiary hospitals in Ghana: a quasi-experimental study. BMJ Open 2023; 13:e065233. [PMID: 36813487 PMCID: PMC9950892 DOI: 10.1136/bmjopen-2022-065233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE To evaluate knowledge of antimicrobial resistance (AMR), to study how the judgement of health value (HVJ) and economic value (EVJ) affects antibiotic use, and to understand if access to information on AMR implications may influence perceived AMR mitigation strategies. DESIGN A quasi-experimental study with interviews performed before and after an intervention where hospital staff collected data and provided one group of participants with information about the health and economic implications of antibiotic use and resistance compared with a control group not receiving the intervention. SETTING Korle-Bu and Komfo Anokye Teaching Hospitals, Ghana. PARTICIPANTS Adult patients aged 18 years and older seeking outpatient care. MAIN OUTCOME MEASURES We measured three outcomes: (1) level of knowledge of the health and economic implications of AMR; (2) HVJ and EVJ behaviours influencing antibiotic use and (3) differences in perceived AMR mitigation strategy between participants exposed and not exposed to the intervention. RESULTS Most participants had a general knowledge of the health and economic implications of antibiotic use and AMR. Nonetheless, a sizeable proportion disagreed or disagreed to some extent that AMR may lead to reduced productivity/indirect costs (71% (95% CI 66% to 76%)), increased provider costs (87% (95% CI 84% to 91%)) and costs for carers of AMR patients/societal costs (59% (95% CI 53% to 64%)). Both HVJ-driven and EVJ-driven behaviours influenced antibiotic use, but the latter was a better predictor (reliability coefficient >0.87). Compared with the unexposed group, participants exposed to the intervention were more likely to recommend restrictive access to antibiotics (p<0.01) and pay slightly more for a health treatment strategy to reduce their risk of AMR (p<0.01). CONCLUSION There is a knowledge gap about antibiotic use and the implications of AMR. Access to AMR information at the point of care could be a successful way to mitigate the prevalence and implications of AMR.
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Affiliation(s)
- Evans Otieku
- Economics Division, Institute of Statistical, Social, and Economic Research (ISSER), University of Ghana, Legon, Ghana
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ama Pokuaa Fenny
- Economics Division, Institute of Statistical, Social, and Economic Research (ISSER), University of Ghana, Legon, Ghana
| | - Appiah-Koran Labi
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Alex Kwame Owusu-Ofori
- Laboratory Services Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jørgen Kurtzhals
- ISIM, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Microbiology, Rigshospitalet, Kobenhavn, Denmark
| | - Ulrika Enemark
- Department of Public Health, Aarhus University, Aarhus, Denmark
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10
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Koduah A, Baatiema L, de Chavez AC, Danso-Appiah A, Kretchy IA, Agyepong IA, King N, Ensor T, Mirzoev T. Implementation of medicines pricing policies in sub-Saharan Africa: systematic review. Syst Rev 2022; 11:257. [PMID: 36457058 PMCID: PMC9714131 DOI: 10.1186/s13643-022-02114-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/02/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND High medicine prices contribute to increasing cost of healthcare worldwide. Many patients with limited resources in sub-Saharan Africa (SSA) are confronted with out-of-pocket charges, constraining their access to medicines. Different medicine pricing policies are implemented to improve affordability and availability; however, evidence on the experiences of implementations of these policies in SSA settings appears limited. Therefore, to bridge this knowledge gap, we reviewed published evidence and answered the question: what are the key determinants of implementation of medicines pricing policies in SSA countries? METHODS We identified policies and examined implementation processes, key actors involved, contextual influences on and impact of these policies. We searched five databases and grey literature; screening was done in two stages following clear inclusion criteria. A structured template guided the data extraction, and data analysis followed thematic narrative synthesis. The review followed best practices and reported using PRISMA guidelines. RESULTS Of the 5595 studies identified, 31 met the inclusion criteria. The results showed thirteen pricing policies were implemented across SSA between 2003 and 2020. These were in four domains: targeted public subsides, regulatory frameworks and direct price control, generic medicine policies and purchasing policies. Main actors involved were government, wholesalers, manufacturers, retailers, professional bodies, community members and private and public health facilities. Key contextual barriers to implementation were limited awareness about policies, lack of regulatory capacity and lack of price transparency in external reference pricing process. Key facilitators were favourable policy environment on essential medicines, strong political will and international support. Evidence on effectiveness of these policies on reducing prices of, and improving access to, medicines was mixed. Reductions in prices were reported occasionally, and implementation of medicine pricing policy sometimes led to improved availability and affordability to essential medicines. CONCLUSIONS Implementation of medicine pricing policies in SSA shows some mixed evidence of improved availability and affordability to essential medicines. It is important to understand country-specific experiences, diversity of policy actors and contextual barriers and facilitators to policy implementation. Our study suggests three policy implications, for SSA and potentially other low-resource settings: avoiding a 'one-size-fits-all' approach, engaging both private and public sector policy actors in policy implementation and continuously monitoring implementation and effects of policies. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020178166.
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Affiliation(s)
- Augustina Koduah
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.
| | - Leonard Baatiema
- Department of Health Policy, Planning & Management, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Anna Cronin de Chavez
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Anthony Danso-Appiah
- Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Irene A Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | | | - Natalie King
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Timothy Ensor
- Nuffield Centre for International Health, University of Leeds, Leeds, UK
| | - Tolib Mirzoev
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Koduah A, Baatiema L, Kretchy IA, Agyepong IA, Danso-Appiah A, de Chavez AC, Ensor T, Mirzoev T. Powers, engagements and resultant influences over the design and implementation of medicine pricing policies in Ghana. BMJ Glob Health 2022; 7:bmjgh-2021-008225. [PMID: 35589156 PMCID: PMC9121428 DOI: 10.1136/bmjgh-2021-008225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/19/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Universal availability and affordability of essential medicines are determined by effective design and implementation of relevant policies, typically involving multiple stakeholders. This paper examined stakeholder engagements, powers and resultant influences over design and implementation of four medicines pricing policies in Ghana: Health Commodity Supply Chain Master Plan, framework contracting for high demand medicines, Value Added Tax (VAT) exemptions for selected essential medicines, and ring-fencing medicines for local manufacturing. Methods Data were collected using reviews of policy documentation (n=16), consultative meetings with key policy actors (n=5) and in-depth interviews (n=29) with purposefully identified national-level policymakers, public and private health professionals including members of the National Medicine Pricing Committee, pharmaceutical wholesalers and importers. Data were analysed using thematic framework. Results A total of 46 stakeholders were identified, including representatives from the Ministry of Health, other government agencies, development partners, pharmaceutical industry and professional bodies. The Ministry of Health coordinated policy processes, utilising its bureaucratic mandate and exerted high influences over each policy. Most stakeholders were highly engaged in policy processes. Whereas some led or coproduced the policies in the design stage and participated in policy implementation, others were consulted for their inputs, views and opinions. Stakeholder powers reflected their expertise, bureaucratic mandates and through participation in national level consultation meetings, influences policy contents and implementation. A wider range of stakeholders were involved in the VAT exemption policies, reflecting their multisectoral nature. A minority of stakeholders, such as service providers were not engaged despite their interest in medicines pricing, and consequently did not influence policies. Conclusions Stakeholder powers were central to their engagements in, and resultant influences over medicine pricing policy processes. Effective leadership is important for inclusive and participatory policymaking, and one should be cognisant of the nature of policy issues and approaches to policy design and implementation.
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Affiliation(s)
- Augustina Koduah
- Pharmacy Practice and Clinical Pharmacy, University of Ghana School of Pharmacy, Legon, Accra, Ghana
| | - Leonard Baatiema
- Health Policy, Planning & Management, University of Ghana School of Public Health, Legon, Accra, Ghana
| | - Irene A Kretchy
- Pharmacy Practice and Clinical Pharmacy, University of Ghana School of Pharmacy, Legon, Accra, Ghana
| | - Irene Akua Agyepong
- Dodowa Health Research Centre, Ghana Health Service, Accra, Greater Accra, Ghana.,Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Greater Accra, Ghana
| | - Anthony Danso-Appiah
- Epidemiology and Disease Control, University of Ghana School of Public Health, Legon, Accra, Ghana
| | - Anna Cronin de Chavez
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, London, UK
| | - Timothy Ensor
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Tolib Mirzoev
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, London, UK
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12
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Chhabra H, Mouslim MC, Kashiramka S, Rathore AS. Dynamics of biosimilar uptake in emerging markets. Expert Opin Biol Ther 2022; 22:679-688. [PMID: 35535988 DOI: 10.1080/14712598.2022.2076557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Globally, biosimilars are expected to play a key role in lowering healthcare costs and providing increased patient access to biological therapies. Given this, and in line with the European Union and World Health Organization, many emerging nations have adapted and established biosimilar regulatory guidelines. Emerging nations present a lucrative market for biosimilar development and commercialization, yet they also pose unique challenges. A thorough understanding of the unique attributes of emerging markets in relation to biosimilars is needed to promote their successful uptake in low- and middle-income countries. AREAS COVERED This article highlights the opportunities and challenges that emerging markets represent in terms of biosimilar uptake. A comprehensive analysis of biosimilar uptake in European countries, where biosimilars have gained significant market share, was carried out to identify policies that can enhance market penetration in emerging nations. EXPERT OPINION Implementation of pricing and procurement policies, as well as provider and patient confidence in biosimilar efficacy, are key factors in their uptake. Due to the high cost of biosimilar development, incentivizing domestic companies with the biosimilar manufacturing capability to produce these drugs will be helpful in ensuring a sustainable biosimilar market and a steady supply chain.
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Affiliation(s)
- Hemlata Chhabra
- Department of Chemical Engineering, Indian Institute of Technology, Delhi, India
| | - Morgane C Mouslim
- The Hilltop Institute, University of Maryland Baltimore County, Baltimore MD
| | - Smita Kashiramka
- Department of Management Studies, Indian Institute of Technology, Delhi, India
| | - Anurag S Rathore
- Department of Chemical Engineering, Indian Institute of Technology, Delhi, India
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13
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Babar ZUD. Forming a medicines pricing policy for low and middle-income countries (LMICs): the case for Pakistan. J Pharm Policy Pract 2022; 15:9. [PMID: 35209945 PMCID: PMC8867617 DOI: 10.1186/s40545-022-00413-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Equitable access to medicines has played a vital role to improve patient health outcomes and reducing mortality globally. However, it is important to note that medicines pricing is a key determinant in promoting access to medicines. The studies and empirical data have shown that there are wide variations in prices across countries for the same brand of medicines. World Health Organisation (WHO) has provided guidelines to formulate country pharmaceutical pricing policies. However, little is known how these guidelines will be used in the country-specific setting. This commentary provides guiding principles and outlines the basis to form a medicines pricing policy in a low and middle-income country, Pakistan. It discusses the current medicines pricing policy and provides suggestions for future work. The suggested medicines pricing structure and lessons learned in this commentary can also be applied in other low-resource settings.
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Affiliation(s)
- Zaheer-Ud-Din Babar
- Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK.
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14
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Moye-Holz D, Vogler S. Comparison of Prices and Affordability of Cancer Medicines in 16 Countries in Europe and Latin America. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:67-77. [PMID: 34228312 PMCID: PMC8752537 DOI: 10.1007/s40258-021-00670-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 06/01/2023]
Abstract
BACKGROUND There are concerns that high prices of cancer medicines may limit patient access. Since information on prices for cancer medicines and their impact on affordability is lacking for several countries, particularly for lower income countries, this study surveys prices of originator cancer medicines in Europe and Latin America and assesses their affordability. METHODS For 19 cancer medicines, public procurement and ex-factory prices, as of 2017, were surveyed in five Latin American (LATAM) countries (Brazil, Chile, Colombia, Mexico, and Peru) and 11 European countries (Austria, France, Germany, Greece, Hungary, the Netherlands, Poland, Romania, Spain, Sweden, and the UK). Price data (public procurement prices in LATAM and ex-factory prices in Europe) in US dollar purchasing power parities (PPP) were analyzed per defined daily dose. Affordability was measured by setting medicines prices in relation to national minimum wages. RESULTS The prices of cancer medicines varied considerably between countries. In European countries with higher levels of income, PPP-adjusted prices tended to be lower than in European countries of lower income and LATAM countries. Except for one medicine, all surveyed medicines were considered unaffordable in most countries. In European countries of lower income and LATAM countries, more than 15 days' worth of minimum wages would be required by a worker to purchase one defined daily dose of several of the studied medicines. CONCLUSIONS The high prices and large unaffordability of cancer medicines call for strengthening pricing policies with the aim of ensuring affordable treatment in cancer care.
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Affiliation(s)
- Daniela Moye-Holz
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - S. Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (GÖG/Austrian National Public Health Institute), Stubenring 6, 1010 Vienna, Austria
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15
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Mureyi D, Katena NA, Monera-Penduka T. Perceptions of diabetes patients and their caregivers regarding access to medicine in a severely constrained health system: A qualitative study in Harare, Zimbabwe. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000255. [PMID: 36962297 PMCID: PMC10021663 DOI: 10.1371/journal.pgph.0000255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/13/2022] [Indexed: 11/19/2022]
Abstract
Nearly half of all sub-Saharan African countries lack operational Diabetes Mellitus policies. This represents an opportunity to build reliable evidence to underpin such policies when they are eventually developed. Representing the interests of those with the experience of living with the condition in national diabetes policies is important, particularly the interests regarding medicine access, a key pillar in diabetes management. One way to achieve this representation is to publish patient perceptions. Patient perspectives are especially valuable in the context of diabetes in Sub-Saharan Africa, where much of the empirical work has focused on clinical and epidemiological questions. We therefore captured the challenges and suggestions around medicine access articulated by a population of diabetes patients and their caregivers. This was a qualitative interpretivist study based on data from focus group discussions with adult diabetes patients and their caregivers. Eight FGDs of 4-13 participants each whose duration averaged 13.35 minutes were conducted. Participants were recruited from diabetes outpatient clinics at two health facilities in Harare. One site was Parirenyatwa Hospital, the largest public referral and teaching hospital in Zimbabwe. The other was a private for-profit facility. Ethics approval was granted by the Joint Research Ethics Committee for University of Zimbabwe College of Health Sciences and the Parirenyatwa Group of Hospitals (Ref: JREC 295/18). Diabetes patients and their caregivers are interested in affordable access to medicines of acceptable form and quality with minimum effort. Yet, they often find themselves privileging one dimension of access over another e.g. prioritising affordability over acceptability. Based on participants' articulations, a sound diabetes policy should: 1. provide for financial and consumer protections, 2. regulate healthcare business practices and medicine prices, 3. provide for a responsive health workforce attentive to patient problems, 4. accord the same importance to diabetes that is accorded to communicable diseases, 5. decentralize diabetes management to lower levels of care, 6. limit wastage, corruption, bad macro-financial governance and a lack of transparency about how funding for health is used, and 7. provide support to strengthen patients' and caregivers' psychosocial networks. A diabetes policy acceptable to patients is one infused with principles of good governance, fairness, inclusiveness and humanity; characterised by: financial protection and price regulation, consumer protection, equity in the attention accorded to different diseases, decentralized service delivery, inclusion of patient voice in political decision-making, a responsive compassionate health workforce, psychosocial support for patients and their caregivers and allocative efficiency and transparency in public expenditure.
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Affiliation(s)
- Dudzai Mureyi
- Faculty of Medicine and Health Sciences, Department of Biomedical Informatics and Biomedical Engineering, University of Zimbabwe, Harare, Zimbabwe
| | - Nyaradzai Arster Katena
- Faculty of Medicine and Health Sciences, Department of Primary Healthcare Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Tsitsi Monera-Penduka
- Faculty of Medicine and Health Sciences, Department of Pharmacy and Pharmaceutical Sciences, University of Zimbabwe, Harare, Zimbabwe
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16
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Gunawardena IPC, Retinasamy T, Shaikh MF. Is Aducanumab for LMICs? Promises and Challenges. Brain Sci 2021; 11:1547. [PMID: 34827546 PMCID: PMC8615623 DOI: 10.3390/brainsci11111547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 12/02/2022] Open
Abstract
Aducanumab, a human monoclonal antibody, was approved in June of 2021 as the first disease-modifying treatment for Alzheimer's disease by the United States Food and Drug Administration (U.S. FDA). A substantial proportion of patients with Alzheimer's disease live in low- and middle-income countries (LMICs), and the debilitating effects of this disease exerts burdens on patients and caregivers in addition to the significant economic strains many nations bear. While the advantages of a disease-modifying therapy are clear in delaying the progression of disease to improve patient outcomes, aducanumab's approval by the U.S. FDA was met with controversy for a plethora of reasons. This paper will provide precursory insights into aducanumab's role, appropriateness, and cost-effectiveness in low- and middle-income countries. We extend some of the controversies associated with aducanumab, including the contradicting evidence from the two trials (EMERGE and ENGAGE) and the resources required to deliver the treatment safely and effectively to patients, among other key considerations.
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Affiliation(s)
- Illangage P. C. Gunawardena
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru 80100, Johor, Malaysia;
| | - Thaarvena Retinasamy
- Neuropharmacology Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Selangor, Malaysia;
| | - Mohd. Farooq Shaikh
- Neuropharmacology Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Selangor, Malaysia;
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17
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Sisay M, Amare F, Hagos B, Edessa D. Availability, pricing and affordability of essential medicines in Eastern Ethiopia: a comprehensive analysis using WHO/HAI methodology. J Pharm Policy Pract 2021; 14:57. [PMID: 34225781 PMCID: PMC8256563 DOI: 10.1186/s40545-021-00339-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/24/2021] [Indexed: 02/04/2023] Open
Abstract
Background Access to essential medicines is a universal human right and availability and affordability are the preconditions for it. In line with the sustainable development goals, World Health Organization (WHO) has outlined a framework that assists the policy makers to improve access to essential medicines for universal health coverage by 2030. However, the availability and affordability of essential medicines remains suboptimal in several low-income countries. Therefore, this study was designed to investigate the availability, pricing and affordability of essential medicines in eastern Ethiopia. Methods A cross-sectional study design was employed to conduct this study. Public and private health facilities found in Eastern Ethiopia and which fulfilled criteria set forth by WHO/Health Action International (HAI) guideline and essential medicines listed on WHO/HAI guideline and essential medicine list of Ethiopia were included. Accordingly, 60 medicine outlets were selected based on the WHO/HAI standardized sampling methodology. A standardized data collection tools developed by WHO/HAI, with necessary modifications, was employed to collect the data. Median Price Ratio (MPR) was computed as a ratio of median local buyers’ price to international buyers’ reference price. The Mann–Whitney U test was employed to compare the median buyers’ price between public and private health facilities. Kruskal–Wallis test was also run to explore the median price difference among all facilities. Treatment affordability was calculated based on the number of days of wage of the lowest-paid government employee of Ethiopia required to purchase the prescribed regimen. Results The overall percent availability of originator brand (OB) versions of essential medicines was found to be 3.6% (range: 0.0–31.7%), with the public and private sectors contributing 1.43% and 5.50%, respectively. The overall percent availability of lowest price generics (LPGs) was 46.97% (range: 1.7–93.3%) (Public: 42.5%; private: 50.8%). Only eight LPGs (16.0%) met the WHO target of 80%. The Mann–Whitney U test indicated that 64% drugs showed statistically significant median price difference between public and private settings (p < 0.05). The MPR value indicated that the median buyers’ price of drugs in private sector were more than four times the international reference price in 30% of drugs. The percentage of unaffordable medicine were 72.09 and 91.84% for public and private facilities, respectively, with 79.17% of the medicines were unaffordable when both settings were combined. Conclusion Only 16% of the surveyed medicines surpassed the WHO cut-off point of 80%. Nearly one-third of drugs in the private sector had a price of more than four times compared to the international reference prices. Moreover, four out of five drugs were found unaffordable when both settings were combined, demanded several days of wage of lowest paid government employee. This finding calls a prompt action from stakeholders to devise a strategy that help promote the access of essential medicines and rescue the struggling healthcare system of Ethiopia.
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Affiliation(s)
- Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia.
| | - Firehiwot Amare
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Bisrat Hagos
- Department of Social Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Dumessa Edessa
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
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18
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Hasnida A, Kok MO, Pisani E. Challenges in maintaining medicine quality while aiming for universal health coverage: a qualitative analysis from Indonesia. BMJ Glob Health 2021; 6:bmjgh-2020-003663. [PMID: 34049935 PMCID: PMC8166595 DOI: 10.1136/bmjgh-2020-003663] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/11/2020] [Accepted: 10/21/2020] [Indexed: 01/15/2023] Open
Abstract
Introduction Indonesia, the world’s fourth most populous nation, is close to achieving universal health coverage (UHC). A widely-publicised falsified vaccine case in 2016, coupled with a significant financial deficit in the national insurance system, has contributed to concern that the rapid scale-up of UHC might undermine medicine quality. We investigated the political and economic factors that drive production and trade of poor-quality medicines in Indonesia. Methods We reviewed academic publications, government regulations, technical agency documents and news reports to develop a semi-structured questionnaire. We interviewed healthcare providers, policy-makers, medicine regulators, pharmaceutical manufacturers, patients and academics (n=31). We included those with in-depth knowledge about the falsified vaccine case or the pharmaceutical business, medicine regulation, prescribing practice and the implementation of UHC. We coded data using NVivo software and analysed by constant comparative method. Results The scale-up of UHC has cut revenues for physicians and pharmaceutical manufacturers. In the vaccine case, free, quality-assured vaccines were available but some physicians, seeking extra revenue, promoted expensive alternatives. Taking advantage of poor governance in private hospitals, they purchased cut-price ‘vaccines’ from freelance salespeople. A single-winner public procurement system which does not explicitly consider quality has slashed the price paid for covered medicines. Trade, industrial and religious policies simultaneously increased production costs, pressuring profit margins for manufacturers and distributors. They reacted by cutting costs (potentially threatening quality) or by market withdrawal (leading to shortages which provide a market for falsifiers). Shortages and physician-promoted irrational demand push patients to buy medicines in unregulated channels, increasing exposure to falsified medicines. Conclusion Market factors, including political pressure to reduce medicine prices and healthcare provider incentives, can drive markets for substandard and falsified medicines. To protect progress towards UHC, policy-makers must consider the potential impact on medicine quality when formulating rules governing health financing, procurement, taxation and industry.
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Affiliation(s)
- Amalia Hasnida
- Health Care Governance, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, Netherlands .,Migunani Research Institute, Yogyakarta, Indonesia
| | - Maarten Olivier Kok
- Health Care Governance, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, Netherlands.,Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Elizabeth Pisani
- Health Care Governance, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, Netherlands.,Policy Institute, King's College London, London, London, UK
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Health System Capacity and Access Barriers to Diagnosis and Treatment of CVD and Diabetes in Nepal. Glob Heart 2021; 16:38. [PMID: 34040951 PMCID: PMC8139299 DOI: 10.5334/gh.927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Universal access to essential medicines and routine diagnostics is required to combat the growing burden of cardiovascular disease (CVD) and diabetes. Evaluating health systems and various access dimensions availability, affordability, accessibility, acceptability, and quality is crucial yet rarely performed, especially in low- and middle-income countries. Objective: To evaluate health system capacity and barriers in accessing diagnostics and essential medicines for CVD and diabetes in Nepal. Methods: We conducted a WHO/HAI nationally-representative survey in 45 health-facilities (public-sector: 11; private-sector: 34) in Nepal to collect availability and price data for 21 essential medicines for treating CVD and diabetes, during MayJuly 2017. Data for 13 routine diagnostics was obtained in 12 health facilities. Medicines were considered unaffordable if the lowest paid worker spends >1 days wage to purchase a monthly supply. To evaluate accessibility, we conducted facility exit interviews among 636 CVD patients. Accessibility (e.g., private-public health facility mix, travel to hospital/pharmacy) and acceptability (i.e. Nepals adoption of WHO Essential Medicine List, and patient medication adherence) were summarized using descriptive statistics, and we conducted a systematic review of relevant literature. We did not evaluate medicine quality. Results: We found that mean availability of generic medicines is low (<50%) in both public and private sectors, and less than one-third medicines met WHOs availability target (80%). Mean (SD) availability of diagnostics was 73.1% (26.8%). Essential medicines appear locally unaffordable. On average, the lowest-paid worker would spend 1.03 (public-sector) and 1.26 (private-sector) days wages to purchase a monthly supply. For a person undergoing CVD secondary preventive-interventions in the private sector, the associated expenditure would be 7.511.2% of monthly household income. Exit-interviews suggest that a long/expensive commute to health-facilities and poor medicine affordability constrain access. Conclusions: This study highlights critical gaps in Nepals health system capacity to offer basic health services to CVD and diabetes patients, owing to low availability, poor affordability and accessibility of essential medicines and diagnostics. Research and policy initiatives are needed to ensure uninterrupted supply of affordable essential medicines and diagnostics.
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20
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Hughes TM, Empringham B, Wagner AK, Ward ZJ, Yeh J, Gupta S, Frazier AL, Denburg AE. Forecasting essential childhood cancer drug need: An innovative model-based approach. Cancer 2021; 127:2990-3001. [PMID: 33844270 DOI: 10.1002/cncr.33568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/21/2021] [Accepted: 03/04/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Childhood cancer outcomes in low-income and middle-income countries have not kept pace with advances in care and survival in high-income countries. A contributing factor to this survival gap is unreliable access to essential drugs. METHODS The authors created a tool (FORx ECAST) capable of predicting drug quantity and cost for 18 pediatric cancers. FORx ECAST enables users to estimate the quantity and cost of each drug based on local incidence, stage breakdown, treatment regimen, and price. Two country-specific examples are used to illustrate the capabilities of FORx ECAST to predict drug quantities. RESULTS On the basis of domestic public-sector price data, the projected annual cost of drugs to treat childhood cancer cases is 0.8 million US dollars in Kenya and 3.0 million US dollars in China, with average median price ratios of 0.9 and 0.1, respectively, compared with costs sourced from the Management Sciences for Health (MSH) International Medical Products Price Guide. According to the cumulative chemotherapy cost, the most expensive disease to treat is acute lymphoblastic lymphoma in Kenya, but a higher relative unit cost of methotrexate makes osteosarcoma the most expensive diagnosis to treat in China. CONCLUSIONS FORx ECAST enables needs-based estimates of childhood cancer drug volumes to inform health system planning in a wide range of contexts. It is broadly adaptable, allowing decision makers to generate results specific to their needs. The resultant estimates of drug need can help equip policymakers and health governance institutions with evidence-informed data to advance innovative procurement strategies that drive global improvements in childhood cancer drug access.
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Affiliation(s)
- Terence M Hughes
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brianna Empringham
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anita K Wagner
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Zachary J Ward
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Jennifer Yeh
- Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sumit Gupta
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - A Lindsay Frazier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Avram E Denburg
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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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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Mirzoev T, Koduah A, Cronin de Chavez A, Baatiema L, Danso-Appiah A, Ensor T, Agyepong IA, Wright JM, Kretchy IA, King N. Implementation of medicines pricing policies in sub-Saharan Africa: protocol for a systematic review. BMJ Open 2021; 11:e044293. [PMID: 33622951 PMCID: PMC7907884 DOI: 10.1136/bmjopen-2020-044293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Ensuring universal availability and accessibility of medicines and supplies is critical for national health systems to equitably address population health needs. In sub-Saharan Africa (SSA), this is a recognised priority with multiple medicines pricing policies enacted. However, medicine prices have remained high, continue to rise and constrain their accessibility. In this systematic review, we aim to identify and analyse experiences of implementation of medicines pricing policies in SSA. Our ambition is for this evidence to contribute to improved implementation of medicines pricing policies in SSA. METHODS AND ANALYSIS We will search: Medline, Web of Science, Scopus, Global Health, Embase, Cairn.Info International Edition, Erudit and African Index Medicus, the grey literature and reference from related publications. The searches will be limited to literature published from the year 2000 onwards that is, since the start of the Millennium Development Goals.Published peer-reviewed studies of implementation of medicines pricing policies in SSA will be eligible for inclusion. Broader policy analyses and documented experiences of implementation of other health policies will be excluded. The team will collaboratively screen titles and abstracts, then two reviewers will independently screen full texts, extract data and assess quality of the included studies. Disagreements will be resolved by discussion or a third reviewer. Data will be extracted on approaches used for policy implementation, actors involved, evidence used in decision making and key contextual influences on policy implementation. A narrative approach will be used to synthesise the data. Reporting will be informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guideline. ETHICS AND DISSEMINATION No ethics approvals are required for systematic reviews.Results will be disseminated through academic publications, policy briefs and presentations to national policymakers in Ghana and mode widely across countries in SSA. PROSPERO REGISTRATION NUMBER CRD42020178166.
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Affiliation(s)
- Tolib Mirzoev
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, West Yorkshire, UK
| | - Augustina Koduah
- School of Pharmacy, University of Ghana, Legon, Greater Accra, Ghana
| | - Anna Cronin de Chavez
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, West Yorkshire, UK
| | - Leonard Baatiema
- School of Public Health, University of Ghana, Accra-Legon, Ghana
| | | | - Tim Ensor
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, West Yorkshire, UK
| | - Irene Akua Agyepong
- Research and Development Division, Ghana Health Service, Accra, Greater Accra, Ghana
| | - Judy M Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, West Yorkshire, UK
| | - Irene A Kretchy
- School of Pharmacy, University of Ghana, Legon, Greater Accra, Ghana
| | - Natalie King
- Leeds Institute of Health Sciences, University of Leeds, Leeds, West Yorkshire, UK
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Oleszkiewicz P, Krysinski J, Religioni U, Merks P. Access to Medicines via Non-Pharmacy Outlets in European Countries-A Review of Regulations and the Influence on the Self-Medication Phenomenon. Healthcare (Basel) 2021; 9:healthcare9020123. [PMID: 33530630 PMCID: PMC7911380 DOI: 10.3390/healthcare9020123] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022] Open
Abstract
Non-pharmacy trade concerns the sale of medicinal products outside of pharmacies, such as limited-service pharmacies, supermarkets, petrol stations, shops open to the public, and kiosks. Access to medicinal products via non-pharmacy outlets varies across the European countries, with a general deregulation of this market area observable. Increasing the availability of medicines by allowing patients to obtain them outside of pharmacies contributes to the spread of self-medication. The aim of this article was to review the legal regulations enabling the non-pharmacy trade in OTC (over the counter) medicinal products in European countries, with particular emphasis on the analysis of active substances contained in medicines available in the non-pharmacy trade. This analysis has made it possible to distinguish three categories of countries: (1) where there is a non-pharmacy trade in OTC medicinal products, (2) where there is a limited non-pharmacy trade in OTC medicines, (3) where there is only a pharmacy trade in OTC medicinal products. In the context of these considerations, we highlight the impact of patient access to medicinal products via non-pharmacy sources on raising the prevalence of self-medication. This article identifies the advantages and risks of self-medication, emphasising the role of the pharmacist as an advisor to patients within the scope of the therapies used.
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Affiliation(s)
- Patrycja Oleszkiewicz
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, 85-089 Bydgoszcz, Poland; (P.O.); (J.K.); (P.M.)
| | - Jerzy Krysinski
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, 85-089 Bydgoszcz, Poland; (P.O.); (J.K.); (P.M.)
| | - Urszula Religioni
- Collegium of Business Administration, Warsaw School of Economics, Al. Niepodległości 162, 02-554 Warsaw, Poland
- Correspondence:
| | - Piotr Merks
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, 85-089 Bydgoszcz, Poland; (P.O.); (J.K.); (P.M.)
- Collegium Medicum, Faculty of Medicine, Cardinal Stefan Wyszyński University in Warsaw, Auditorium Maximum, bldg. 21, Room 201 (II Floor), st. Kazimierza Wóycickiego 1/3, 01-938 Warsaw, Poland
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Perehudoff K, Demchenko I, Alexandrov NV, Brutsaert D, Ackon A, Durán CE, El-Dahiyat F, Hafidz F, Haque R, Hussain R, Salenga R, Suleman F, Babar ZUD. Essential Medicines in Universal Health Coverage: A Scoping Review of Public Health Law Interventions and How They Are Measured in Five Middle-Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9524. [PMID: 33353250 PMCID: PMC7765934 DOI: 10.3390/ijerph17249524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 11/18/2022]
Abstract
Very few studies exist of legal interventions (national laws) for essential medicines as part of universal health coverage in middle-income countries, or how the effect of these laws is measured. This study aims to critically assess whether laws related to universal health coverage use five objectives of public health law to promote medicines affordability and financing, and to understand how access to medicines achieved through these laws is measured. This comparative case study of five middle-income countries (Ecuador, Ghana, Philippines, South Africa, Ukraine) uses a public health law framework to guide the content analysis of national laws and the scoping review of empirical evidence for measuring access to medicines. Sixty laws were included. All countries write into national law: (a) health equity objectives, (b) remedies for users/patients and sanctions for some stakeholders, (c) economic policies and regulatory objectives for financing (except South Africa), pricing, and benefits selection (except South Africa), (d) information dissemination objectives (ex. for medicines prices (except Ghana)), and (e) public health infrastructure. The 17 studies included in the scoping review evaluate laws with economic policy and regulatory objectives (n = 14 articles), health equity (n = 10), information dissemination (n = 3), infrastructure (n = 2), and sanctions (n = 1) (not mutually exclusive). Cross-sectional descriptive designs (n = 8 articles) and time series analyses (n = 5) were the most frequent designs. Change in patients' spending on medicines was the most frequent outcome measure (n = 5). Although legal interventions for pharmaceuticals in middle-income countries commonly use all objectives of public health law, the intended and unintended effects of economic policies and regulation are most frequently investigated.
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Affiliation(s)
- Katrina Perehudoff
- Law Center for Health and Life, University of Amsterdam, 1018 WV Amsterdam, The Netherlands
- Department of Public Health & Primary Care, Ghent University, 9000 Gent, Belgium;
- WHO Collaborating Centre for Governance, Accountability, and Transparency in the Pharmaceutical Sector, University of Toronto, 144 College Street, Toronto, ON M5S 3M2, Canada
| | - Ivan Demchenko
- Forensic Medicine and Medical Law Department, National Medical University ‘O.O. Bogomolec’, 01601 Kyiv, Ukraine;
| | - Nikita V. Alexandrov
- Global Health Law Groningen Research Centre, Department of Transboundary Legal Studies, Faculty of Law, University of Groningen, 9700 AS Groningen, The Netherlands;
| | - David Brutsaert
- Department of Public Health & Primary Care, Ghent University, 9000 Gent, Belgium;
| | - Angela Ackon
- Directorate of Pharmacy, Ministry of Health, P. O. Box M 44 Accra, Ghana;
| | - Carlos E. Durán
- Clinical Pharmacology Research Group, Department of Basic & Applied Medical Sciences, Ghent University, 9000 Ghent, Belgium;
| | | | - Firdaus Hafidz
- Department of Health Policy & Management, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia;
| | - Rezwan Haque
- Access to Information (a2i) Programme (Former Project Director, SWASTI), Dhaka 1207, Bangladesh;
- Department of Pharmacy (Adjunct), Ranada Prasad Shaha University, Narayanganj 1400, Bangladesh
| | - Rabia Hussain
- Faculty of Pharmacy, The University of Lahore, Lahore 54590, Pakistan;
- Commonwealth Pharmacists Association, London E1W 1AW, UK
| | - Roderick Salenga
- College of Pharmacy, University of the Philippines Manila, Metro Manila 1000, Philippines;
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban 4041, South Africa;
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK;
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Chen L, Yang Y, Luo M, Hu B, Yin S, Mao Z. The Impacts of National Centralized Drug Procurement Policy on Drug Utilization and Drug Expenditures: The Case of Shenzhen, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249415. [PMID: 33334027 PMCID: PMC7765443 DOI: 10.3390/ijerph17249415] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 02/08/2023]
Abstract
In 2019, the Chinese government implemented the first round of the National Centralized Drug Procurement (NCDP) pilot (so-called “4 + 7” policy) in mainland China, in which 25 drugs were included. We conducted this study to examine the impacts of NCDP policy on drug utilization and expenditures, and to clarify the main factors contributing to drug expenditure changes. This study used drug purchasing order data from the Centralized Drug Procurement Survey in Shenzhen 2019. Drugs related to the “4 + 7” policy were selected as study samples, including 23 “4 + 7” policy-related varieties and 15 basic alternative drugs. Driving factors for drug expenditures changes were analyzed using A.M. index system analysis (Addis A. & Magrini N.’ method). After the implementation of the NCDP policy, the volume of “4 + 7” policy-related varieties increased by 73.8%, among which winning products jumped by 1638.2% and non-winning products dropped by 70.8%; the expenditures of “4 + 7” policy-related varieties decreased by 36.9%. Structure effects (0.47) and price effects (0.78) negatively contributed to the increase in drug expenditures of “4 + 7” policy-related varieties, while volume effects (1.73) had positive influence. NCDP policy successfully decreased drug expenditures of “4 + 7” policy-related varieties with structure effects playing a leading role. However, total drug expenditures were not effectively controlled due to the increasing use of alternative drugs.
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Affiliation(s)
- Lei Chen
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China; (L.C.); (Y.Y.); (M.L.); (B.H.); (S.Y.)
- Global Health Institute, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Ying Yang
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China; (L.C.); (Y.Y.); (M.L.); (B.H.); (S.Y.)
- Global Health Institute, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Mi Luo
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China; (L.C.); (Y.Y.); (M.L.); (B.H.); (S.Y.)
| | - Borui Hu
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China; (L.C.); (Y.Y.); (M.L.); (B.H.); (S.Y.)
| | - Shicheng Yin
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China; (L.C.); (Y.Y.); (M.L.); (B.H.); (S.Y.)
| | - Zongfu Mao
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China; (L.C.); (Y.Y.); (M.L.); (B.H.); (S.Y.)
- Global Health Institute, Wuhan University, 115# Donghu Road, Wuhan 430071, China
- Correspondence: ; Tel.: +86-27-6875-9118
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Wiśniewski M, Religioni U, Merks P. Community Pharmacies in Poland-The Journey from a Deregulated to a Strictly Regulated Market. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238751. [PMID: 33255672 PMCID: PMC7728088 DOI: 10.3390/ijerph17238751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 12/18/2022]
Abstract
Community pharmacies are the primary entities providing drugs to individual patients in Poland. The pharmacy market has been changing for many years due to significant changes in market regulations. These changes significantly affect the profitability of pharmacies, which may impact the quality of pharmacotherapy. The small number of pharmacies, which resulted from changes in the law in 2017, can influence the level of patient care. The article presents the community pharmacies market in Poland. Particular attention is paid to the legal regulations affecting community pharmacies and the impact of these regulations on the overall shape of the market. The Polish system’s specificity, including the pharmacy market indicators, has been compared with data from other European Union countries.
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Affiliation(s)
- Marcin Wiśniewski
- Association of Pharmacists of Employers of Polish Pharmacies, 01-711 Warsaw, Poland;
| | - Urszula Religioni
- Collegium of Business Administration, Warsaw School of Economics, 02-513 Warsaw, Poland;
| | - Piotr Merks
- Cardinal Stefan Wyszyński University in Warsaw Faculty of Medicine, Collegium Medicum, 01-938 Warsaw, Poland
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, 85-067 Bydgoszcz, Poland
- Employed Pharmacist in Europe (EPhEU) Verband Angestellter Apotheker Österreichs (VAAÖ) Berufliche Interessenvertretung Spitalgasse 31/4, Vienna 1090, Austria
- Correspondence:
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Ahmad NS, Makmor-Bakry M, Hatah E. Drug price transparency initiative: A scoping review. Res Social Adm Pharm 2020; 16:1359-1369. [DOI: 10.1016/j.sapharm.2020.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 01/03/2020] [Accepted: 01/03/2020] [Indexed: 10/25/2022]
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Moye-Holz D, Dreser A, van Dijk JP, Reijneveld SA, Hogerzeil HV. Access to cancer medication in public hospitals in a middle-income country: The view of stakeholder. Res Social Adm Pharm 2020; 16:1255-1263. [PMID: 31796333 DOI: 10.1016/j.sapharm.2019.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Access to cancer medicines is a core component of comprehensive cancer care; as such, it is included in Mexico's public health insurance: Seguro Popular de Salud (SPS). Learning about stakeholders' experiences on processes and barriers influencing access to essential cancer medicines within healthcare facilities allows identifying needed policies to improve access to cancer care. OBJECTIVE The aim of this study was to obtain the insights of health professionals in public hospitals in Mexico on how SPS influences access to cancer medicines regarding medicine selection, financing, and procurement and supply systems. The purpose is to identify policy areas that need strengthening to improve access to cancer medicines. METHODS Semi-structured interviews were conducted with 67 health professionals from 21 public hospitals accredited by SPS across Mexico. A framework analysis was used with categories of analysis derived from the World Health Organization's Access framework. RESULTS Most stakeholders reported that the availability of listed cancer medicines was sufficient. However, cancer specialists reported that medicines coverage by SPS was restrictive covering only basic cancer care. Public hospitals followed SPS treatment protocols in selecting and prescribing cancer medicines but used different procurement procedures. When essential cancer medicines were unavailable (not listed or stocked-out), hospitals reported several strategies such as prescribing alternative therapies, resorting to direct purchases, and assisting patients in obtaining medicines elsewhere. Other reported barriers to access to treatment were: distance to health facilities, poor insurance coverage, and financial restrictions. CONCLUSIONS Health professionals have encountered benefits and challenges from the implementation of SPS influencing access to cancer medicines and care in Mexico, pointing to areas in which action is necessary. Finding the right balance between expanding the range and cost of cancer treatments covered by insurance and making basic cancer care available to all is a challenge faced by Mexico and other middle-income countries.
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Affiliation(s)
- Daniela Moye-Holz
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands.
| | - Anahi Dreser
- National Institute of Public Health (Instituto Nacional de Salud Pública), Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico.
| | - Jitse P van Dijk
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands.
| | - Sijmen A Reijneveld
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands.
| | - Hans V Hogerzeil
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands.
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Gill J, Fontrier AM, Kyriopoulos D, Kanavos P. Variations in external reference pricing implementation: does it matter for public policy? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:1375-1397. [PMID: 31444673 DOI: 10.1007/s10198-019-01100-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 08/09/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND External reference pricing (ERP) seeks to rationalize prices and contain costs using foreign prices as a reference for the determination of domestic prices and is often used as the starting point for the facilitation of negotiations between health authorities and pharmaceutical manufacturers. METHODS A systematic literature review was used to identify characteristics of ERP implementation across 29 countries. Primary data collection, in the form of surveys directed at key stakeholders, was also used to supplement data in instances where information received from the systematic literature review was outdated or minimal. Findings from the systematic literature review and primary evidence from key stakeholders were bench-marked against 14 best practice principles inherent to an optimal ERP system. RESULTS Significant heterogeneity in ERP implementation across countries was identified. Country basket size, pricing calculation, and frequency of price revisions varied between countries. Belgium, France, and South Africa were more likely to adhere to the best practice principles, whilst Bulgaria, Hungary, and Romania had the most instances of non-adherence. CONCLUSION The observed heterogeneity has policy implications for governments including globally declining pharmaceutical prices, launch delays in lower income countries, reduced incentive for continued R&D, and reduced access to medicines. Overcoming this issue to ensure that ERP is beneficial to all stakeholders will require a focus on developing sustainable, transparent, simple, and stable systems using a set of key guidelines that should maximize the benefits of the pricing policy.
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Affiliation(s)
- Jennifer Gill
- Department of Health Policy and LSE Health, Medical Technology Research Group, Cowdray House, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | - Anna-Maria Fontrier
- Department of Health Policy and LSE Health, Medical Technology Research Group, Cowdray House, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Dionysis Kyriopoulos
- Department of Health Policy and LSE Health, Medical Technology Research Group, Cowdray House, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Panos Kanavos
- Department of Health Policy and LSE Health, Medical Technology Research Group, Cowdray House, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
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Anggriani Y, Ramadaniati HU, Sarnianto P, Pontoan J, Suryawati S. The Impact of Pharmaceutical Policies on Medicine Procurement Pricing in Indonesia Under the Implementation of Indonesia's Social Health Insurance System. Value Health Reg Issues 2019; 21:1-8. [PMID: 31634791 DOI: 10.1016/j.vhri.2019.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/26/2019] [Accepted: 05/01/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Indonesia's social health insurance (Jaminan Kesehatan Nasional, JKN) has been implemented since 2014. To support medicine provision, the government launched policies reform on medicine pricing, procurement and reimbursement; hence, the system might affect medicine prices in the country. OBJECTIVE To evaluate the effects of the pharmaceutical policies reforms on medicine procurement prices. METHODS This was a pre-post observational study. Medicine price data were collected retrospectively from the 2013 Ministry of Health procurement price list, the 2017 e-catalogue procurement system, and the procurement departments at 2 hospitals in Jakarta and Cilegon (both categorized as region I). The 2013 national procurement price was compared with the 2017 e-catalogue price. The hospitals' procurement prices were collected from the data 3 years before and 3 years under Indonesia's social health insurance JKN (2011-2016), and the data were used to assess the medicine procurement prices in real conditions. The outcome measure was the difference in procurement prices before and under the JKN. RESULTS The results showed that the procurement prices of 429 (79.6%) of 539 medicines listed in the 2017 e-catalogue decreased, of which 210 items (39.0%) showed over a 50% decrease. Nevertheless, the procurement prices of 104 items (19.3%) increased, especially those that were still under patent or those with a few brands registered in Indonesia. The procurement prices in public and private hospitals showed a similar trend, that is, a significant decrease. Interestingly, non-e-catalogue medicine prices also decreased quite steeply, although the prices of the branded generic category in the private hospital remained unchanged. CONCLUSION The pharmaceutical policies under the JKN implementation had a profound impact on decreasing medicine procurement prices in Indonesia.
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Affiliation(s)
- Yusi Anggriani
- Faculty of Pharmacy, University of Pancasila, Jl. Srengseng Sawah, Jagakarsa, Jakarta Selatan, Indonesia.
| | - Hesty Utami Ramadaniati
- Faculty of Pharmacy, University of Pancasila, Jl. Srengseng Sawah, Jagakarsa, Jakarta Selatan, Indonesia
| | - Prih Sarnianto
- Faculty of Pharmacy, University of Pancasila, Jl. Srengseng Sawah, Jagakarsa, Jakarta Selatan, Indonesia
| | - Jenny Pontoan
- National Institute of Science and Technology, Jakarta, Indonesia
| | - Sri Suryawati
- Division of Clinical Pharmacology and Medicine Policy, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Wong SL, Ibrahim S, Abdul Kadir N, Mohd Salleh S. Access and Affordability of Medicines in Malaysia: Need for a National Pricing Policy. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:641-654. [PMID: 31093937 DOI: 10.1007/s40258-019-00480-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND High medicines prices are a barrier to medicines access, and their impact is greater in developing countries. OBJECTIVE This study assessed the availability, prices and affordability of medicines in public and private sectors in Malaysia to understand the pharmaceutical environment and guide policy recommendations. METHODS This nationwide cross-sectional study adapted the World Health Organization/Health Action International (WHO/HAI) methodology. A total of 87 premises from both public and private sectors participated in this study. Data on 50 medicines were collected to analyze availability, prices and affordability. Medicine prices were compared against the international reference prices (IRPs), and affordability was assessed by daily income level. RESULTS In the public sector, the average availability of generics (74.8%) was higher than that of the originator brand name products (19.4%). However, in the private sector, the availability of originator brands was higher (52.2%) than generics (49.1%). Procurement prices in the public sector were up to 1.5 times the IRPs, but up to 8.4 times in the private sector. The study also observed large price variation across medicines in the private sector. Median retail mark-ups in private hospitals (generics 166.9%; originators 51.0%) were higher than in retail pharmacies (generics 94.7%; originators 22.4%). Generics were generally affordable, but originator brands were unaffordable. CONCLUSION Current policies on generic medicines need to be strengthened to improve the availability and use of generics in the country. High medicine prices and large price variation in the current free market suggest that coherent pricing policies and regulations are needed to safeguard the accessibility and affordability of medicines for the people.
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Affiliation(s)
- Shui Ling Wong
- Pharmaceutical Services Programme, Ministry of Health Malaysia, Lot 36, Jalan Universiti, 46200, Petaling Jaya, Selangor, Malaysia.
| | - Saliza Ibrahim
- Pharmaceutical Services Programme, Ministry of Health Malaysia, Lot 36, Jalan Universiti, 46200, Petaling Jaya, Selangor, Malaysia
| | - Norazlin Abdul Kadir
- Pharmaceutical Services Programme, Ministry of Health Malaysia, Lot 36, Jalan Universiti, 46200, Petaling Jaya, Selangor, Malaysia
| | - Salbiah Mohd Salleh
- Pharmaceutical Services Programme, Ministry of Health Malaysia, Lot 36, Jalan Universiti, 46200, Petaling Jaya, Selangor, Malaysia
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Moodley R, Suleman F. Evaluating the impact of the single exit price policy on a basket of originator medicines in South Africa from 1999 to 2014 using a time series analysis. BMC Health Serv Res 2019; 19:576. [PMID: 31419977 PMCID: PMC6697979 DOI: 10.1186/s12913-019-4403-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 08/05/2019] [Indexed: 11/24/2022] Open
Abstract
Background Affordability and availability of quality medicines to all its citizens has been a key priority area for South Africa since democracy in 1994. In order to introduce transparency in the private market the government introduced the Single Exit Price (SEP) for medicines in 2004, for all prescription medicines, comprising of a fixed ex-factory price with a logistics fee component (and value added tax) for medicines sold to all purchasers other than the State. This is complemented with a provision for an annual regulated maximum percentage increase. The study evaluates the impact of the SEP on a basket of originator medicines, in terms of costs, immediate price reductions and projected price reductions. Method This is an analytical, quantitative study. A basket of medicines was selected, based on the WHO/HAI list, and adapted to include registered medicines in South Africa. Prices of 50 originator medicines were assessed from 1999 to 2014 in terms of the single exit price and the changes in prices in accordance with legislation using a time series analysis methodology. Results Of the 50 originator medicines investigated 35 showed a statistically significant change in level. For the Global Core list, the percentage change ranged from 2.45–39.12% (mean = 19.87%, SD = 10.62%, IQR = 10.2%). The range for the Regional Core list was 1.77–42.17% (mean = 23.38%, SD = 12.43%, IQR = 15.65%). The Supplementary list was 11.68–55.86% (mean = 22.97%, SD = 16.26%, IQR = 17.34). This study indicates that the SEP regulation had an impact on medicine pricing in South Africa in both the short and long term. Most medicines investigated showed a smaller yearly increase in price compared to before regulations due to the controlled pricing environment introduced by Government. Conclusion This study provides evidence of the impact of medicine pricing intervention from a middle–income country, and other developing countries looking at introducing medicine price controls can draw useful lessons.
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Affiliation(s)
- R Moodley
- Discipline of Pharmaceutical Sciences, School of Health Sciences, Westville Campus, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000, South Africa
| | - F Suleman
- Discipline of Pharmaceutical Sciences, School of Health Sciences, Westville Campus, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000, South Africa. .,Prince Claus Chair of Development and Equity for the theme Affordable (Bio) Therapeutics for Public Health (September 2016 to September 2018), Faculty of Sciences, Utrecht University, Utrecht, The Netherlands.
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Oliver VL, Tolera M, Teklu AM, Minaye A, Lambert P, McIntosh MP. Qualitative formative implementation research to inform introduction of a new essential medicine. Res Social Adm Pharm 2019; 16:535-543. [PMID: 31375358 DOI: 10.1016/j.sapharm.2019.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND The launch of novel pharmaceuticals in the developing world faces significant barriers that can delay or ultimately inhibit uptake. Implementation research can provide an understanding of factors influencing the introduction and scale up of a new product and thus can inform implementation strategy development. OBJECTIVE This study explored the factors likely to influence introduction of a novel oxytocin formulation for the prevention of postpartum hemorrhage in Ethiopia. METHODS Qualitative research methods were used to assess barriers and enablers associated with pre-determined domains: regulatory approval, pricing, supply and demand side advocacy, policy inclusion, end-user training and drug supply. Data were collected through focus group discussions and in-depth interviews with community members, healthcare providers and key informants. Verbatim transcripts were translated to English and analyzed using a thematic content framework. RESULTS Approval from stringent regulatory bodies was an enabler for gaining national regulatory approval. Purchasers (government and patients) expressed price sensitivity but would be willing to pay a price comparable to or higher than current alternatives if improved quality is delivered. Endorsement from the World Health Organization was described as critical for national policy inclusion. Supply side advocacy should be directed towards the Ministry of Health, which is receptive to advice from reputable agencies with whom they have an existing relationship. Demand side advocacy should be delivered through existing health system channels such as Ministry of Health authorities (for healthcare workers) and community health workers (for community members). The requirement to purchase the product directly from a single manufacturer was highlighted as a potential barrier for entry into the local supply chain. CONCLUSION This study highlighted several barriers and enablers associated with the introduction of a new drug product into the health system of Ethiopia. An advanced understanding of these influences can inform the design of locally-appropriate implementation strategies.
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Affiliation(s)
- Victoria L Oliver
- Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Moti Tolera
- MERQ Consultancy PLC, Addis Ababa, Ethiopia; School of Public Health, Haramaya University, Harar, Ethiopia
| | | | - Abebaw Minaye
- MERQ Consultancy PLC, Addis Ababa, Ethiopia; School of Psychology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Pete Lambert
- Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michelle P McIntosh
- Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.
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Moye-Holz D, van Dijk JP, Reijneveld SA, Hogerzeil HV. The Impact of Price Negotiations on Public Procurement Prices and Access to 8 Innovative Cancer Medicines in a Middle-Income Country: The Case of Mexico. Value Health Reg Issues 2019; 20:129-135. [PMID: 31374426 DOI: 10.1016/j.vhri.2019.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/08/2019] [Accepted: 04/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND To mitigate the effect of high prices, in 2008 Mexico established a commission that negotiates single procurement prices for patented medicines in the public sector. OBJECTIVES We assessed the possible effect of price negotiations on the prices of new essential cancer medicines in Mexico between 2010 and 2016 and on access to these new cancer medicines. METHODS We retrieved the public procurement prices and volume of 8 selected innovative cancer medicines in Mexico in addition to their maximum retail prices in the private sector. We calculated the median, interquartile (25%-75%) range, and maximum and minimum public procurement prices to analyze price changes and trends. We assessed changes between the maximum retail prices and the public procurement prices and changes in the volume procured from 2010 to 2016. RESULTS Between 2010 and 2016, the prices of selected patented cancer medicines in the public sector decreased by 40% to 85%, expressed in US dollars. When expressed in Mexican pesos, public prices for 5 medicines reduced and others remained stable, whereas prices increased in the private sector over the same period. Procurement prices were not uniform between and within public institutions. The volumes of selected cancer medicines supplied in the public sector increased over the years, suggesting better access. CONCLUSION Although direct causality is difficult to prove, the establishment of the negotiating commission seems to have led to reduced prices and possibly better access in the public sector. Medicine procurement by public hospitals should be monitored to ensure that negotiated prices benefit all institutions.
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Affiliation(s)
- Daniela Moye-Holz
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Jitse P van Dijk
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hans V Hogerzeil
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Vogler S, Schneider P, Dedet G, Bak Pedersen H. Affordable and equitable access to subsidised outpatient medicines? Analysis of co-payments under the Additional Drug Package in Kyrgyzstan. Int J Equity Health 2019; 18:89. [PMID: 31196109 PMCID: PMC6567501 DOI: 10.1186/s12939-019-0990-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 05/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Out-of-pocket (OOP) payments can constitute a major barrier for affordable and equitable access to essential medicines. Household surveys in Kyrgyzstan pointed to a perceived growth in OOP payments for outpatient medicines, including those covered by the benefits package scheme (the Additional Drug Package, ADP). The study aimed to explore the extent of co-payments for ADP-listed medicines and to explain the reasons for developments. METHODS A descriptive statistical analysis was performed on prices and volumes of prescribed ADP-listed medicines dispensed in pharmacies during 2013-2015 (1,041,777 prescriptions claimed, data provided by the Mandatory Health Insurance Fund). Additionally, data on the value and volume of imported medicines in 2013-2015 (obtained from the National Medicines Regulatory Agency) were analysed. RESULTS In 2013-2015, co-payments for medicines dispensed under the ADP grew, on average, by 22.8%. Co-payments for ADP-listed medicines amounted to around 50% of a reimbursed baseline price, but as pharmacy retail prices were not regulated, co-payments tended to be higher in practice. The increase in co-payments coincided with a reduction in the number of prescriptions dispensed (by 14%) and an increase in average amounts reimbursed per prescription in nearly all therapeutic groups (by 22%) in the study period. While the decrease in prescriptions suggests possible underuse, as patients might forego filling prescriptions due to financial restraints, the growth in average amounts reimbursed could be an indication of inefficiencies in public funding. Variation between the regions suggests regional inequity. Devaluation of the national currency was observed, and the value of imported medicines increased by nearly 20%, whereas volumes of imports remained at around the same level in 2013-2015. Thus, patients and public procurers had to pay more for the same amount of medicines. CONCLUSIONS The findings suggest an increase in pharmacy retail prices as the major driver for higher co-payments. The national currency devaluation contributed to the price increases, and the absence of medicine price regulation aggravated the effects of the depreciation. It is recommended that Kyrgyzstan should introduce medicine price regulation and exemptions for low-income people from co-payments to ensure a more affordable and equitable access to medicines.
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Affiliation(s)
- Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (GÖG / Austrian Public Health Institute), Vienna, Austria
| | - Peter Schneider
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (GÖG / Austrian Public Health Institute), Vienna, Austria
| | - Guillaume Dedet
- Organisation for Economic Co-operation and Development (OECD), Paris, France
| | - Hanne Bak Pedersen
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark
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Abdel Rida N, Mohamed Ibrahim MI, Babar Z. Pharmaceutical pricing policies in Qatar and Lebanon: narrative review and document analysis. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2019. [DOI: 10.1111/jphs.12304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Determinants of price negotiations for new drugs. The experience of the Italian Medicines Agency. Health Policy 2019; 123:595-600. [DOI: 10.1016/j.healthpol.2019.03.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/07/2019] [Accepted: 03/11/2019] [Indexed: 12/16/2022]
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Ongarora D, Karumbi J, Minnaard W, Abuga K, Okungu V, Kibwage I. Medicine Prices, Availability, and Affordability in Private Health Facilities in Low-Income Settlements in Nairobi County, Kenya. PHARMACY 2019; 7:pharmacy7020040. [PMID: 31022841 PMCID: PMC6631117 DOI: 10.3390/pharmacy7020040] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 01/07/2023] Open
Abstract
Medicine prices are a major determinant of access to healthcare. Owing to low availability of medicines in the public health facilities and poor accessibility to these facilities, most low-income residents pay out-of-pocket for health services and transport to the private health facilities. In low-income settlements, high retail prices are likely to push the population further into poverty and ill health. This study assessed the retail pricing, availability, and affordability of medicines in private health facilities in low-income settlements within Nairobi County. Medicine prices and availability data were collected between September and December 2016 at 45 private healthcare facilities in 14 of Nairobi’s low-income settlements using electronic questionnaires. The International Medical Products Price Guide provided international medicine reference prices for comparison. Affordability and availability proxies were calculated according to existing methods. Innovator brands were 13.8 times more expensive than generic brands. The lowest priced generics and innovator brands were, on average, sold at 2.9 and 32.6 times the median international reference prices of corresponding medicines. Assuming a 100% disposable income, it would take 0.03 to 1.33 days’ wages for the lowest paid government employee to pay for treatment courses of selected single generic medicines. Medicine availability in the facilities ranged between 2% and 76% (mean 43%) for indicator medicines. Prices of selected medicines varied within the 14 study regions. Retail medicine prices in the low-income settlements studied were generally higher than corresponding international reference prices. Price variations were observed across different regions although the regions comprise similar socioeconomic populations. These factors are likely to impact negatively on healthcare access.
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Affiliation(s)
- Dennis Ongarora
- Department of Pharmaceutical Chemistry, University of Nairobi, Nairobi 19676-00202, Kenya.
| | | | - Warnyta Minnaard
- Stichting PharmAccess International, Amsterdam 22700 1100 DE, Netherlands.
| | - Kennedy Abuga
- Department of Pharmaceutical Chemistry, University of Nairobi, Nairobi 19676-00202, Kenya.
| | | | - Isaac Kibwage
- Department of Pharmaceutical Chemistry, University of Nairobi, Nairobi 19676-00202, Kenya.
- Administration, Planning and Development, Egerton University, Njoro 20115, Kenya.
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Wasir R, Irawati S, Makady A, Postma M, Goettsch W, Buskens E, Feenstra T. Use of medicine pricing and reimbursement policies for universal health coverage in Indonesia. PLoS One 2019; 14:e0212328. [PMID: 30779809 PMCID: PMC6380537 DOI: 10.1371/journal.pone.0212328] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/31/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This study aimed to define the problems of the current use of the e-Catalogue and the national formulary (NF)-two elements of medicine pricing and reimbursement policies in Indonesia for achieving universal health coverage (UHC)-by examining the knowledge and attitudes of stakeholders. Specifically, to investigate (1) the perceived challenges involved in the further implementation of the e-Catalogue and the NF, (2) reasons of prescribing medicines not listed in the NF, and (3) possible improvements in the acceptance and use of the e-Catalogue and the NF. METHODS Semi-structured interviews were conducted with stakeholders (policymakers, healthcare providers, a pharmaceutical industry representative, and experienced patients) to collect the qualitative data. The data was analysed using directed content analysis, following the guidelines of the COnsolidated criteria for REporting Qualitative studies (COREQ) in reporting the findings. RESULTS Interestingly, 20 of 45 participants decided to withdraw from the interview due to their lack of knowledge of the e-Catalogue and the NF. All 25 stakeholders who fully participated in this research were in favor of the e-Catalogue and the NF. However, interviewees identified a range of challenges. A major challenge was the lack of harmonization between the lists of medicines in the e-Catalogue and the NF. Several system and personal reasons for prescribing medicines not listed in the NF were identified. Important reasons were a lack of incentives for physicians as well as a lack of transparent and evidence-based methods of selection for the medicines to be listed in the NF. CONCLUSIONS The e-Catalogue and the NF have not been fully utilized for achieving UHC in Indonesia. Some possible improvements suggested were harmonization of medicines listed in the e-Catalogue and the NF, restructuring incentive programs for prescribing NF medicines, and increasing the transparency and evidence-based approach for selection of medicines listed in the e-Catalogue and the NF.
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Affiliation(s)
- Riswandy Wasir
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Sekolah Tinggi Ilmu Farmasi Makassar, Makassar, Indonesia
- Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, the Netherlands
| | - Sylvi Irawati
- Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, the Netherlands
- Center for Medicines Information and Pharmaceutical Care, Faculty of Pharmacy, Universitas Surabaya, Surabaya, Indonesia
- Department of Clinical and Community Pharmacy, Faculty of Pharmacy, Universitas Surabaya, Surabaya, Indonesia
| | - Amr Makady
- National Health Care Institute, Diemen, the Netherlands
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Maarten Postma
- Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, the Netherlands
- Department of Health Sciences, University of Groningen, Groningen, the Netherlands
- Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, the Netherlands
- Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Wim Goettsch
- National Health Care Institute, Diemen, the Netherlands
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Erik Buskens
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Operations, Faculty of Economics & Business, University of Groningen Groningen, the Netherlands
| | - Talitha Feenstra
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Dutch National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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Wouters OJ, Sandberg DM, Pillay A, Kanavos PG. The impact of pharmaceutical tendering on prices and market concentration in South Africa over a 14-year period. Soc Sci Med 2019; 220:362-370. [DOI: 10.1016/j.socscimed.2018.11.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/08/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
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Kivoto PM, Mulaku M, Ouma C, Ferrario A, Kurdi A, Godman B, Oluka M. Clinical and Financial Implications of Medicine Consumption Patterns at a Leading Referral Hospital in Kenya to Guide Future Planning of Care. Front Pharmacol 2018; 9:1348. [PMID: 30618729 PMCID: PMC6295578 DOI: 10.3389/fphar.2018.01348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/01/2018] [Indexed: 12/31/2022] Open
Abstract
Background: Medicines can constitute up to 70% of total health care budgets in developing countries as well as considerable expenditure in hospitals. Inventory management techniques can assist with managing resources efficiently. In Kenyatta National Hospital (KNH), a leading hospital in Kenya, over 30% of expenditure is currently allocated to medicines, and this needs to be optimally managed. Objective: To investigate drug consumption patterns, their costs and morbidity patterns at KNH in recent years. Methodology: Cross-sectional retrospective record review. Inventory control techniques, ABC (Always, Better, and Control), VEN (Vital, Essential, and Non-essential) and ABC-VEN matrix analyses were used to study drug expenditure patterns. Morbidity data was extracted from the Medical Records. Results: Out of an average of 811 medicine types procured annually (ATC 5), 80% were formulary drugs and 20% were non-formulary. Class A medicines constituted 13.2–14.2% of different medicines procured each year but accounted for an average of 80% of total annual drug expenditure. Class B medicines constituted 15.9–17% of all the drugs procured yearly but accounted for 15% of the annual expenditure, whilst Class C medicines constituted 70% of total medicines procured but only 5% of the total expenditure. Vital and Essential medicines consumed the highest percentage of drug expenditure. ABC-VEN categorization showed that an average of 31% of medicine types consumed an average of 85% of total drug expenditure. Therapeutic category and Morbidity patterns analysis showed a mismatch between drug expenditure and morbidity patterns in over 85% of the categories. Conclusion: Class A medicines are few but consume the largest proportion of hospital drug expenditure. Vital and essential items account for the highest drug expenditure, and need to be carefully managed. ABC-VEN categorization identified medicines where major savings could potentially be made helped by Therapeutic category and Morbidity pattern analysis. There was a high percentage of non-formulary items, which needs to be addressed. Inventory control techniques should be applied routinely to optimize medicine use within available budgets especially in low and middle income countries.
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Affiliation(s)
- Patrick M Kivoto
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Mercy Mulaku
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Charles Ouma
- Health Commodities and Services Management (HCSM) Program, Management Sciences for Health (MSH), Nairobi, Kenya
| | - Alessandra Ferrario
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Healthcare Institute, Boston, MA, United States
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, United Kingdom.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, United Kingdom.,Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Health Economics Centre, Management School, University of Liverpool, Liverpool, United Kingdom
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
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Godman B, Bucsics A, Vella Bonanno P, Oortwijn W, Rothe CC, Ferrario A, Bosselli S, Hill A, Martin AP, Simoens S, Kurdi A, Gad M, Gulbinovič J, Timoney A, Bochenek T, Salem A, Hoxha I, Sauermann R, Massele A, Guerra AA, Petrova G, Mitkova Z, Achniotou G, Laius O, Sermet C, Selke G, Kourafalos V, Yfantopoulos J, Magnusson E, Joppi R, Oluka M, Kwon HY, Jakupi A, Kalemeera F, Fadare JO, Melien O, Pomorski M, Wladysiuk M, Marković-Peković V, Mardare I, Meshkov D, Novakovic T, Fürst J, Tomek D, Zara C, Diogene E, Meyer JC, Malmström R, Wettermark B, Matsebula Z, Campbell S, Haycox A. Barriers for Access to New Medicines: Searching for the Balance Between Rising Costs and Limited Budgets. Front Public Health 2018; 6:328. [PMID: 30568938 PMCID: PMC6290038 DOI: 10.3389/fpubh.2018.00328] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/26/2018] [Indexed: 01/26/2023] Open
Abstract
Introduction: There is continued unmet medical need for new medicines across countries especially for cancer, immunological diseases, and orphan diseases. However, there are growing challenges with funding new medicines at ever increasing prices along with funding increased medicine volumes with the growth in both infectious diseases and non-communicable diseases across countries. This has resulted in the development of new models to better manage the entry of new medicines, new financial models being postulated to finance new medicines as well as strategies to improve prescribing efficiency. However, more needs to be done. Consequently, the primary aim of this paper is to consider potential ways to optimize the use of new medicines balancing rising costs with increasing budgetary pressures to stimulate debate especially from a payer perspective. Methods: A narrative review of pharmaceutical policies and implications, as well as possible developments, based on key publications and initiatives known to the co-authors principally from a health authority perspective. Results: A number of initiatives and approaches have been identified including new models to better manage the entry of new medicines based on three pillars (pre-, peri-, and post-launch activities). Within this, we see the growing role of horizon scanning activities starting up to 36 months before launch, managed entry agreements and post launch follow-up. It is also likely there will be greater scrutiny over the effectiveness and value of new cancer medicines given ever increasing prices. This could include establishing minimum effectiveness targets for premium pricing along with re-evaluating prices as more medicines for cancer lose their patent. There will also be a greater involvement of patients especially with orphan diseases. New initiatives could include a greater role of multicriteria decision analysis, as well as looking at the potential for de-linking research and development from commercial activities to enhance affordability. Conclusion: There are a number of ongoing activities across countries to try and fund new valued medicines whilst attaining or maintaining universal healthcare. Such activities will grow with increasing resource pressures and continued unmet need.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Health Economics Centre, University of Liverpool Management School, Liverpool, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Anna Bucsics
- Mechanism of Coordinated Access to Orphan Medicinal Products (MoCA), Brussels, Belgium
| | - Patricia Vella Bonanno
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Wija Oortwijn
- Ecorys, Rotterdam, Netherlands
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Celia C. Rothe
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Alessandra Ferrario
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | | | - Andrew Hill
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Antony P. Martin
- Health Economics Centre, University of Liverpool Management School, Liverpool, United Kingdom
- HCD Economics, The Innovation Centre, Daresbury, United Kingdom
| | - Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Mohamed Gad
- Global Health and Development Group, Imperial College, London, United Kingdom
| | - Jolanta Gulbinovič
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, Vilnius, Lithuania
| | - Angela Timoney
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- NHS Lothian, Edinburgh, United Kingdom
| | - Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | | | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Robert Sauermann
- Hauptverband der Österreichischen Sozialversicherungsträger, Vienna, Austria
| | - Amos Massele
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Augusto Alfonso Guerra
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Av. Presidente Antônio Carlos, Belo Horizonte, Brazil
- SUS Collaborating Centre – Technology Assessment & Excellence in Health (CCATES/UFMG), College of Pharmacy, Federal University of Minas Gerais. Av. Presidente Antônio Carlos, Belo Horizonte, Brazil
| | - Guenka Petrova
- Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Zornitsa Mitkova
- Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | | | - Ott Laius
- State Agency of Medicines, Tartu, Estonia
| | | | - Gisbert Selke
- Wissenschaftliches Institut der AOK (WIdO), Berlin, Germany
| | - Vasileios Kourafalos
- EOPYY-National Organization for the Provision of Healthcare Services, Athens, Greece
| | - John Yfantopoulos
- School of Economics and Political Science, University of Athens, Athens, Greece
| | - Einar Magnusson
- Department of Health Services, Ministry of Health, Reykjavík, Iceland
| | - Roberta Joppi
- Pharmaceutical Drug Department, Azienda Sanitaria Locale of Verona, Verona, Italy
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Hye-Young Kwon
- Division of Biology and Public Health, Mokwon University, Daejeon, South Korea
| | | | - Francis Kalemeera
- Department of Pharmacology and Therapeutics, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph O. Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
| | | | - Maciej Pomorski
- Agency for Health Technology Assessment and Tariff System (AOTMiT), Warsaw, Poland
| | | | - Vanda Marković-Peković
- Ministry of Health and Social Welfare, Banja Luka, Bosnia and Herzegovina
- Department of Social Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Ileana Mardare
- Public Health and Management Department, Faculty of Medicine, “Carol Davila”, University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Dmitry Meshkov
- National Research Institution for Public Health, Moscow, Russia
| | | | - Jurij Fürst
- Health Insurance Institute, Ljubljana, Slovenia
| | - Dominik Tomek
- Faculty of Medicine, Slovak Medical University in Bratislava, Bratislava, Slovakia
| | - Corrine Zara
- Drug Territorial Action Unit, Catalan Health Service, Barcelona, Spain
| | - Eduardo Diogene
- Vall d'Hebron University Hospital, Fundació Institut Català de Farmacologia, Barcelona, Spain
| | - Johanna C. Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Rickard Malmström
- Department of Medicine Solna, Karolinska Institutet and Clinical Pharmacology Karolinska University Hospital, Stockholm, Sweden
| | - Björn Wettermark
- Department of Medicine Solna, Karolinska Institutet and Clinical Pharmacology Karolinska University Hospital, Stockholm, Sweden
- Department of Healthcare Development, Stockholm County Council, Stockholm, Sweden
| | | | - Stephen Campbell
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Alan Haycox
- Health Economics Centre, University of Liverpool Management School, Liverpool, United Kingdom
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DiPette DJ, Skeete J, Ridley E, Campbell NRC, Lopez-Jaramillo P, Kishore SP, Jaffe MG, Coca A, Townsend RR, Ordunez P. Fixed-dose combination pharmacologic therapy to improve hypertension control worldwide: Clinical perspective and policy implications. J Clin Hypertens (Greenwich) 2018; 21:4-15. [PMID: 30480368 DOI: 10.1111/jch.13426] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/15/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Donald J DiPette
- University of South Carolina School of Medicine, University of South Carolina, Columbia, South Carolina
| | - Jamario Skeete
- University of South Carolina School of Medicine, University of South Carolina, Columbia, South Carolina.,Palmetto Health, Columbia, South Carolina
| | | | - Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Patricio Lopez-Jaramillo
- FOSCAL, UDES, Bucaramanga, Colombia.,Eugenio Espejo Medical Sciences Faculty, UTE, Quito, Ecuador
| | - Sandeep P Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York.,Young Professionals Chronic Disease Network, New York, New York
| | - Marc G Jaffe
- Resolve to Save Lives, New York, New York.,Kaiser Permanente South, San Francisco Medical Center South, San Francisco, California
| | | | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, The Pan-American Health Organization, Washington, District of Columbia
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Maniadakis N, Holtorf AP, Otávio Corrêa J, Gialama F, Wijaya K. Shaping Pharmaceutical Tenders for Effectiveness and Sustainability in Countries with Expanding Healthcare Coverage. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:591-607. [PMID: 29987759 PMCID: PMC6132432 DOI: 10.1007/s40258-018-0405-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Policy makers in countries, aiming to build and expand their healthcare systems and coverage, need effective procedures to support the most efficient use of limited financial resources. Tendering is commonly deployed to minimize and fix the purchasing price for the contract duration, especially for off-patent pharmaceuticals. While tenders can reduce acquisition costs, they may also expose the healthcare systems to risks including drug shortages, quality trade-offs, and ultimately, compromised patient health outcomes. Careful planning is therefore required. The effectiveness and impact of tendering were examined in different healthcare settings to establish good tender practices and to develop guidance for tender stakeholders in countries with expanding healthcare coverage for the effective conduct. The literature was reviewed for tender practices and outcomes in all countries, and tender experts from one multi-national pharmaceutical company in 17 countries with expanding healthcare coverage were surveyed on current tender practices. Tendering is a common practice for multisource pharmaceuticals in most countries worldwide. However, countries with expanding healthcare coverage specifically are vulnerable to the risks of defective tendering practices. Risk factors include non-transparent tender practices, a lack of consistency, unclear tender award criteria, a focus on lowest price only, single-winner tendering, and generally, a lack of impact monitoring. If well planned, managed, and conducted, tenders can be advantageous. Countries with expanding healthcare coverage should approach tenders strategically to achieve the desired improvements in healthcare. The good tender practices derived from this study may guide policy makers and purchasers in countries with expanding healthcare coverage on how to expand access to healthcare at an affordable cost. These include the use of multiple selection criteria and performance monitoring. Plain Language Summary Decision makers in countries aiming to expand their healthcare systems must best use the limited money available for healthcare. Tendering is commonly deployed for pharmaceuticals produced by multiple manufacturers (so-called multisource pharmaceuticals), to choose the product with the lowest price. Through tenders, purchasers request offers from suppliers for the needed products.The ultimate purpose of our research was to develop a guidance on robust tender processes. Therefore, we reviewed the literature to examine the effectiveness and impact of current tendering practices. In addition, we conducted a survey among tender experts from one pharmaceutical company in 17 countries with expanding healthcare coverage.In both the survey and the literature review, we confirmed that worldwide, tendering is a common practice for multisource pharmaceuticals. However, defective tendering practices may increase the vulnerability for some risks including abuse due to intransparent processes, lack of consistency, unclear tender award criteria, a focus on lowest price only, single winner tendering, and generally, a lack of impact monitoring after the end of the tender process.Hence, tenders must be well planned, managed, and conducted to be advantageous. Countries with defined and transparent tender frameworks and processes will be better equipped to achieve the desired improvements in the healthcare systems. 'Good tender practices' include the clear definition of requirements to be used as selection criteria in addition to acquisition costs, and for monitoring of the tender success. 'Good tender practices' may help to manage cost and improve healthcare at the same time.
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Affiliation(s)
- Nikolaos Maniadakis
- Department of Health Services Management, National School of Public Health, Athens, Greece
| | - Anke-Peggy Holtorf
- Health Outcomes Strategies GmbH, Colmarerstrasse 58, 4055 Basel, Switzerland
| | | | - Fotini Gialama
- Department of Health Services Management, National School of Public Health, Athens, Greece
| | - Kalman Wijaya
- Abbott Products Operations AG, Allschwil, Switzerland
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Prada SI, Soto VE, Andia TS, Vaca CP, Morales ÁA, Márquez SR, Gaviria A. Higher pharmaceutical public expenditure after direct price control: improved access or induced demand? The Colombian case. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:8. [PMID: 29507533 PMCID: PMC5833155 DOI: 10.1186/s12962-018-0092-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 02/13/2018] [Indexed: 11/10/2022] Open
Abstract
Background High pharmaceutical expenditure is one of the main concerns for policymakers worldwide. In Colombia, a middle-income country, outpatient prescription represents over 10% of total health expenditure in the mandatory benefits package (POS), and close to 90% in the complementary government fund (No POS). In order to control expenditure, since 2011, the Ministry of Health introduced price caps on inpatient drugs reimbursements by active ingredient. By 2013, more than 400 different products, covering 80% of public pharmaceutical expenditure were controlled. This paper investigates the effects of the Colombian policy efforts to control expenditure by controlling prices. Methods Using SISMED data, the official database for prices and quantities sold in the domestic market, we estimate a Laspeyres price index for 90 relevant markets in the period 2011-2015, and, then, we estimate real pharmaceutical expenditure. Results Results show that, after direct price controls were enacted, price inflation decreased almost - 43%, but real pharmaceutical expenditure almost doubled due mainly to an increase in units sold. Such disproportionate increase in units sold maybe attributable to better access to drugs due to lower prices, and/or to an increase in marketing efforts by the pharmaceutical industry to maintain profits. Conclusions We conclude that pricing interventions should be implemented along with a strong market monitoring to prevent market distortions such as inappropriate and unnecessary drug use.
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Affiliation(s)
- Sergio I Prada
- 1Centro PROESA, Universidad Icesi, Calle 18 No. 122-135, Cali, Colombia
| | - Victoria E Soto
- 1Centro PROESA, Universidad Icesi, Calle 18 No. 122-135, Cali, Colombia
| | - Tatiana S Andia
- 2Facultad de Ciencias Sociales, Universidad de los Andes, Carrera 1 # 18A-12, Bogotá, Colombia
| | - Claudia P Vaca
- 3Centro de Pensamiento Medicamentos, Información y Poder, Facultad de Ciencias/Departamento de Farmacia, Universidad Nacional, Bogotá, Colombia
| | - Álvaro A Morales
- 2Facultad de Ciencias Sociales, Universidad de los Andes, Carrera 1 # 18A-12, Bogotá, Colombia
| | - Sergio R Márquez
- 4Ministerio de Salud y Protección Social, Carrera 13 # 32-76, Bogotá, Colombia
| | - Alejandro Gaviria
- 4Ministerio de Salud y Protección Social, Carrera 13 # 32-76, Bogotá, Colombia
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Shrestha M, Moles R, Ranjit E, Chaar B. Medicine procurement in hospital pharmacies of Nepal: A qualitative study based on the Basel Statements. PLoS One 2018; 13:e0191778. [PMID: 29401474 PMCID: PMC5798759 DOI: 10.1371/journal.pone.0191778] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 01/04/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Accessibility and affordability of evidence-based medicines are issues of global concern. For low-income countries like Nepal, it is crucial to have easy and reliable access to affordable, good-quality, evidence-based medicines, especially in the aftermath of natural or manmade disasters. Availability of affordable and evidence-based high quality medicines depends on the medicine procurement procedure, which makes it an important aspect of healthcare delivery. In this study, we aimed to investigate medicine procurement practices in hospital pharmacies of Nepal within the framework of International Pharmaceutical Federation [FIP] hospital pharmacy guidelines "the Basel Statements". METHOD We conducted semi-structured interviews with hospital pharmacists or procurement officers in hospital pharmacies of four major regions in Nepal to explore procurement practices. Data were collected until saturation of themes, analysed using the framework approach, and organised around the statements within the procurement theme of the Basel Statements. RESULTS Interviews conducted with 53 participants revealed that the procurement guidelines of the Basel Statements were adopted to a certain extent in hospital pharmacies of Nepal. It was found that the majority of hospital pharmacies in Nepal reported using an expensive direct-procurement model for purchasing medicines. Most had no formulary and procured medicines solely based on doctors' prescriptions, which were heavily influenced by pharmaceutical companies' marketing strategies. Whilst most procured only registered medicines, a minority reported purchasing unregistered medicines through unauthorised supply-chains. And although the majority of hospital pharmacies had some contingency plans for managing medicine shortages, a few had none. CONCLUSIONS Procurement guidelines of the Basel Statements were thus found to be partially adopted; however, there is room for improvement in current procurement practices in hospital pharmacies of Nepal. Adoption and regulation of national and international policies is recommended for enhancing medicine accessibility, as well as improving preparedness for health emergencies during natural disasters and health epidemics.
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Affiliation(s)
- Mina Shrestha
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
- World Hospital Pharmacy Research Consortium (WHoPReC)
| | - Rebekah Moles
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
- World Hospital Pharmacy Research Consortium (WHoPReC)
| | - Eurek Ranjit
- World Hospital Pharmacy Research Consortium (WHoPReC)
- Department of Pharmacology, Kathmandu Medical College, Kathmandu, Bagmati, Nepal
| | - Betty Chaar
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
- World Hospital Pharmacy Research Consortium (WHoPReC)
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48
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Distribution of essential medicines to primary care institutions in Hubei of China: effects of centralized procurement arrangements. BMC Health Serv Res 2017; 17:727. [PMID: 29137645 PMCID: PMC5686827 DOI: 10.1186/s12913-017-2720-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 11/09/2017] [Indexed: 11/21/2022] Open
Abstract
Background Poor distribution of essential medicines to primary care institutions has attracted criticism since China adopted provincial centralized regional tendering and procurement systems. This study evaluated the impact of new procurement arrangements that limit the number of distributors at the county level in Hubei province, China. Methods Procurement ordering and distribution data were collected from four counties that pioneered a new distribution arrangement (commencing September 2012) compared with six counties that continued the existing arrangement over the period from August 2011 to September 2013. The new arrangement allowed primary care institutions and/or suppliers to select a local distributor from a limited panel (from 3 to 5) of government nominated distributors. Difference-in-differences analyses were performed to assess the impact of the new arrangements on delivery and receipt of essential medicines. Results Overall, the new distribution arrangement has not improved distribution of essential medicines to primary care institutions. On the contrary, we found a 7.78–19.85 percentage point (p < 0.01) decrease in distribution rates to rural primary care institutions. Similar results were demonstrated using the indicator of received rates, with a 7.89–19.65 percentage point (p < 0.01) decrease. Conclusions Simply limiting the number of distributors does not offer a solution to the poor performance of delivery of essential medicines for primary care institutions, especially those located in rural areas. Procurement arrangements need to consider the special characteristics of rural facilities. In a county, there are more rural primary care institutions than urban ones. On average, rural primary care institutions demand more and are more geographically dispersed compared to their urban counterparts, which may impose increased distribution costs. Electronic supplementary material The online version of this article (10.1186/s12913-017-2720-3) contains supplementary material, which is available to authorized users.
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Abdel Rida N, Mohamed Ibrahim MI, Babar ZUD, Owusu Y. A systematic review of pharmaceutical pricing policies in developing countries. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2017. [DOI: 10.1111/jphs.12191] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Yaw Owusu
- College of Pharmacy; Qatar University; Doha Qatar
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50
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Moye-Holz D, van Dijk JP, Reijneveld SA, Hogerzeil HV. Policy approaches to improve availability and affordability of medicines in Mexico - an example of a middle income country. Global Health 2017; 13:53. [PMID: 28764738 PMCID: PMC5540413 DOI: 10.1186/s12992-017-0281-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 07/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization recommends establishing and implementing a national pharmaceutical policy (NPP) to guarantee effective and equitable access to medicines. Mexico has implemented several policy approaches to regulate the pharmaceutical sector, but it has no formal NPP. This article describes the approach that the Mexican government has taken to improve availability and affordability of essential medicines. METHODS Descriptive policy analysis of public pharmaceutical policy proposals and health action plans on the basis of publicly available data and health progress reports, with a focus on availability and affordability of medicines. RESULTS The government has implemented pooled procurement, price negotiations, and an information platform in the public sector to improve affordability and availability. The government mainly reports on the savings that these strategies have generated in the public expenditure but their full impact on availability and affordability has not been assessed. CONCLUSIONS To increase availability and affordability of medicines in the public sector, the Mexican government has resorted on isolated strategies. In addition to efficient procurement, price negotiations and price information, other policy components and pricing interventions are needed. All these strategies should be included in a comprehensive NPP.
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Affiliation(s)
- Daniela Moye-Holz
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands.
| | - Jitse P van Dijk
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Hans V Hogerzeil
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
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