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Ozieranski P, Martinon L, Jachiet PA, Mulinari S. Tip of the Iceberg? Country- and Company-Level Analysis of Drug Company Payments for Research and Development in Europe. Int J Health Policy Manag 2022; 11:2842-2859. [PMID: 35297231 PMCID: PMC10105170 DOI: 10.34172/ijhpm.2022.6575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 02/21/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Creating new therapies often involves drug companies paying healthcare professionals and institutions for research and development (R&D) activities, including clinical trials. However, industry sponsorship can create conflicts of interest (COIs). We analysed approaches to drug company R&D payment disclosure in European countries and the distribution of R&D payments at the country and company level. METHODS Using documentary sources and a stakeholder survey we identified country- regulatory approaches to R&D payment disclosure. We reviewed company-level descriptions of disclosure practices in the United Kingdom, a country with a major role in Europe's R&D. We obtained country-level R&D payment data from industry trade groups and public authorities and company-level data from eurosfordocs.eu, a publicly available payments database. We conducted content analysis and descriptive statistical analysis. RESULTS In 32 of 37 studied countries, all R&D payments were reported without named recipients, following a self-regulatory approach developed by the industry. The methodological descriptions from 125 companies operating in the United Kingdom suggest that within the self-regulatory approach companies had much leeway in deciding what activities and payments were considered as R&D. In five countries, legislation mandated the disclosure of R&D payment recipients, but only in two were payments practically identifiable and analysable. In 17 countries with available data, R&D constituted 19%-82% of all payments reported, with self-regulation associated with higher shares. Available company-level data from three countries with self-regulation suggests that R&D payments were concentrated by big funders, and some companies reported all, or nearly all, payments as R&D. CONCLUSION The lack of full disclosure of R&D payments in countries with industry self-regulation leaves considerable sums of money unaccounted for and potentially many COIs undetected. Disclosure mandated by legislation exists in few countries and rarely enhances transparency practically. We recommend a unified European approach to R&D payment disclosure, including clear definitions and a centralised database.
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Affiliation(s)
- Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | | | | | - Shai Mulinari
- Department of Sociology, Lund University, Lund, Sweden
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Rickard E, Ozieranski P. A hidden web of policy influence: The pharmaceutical industry's engagement with UK's All-Party Parliamentary Groups. PLoS One 2021; 16:e0252551. [PMID: 34166396 PMCID: PMC8224875 DOI: 10.1371/journal.pone.0252551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/17/2021] [Indexed: 11/23/2022] Open
Abstract
Our objective was to examine conflicts of interest between the UK’s health-focused All-Party Parliamentary Groups (APPGs) and the pharmaceutical industry between 2012 and 2018. APPGs are informal cross-party groups revolving around a particular topic run by and for Members of the UK’s Houses of Commons and Lords. They facilitate engagement between parliamentarians and external organisations, disseminate knowledge, and generate debate through meetings, publications, and events. We identified APPGs focusing on physical or mental health, wellbeing, health care, or treatment and extracted details of their payments from external donors disclosed on the Register for All-Party Parliamentary Groups. We identified all donors which were pharmaceutical companies and pharmaceutical industry-funded patient organisations. We established that sixteen of 146 (11%) health-related APPGs had conflicts of interest indicated by reporting payments from thirty-five pharmaceutical companies worth £1,211,345.81 (16.6% of the £7,283,414.90 received by all health-related APPGs). Two APPGs (Health and Cancer) received more than half of the total value provided by drug companies. Fifty APPGs also had received payments from patient organisations with conflicts of interest, indicated by reporting 304 payments worth £986,054.94 from 57 (of 84) patient organisations which had received £27,883,556.3 from pharmaceutical companies across the same period. In total, drug companies and drug industry-funded patient organisations provided a combined total of £2,197,400.75 (30.2% of all funding received by health-related APPGs) and 468 (of 1,177–39.7%) payments to 58 (of 146–39.7%) health-related APPGs, with the APPG for Cancer receiving the most funding. In conclusion, we found evidence of conflicts of interests through APPGs receiving substantial income from pharmaceutical companies. Policy influence exerted by the pharmaceutical industry needs to be examined holistically, with an emphasis on relationships between actors potentially playing part in its lobbying campaigns. We also suggest ways of improving transparency of payment reporting by APPGs and pharmaceutical companies.
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Affiliation(s)
- Emily Rickard
- Department of Social and Policy Sciences, University of Bath, Bath, Somerset, United Kingdom
| | - Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Bath, Somerset, United Kingdom
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Löblová O, Trayanov T, Csanádi M, Ozierański P. The Emerging Social Science Literature on Health Technology Assessment: A Narrative Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:3-9. [PMID: 31952670 DOI: 10.1016/j.jval.2019.07.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 05/13/2019] [Accepted: 07/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Social scientists have paid increasing attention to health technology assessment (HTA). This paper provides an overview of existing social scientific literature on HTA, with a focus on sociology and political science and their subfields. METHODS Narrative review of key pieces in English. RESULTS Three broad themes recur in the emerging social science literature on HTA: the drivers of the establishment and concrete institutional designs of HTA bodies; the effects of institutionalized HTA on pricing and reimbursement systems and the broader society; and the social and political influences on HTA decisions. CONCLUSION Social scientists bring a focus on institutions and social actors involved in HTA, using primarily small-N research designs and qualitative methods. They provide valuable critical perspectives on HTA, at times challenging its otherwise unquestioned assumptions. However, they often leave aside questions important to the HTA practitioner community, including the role of culture and values. Closer collaboration could be beneficial to tackle new relevant questions pertaining to HTA.
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Affiliation(s)
- Olga Löblová
- Department of Sociology, University of Cambridge, Cambridge, England, UK.
| | - Trayan Trayanov
- Department of Sociology, University of Cambridge, Cambridge, England, UK
| | - Marcell Csanádi
- Doctoral School of Pharmacological and Pharmaceutical Sciences, University of Pécs, Pécs, Hungary; Syreon Research Institute, Budapest, Hungary
| | - Piotr Ozierański
- Department of Social and Policy Sciences, University of Bath, Bath, England, UK
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Abstract
Drug company payment disclosures have limited transparency, but Piotr Ozieranski and colleagues find that they are increasing in value and are targeted at select patient organisations
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Affiliation(s)
- Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Claverton Down, Bath, UK
| | - Emily Rickard
- Department of Social and Policy Sciences, University of Bath, Claverton Down, Bath, UK
| | - Shai Mulinari
- Department of Sociology, Lund University, Lund, Sweden
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If You're a Rawlsian, How Come You're So Close to Utilitarianism and Intuitionism? A Critique of Daniels's Accountability for Reasonableness. HEALTH CARE ANALYSIS 2018; 26:1-16. [PMID: 28332130 PMCID: PMC5816125 DOI: 10.1007/s10728-017-0343-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Norman Daniels’s theory of ‘accountability for reasonableness’ is an influential conception of fairness in healthcare resource allocation. Although it is widely thought that this theory provides a consistent extension of John Rawls’s general conception of justice, this paper shows that accountability for reasonableness has important points of contact with both utilitarianism and intuitionism, the main targets of Rawls’s argument. My aim is to demonstrate that its overlap with utilitarianism and intuitionism leaves accountability for reasonableness open to damaging critiques. The important role that utilitarian-like cost-effectiveness calculations are allowed to play in resource allocation processes disregards the separateness of persons and is seriously unfair towards individuals whose interests are sacrificed for the sake of groups. Furthermore, the function played by intuitions in settling frequent value conflicts opens the door for sheer custom and vested interests to steer decision-making.
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Beaussier AL, Demeritt D, Griffiths A, Rothstein H. Accounting for failure: risk-based regulation and the problems of ensuring healthcare quality in the NHS. HEALTH, RISK & SOCIETY 2016; 18:205-224. [PMID: 27499677 PMCID: PMC4950452 DOI: 10.1080/13698575.2016.1192585] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 05/18/2016] [Indexed: 11/09/2022]
Abstract
In this paper, we examine why risk-based policy instruments have failed to improve the proportionality, effectiveness, and legitimacy of healthcare quality regulation in the National Health Service (NHS) in England. Rather than trying to prevent all possible harms, risk-based approaches promise to rationalise and manage the inevitable limits of what regulation can hope to achieve by focusing regulatory standard-setting and enforcement activity on the highest priority risks, as determined through formal assessments of their probability and consequences. As such, risk-based approaches have been enthusiastically adopted by healthcare quality regulators over the last decade. However, by drawing on historical policy analysis and in-depth interviews with 15 high-level UK informants in 2013-2015, we identify a series of practical problems in using risk-based policy instruments for defining, assessing, and ensuring compliance with healthcare quality standards. Based on our analysis, we go on to consider why, despite a succession of failures, healthcare regulators remain committed to developing and using risk-based approaches. We conclude by identifying several preconditions for successful risk-based regulation: goals must be clear and trade-offs between them amenable to agreement; regulators must be able to reliably assess the probability and consequences of adverse outcomes; regulators must have a range of enforcement tools that can be deployed in proportion to risk; and there must be political tolerance for adverse outcomes.
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Affiliation(s)
| | - David Demeritt
- Department of Geography, King’s College London, London, UK
| | - Alex Griffiths
- School of Management and Business, King’s College London, London, UK
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Shimazawa R, Ikeda M. Conflicts of interest in psychiatry: strategies to cultivate literacy in daily practice. Psychiatry Clin Neurosci 2014; 68:489-97. [PMID: 24802771 DOI: 10.1111/pcn.12201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2014] [Indexed: 01/07/2023]
Abstract
The relationship between psychiatry and pharmaceutical companies has come under scrutiny during the past decade. Concerns are growing that financial ties of psychiatrists to the pharmaceutical industry may unduly influence professional judgments involving the primary interests of patients. Such conflicts of interest threaten the public trust in psychiatry. The goal of conflict of interest policies is to protect the integrity of professional judgment and to preserve public trust. The disclosure of individual and institutional financial relationships is a critical but limited first step in the process of identifying and responding to conflicts of interest. Conflict of interest policies and procedures can be strengthened by engaged psychiatrists, researchers, institutions, and professional associations in developing policies and consensus standards. Research on conflicts of interest can provide a stronger evidence base for policy design and implementation. Society has traditionally granted the medical profession considerable autonomy and may be willing to continue do so in the case of conflicts of interest. Nevertheless, concern is growing that stronger measures are needed. To avoid undue regulatory burdens, psychiatrists can play a vital role in designing responsible and reasonable conflict of interest policies that reduce the risks of bias and the loss of trust. Psychiatrists and the institutions that carry out research, education, clinical care, and practice guideline development must recognize public concerns about conflicts of interest and take effective measures soon to maintain public trust with a cultural change in the practice of psychiatry, from reactive treatment-seeking for mental illness to proactive advocacy for patients.
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Mandeville KL, O'Neill S, Brighouse A, Walker A, Yarrow K, Chan K. Academics and competing interests in H1N1 influenza media reporting. J Epidemiol Community Health 2013; 68:197-203. [PMID: 24218071 PMCID: PMC3932964 DOI: 10.1136/jech-2013-203128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Concerns have been raised over competing interests (CoI) among academics during the 2009 to 2010 A/H1N1 pandemic. Media reporting can influence public anxiety and demand for pharmaceutical products. We assessed CoI of academics providing media commentary during the early stages of the pandemic. METHODS We performed a retrospective content analysis of UK newspaper articles on A/H1N1 influenza, examining quoted sources. We noted when academics made a risk assessment of the pandemic and compared this with official estimations. We also looked for promotion or rejection of the use of neuraminidase inhibitors or H1N1-specific vaccine. We independently searched for CoI for each academic. RESULTS Academics were the second most frequently quoted source after Ministers of Health. Where both academics and official agencies estimated the risk of H1N1, one in two academics assessed the risk as higher than official predictions. For academics with CoI, the odds of a higher risk assessment were 5.8 times greater than those made by academics without CoI (Wald p value=0.009). One in two academics commenting on the use of neuraminidase inhibitors or vaccine had CoI. The odds of CoI in academics promoting the use of neuraminidase inhibitors were 8.4 times greater than for academics not commenting on their use (Fisher's exact p=0.005). CONCLUSIONS There is evidence of CoI among academics providing media commentary during the early H1N1 pandemic. Heightened risk assessments, combined with advocacy for pharmaceutical products to counter this risk, may lead to increased public anxiety and demand. Academics should declare, and journalists report, relevant CoI for media interviews.
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Affiliation(s)
- Kate L Mandeville
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, , London, UK
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Hughes D, Williams-Jones B. Coalition Priorité Cancer and the pharmaceutical industry in Quebec: conflicts of interest in the reimbursement of expensive cancer drugs? Healthc Policy 2013; 9:52-64. [PMID: 23968674 PMCID: PMC3999544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
In the context of scarce public resources, patient interest groups have increasingly turned to private organizations for financing, including the pharmaceutical industry. This practice puts advocacy groups in a situation of potential conflicts between the interests of patients and those of the drug companies. The interests of patients and industry can converge on issues related to the approval and reimbursement of medications. But even on this issue, interests do not always align perfectly. Using the Quebec example of Coalition Priorité Cancer (CPC) as a case study, we examine the ethical issues raised by such financial relationships in the context of drug reimbursement decision-making. We collected, compiled and analyzed publicly available information on the CPC's organization and activities; this approach allowed us to raise and discuss important questions regarding the possible influence exerted on patient groups by donors. We conclude with some recommendations.
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Affiliation(s)
- David Hughes
- Doctoral Student, Applied Human Sciences (Bioethics Option), Bioethics Programme, Department of Social and Preventive Medicine, University of Montreal, Montreal, QC
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Catalá-López F, Sanfélix-Gimeno G, Ridao M, Peiró S. When are statins cost-effective in cardiovascular prevention? A systematic review of sponsorship bias and conclusions in economic evaluations of statins. PLoS One 2013; 8:e69462. [PMID: 23861972 PMCID: PMC3704635 DOI: 10.1371/journal.pone.0069462] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 06/10/2013] [Indexed: 12/03/2022] Open
Abstract
Background We examined sponsorship of published cost-effectiveness analyses of statin use for cardiovascular (CV) prevention, and determined whether the funding source is associated with study conclusions. Methods and Findings We searched PubMed/MEDLINE (up to June 2011) to identify cost-effectiveness analyses of statin use for CV prevention reporting outcomes as incremental costs per quality-adjusted life years (QALY) and/or life years gained (LYG). We examined relationships between the funding source and the study conclusions by means of tests of differences between proportions. Seventy-five studies were included. Forty-eight studies (64.0%) were industry-sponsored. Fifty-two (69.3%) articles compared statins versus non-active alternatives. Secondary CV prevention represented 42.7% of articles, followed by primary CV prevention (38.7%) and both (18.7%). Overall, industry-sponsored studies were much less likely to report unfavourable or neutral conclusions (0% versus 37.1%; p<0.001). For primary CV prevention, the proportion with unfavourable or neutral conclusions was 0% for industry-sponsored studies versus 57.9% for non-sponsored studies (p<0.001). Conversely, no statistically significant differences were identified for studies evaluating secondary CV prevention (0% versus 12.5%; p=0.222). Incremental costs per QALY/LYG estimates reported in industry-sponsored studies were generally more likely to fall below a hypothetical willingness-to-pay threshold of US $50,000. Conclusions Our systematic analysis suggests that pharmaceutical industry sponsored economic evaluations of statins have generally favored the cost-effectiveness profile of their products particularly in primary CV prevention.
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Affiliation(s)
- Ferrán Catalá-López
- Centro Superior de Investigación en Salud Pública (CSISP-FISABIO), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain.
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The politics of health technology assessment in Poland. Health Policy 2012; 108:178-93. [PMID: 23127957 DOI: 10.1016/j.healthpol.2012.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 10/03/2012] [Accepted: 10/03/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE First, to identify risks associated with the scientific evaluation of drugs considered for state reimbursement in Poland through exploring strategies of influence employed by multinational drug companies in relation to the Agency for Health Technology Assessment (AHTAPol). Second, to ascertain whether the outcomes of drug evaluation meet the interests of the public payer in reimbursing cost-effective drugs supported by robust pharmacoeconomic evidence. METHODOLOGY We conducted 109 in-depth semi-structured interviews with a purposive sample of stakeholders involved in the reimbursement process in Poland. We analysed four available documentary sources, including recommendations issued by the AHTAPol. RESULTS AHTAPol recommendations were an instrumental part of the blame avoidance strategy by political elites. Drug producers utilised direct and indirect strategies of influence. The direct strategies involved building relationships with a circle of health technology assessment analysts and medical experts working for the Agency. The indirect strategies employed leaders of opinion in the medical milieu, patient organisations, and political elites to endorse policy positions favourable to drug companies. The AHTAPol positively recommended an increasing proportion of the drugs it assessed, many of them reported as not cost-effective or supported by dubious pharmacoeconomic evidence. CONCLUSIONS The strategies of influence entail a number of risks that may undermine the scientific evaluation of drugs. Some outcomes of drug evaluation may favour the interests of multinational drug companies over those of the public payer. We suggest that the risks involved in drug evaluation might be mitigated through (1) professionalization of health technology assessment; (2) restriction of job seeking and post public-payer employment; (3) disclosure and management of experts' conflicts of interest; (4) institutionalisation of patient and public involvement; and (5) increased institutional separation of the AHTAPol from political elites.
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Pharmaceutical lobbying under postcommunism: universal or country-specific methods of securing state drug reimbursement in Poland? HEALTH ECONOMICS POLICY AND LAW 2011; 7:175-95. [DOI: 10.1017/s1744133111000168] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThis paper aims to fill in the gap in research on the effect of pharmaceutical lobbying on drug reimbursement policy, particularly in Poland, a post-communist country. To this end, we conducted in-depth, semi-structured, anonymous, elite interviews in Poland, supplemented by a review of legislation, policy documents, official reports and press articles, as well as observations. Overall, 109 representatives of stakeholders involved in reimbursement policy were interviewed. We identified two key lobbying methods: informal persuasion and third-party endorsements. These methods are coupled with two supplementary ones: lobbying through parliament and ministries, as well as diplomatic pressure. Pharmaceutical lobbying methods in Poland clearly resemble those used in other European countries. What is notable about the Polish case is extensive reliance on informal lobbying and diplomatic pressure.
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Breaking up is hard to do: the economic impact of provisional funding contingent upon evidence development. HEALTH ECONOMICS POLICY AND LAW 2011; 6:509-27. [DOI: 10.1017/s1744133111000144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractFunding contingent upon evidence development (FED) has recently been the subject of some considerable debate in the literature but relatively little has been made of its economic impact. We argue that FED has the potential to shorten the lag between innovation and access but may also (i) crowd-out more valuable interventions in situations in which there is a fixed dedicated budget; or (ii) lead to a de facto increase in the funding threshold and increased expenditure growth in situations in which the programme budget is open-ended. Although FED would typically entail periodic review of provisional or interim listings, it may prove difficult to withdraw funding even at cost/QALY ratios well in excess of current listing thresholds. Further consideration of the design and implementation of FED processes is therefore required to ensure that its introduction yields net benefits over existing processes.
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Polyzos NP, Valachis A, Mauri D, Ioannidis JPA. Industry involvement and baseline assumptions of cost-effectiveness analyses: diagnostic accuracy of the Papanicolaou test. CMAJ 2011; 183:E337-43. [PMID: 21402681 DOI: 10.1503/cmaj.101506] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Industry involvement has been associated with more favourable cost-effectiveness ratios in cost-effectiveness analyses, but the mechanisms for this association are unclear. We evaluated whether the assumed accuracy of the Papanicolaou (Pap) test was correlated with the features of cost-effectiveness analysis studies. METHODS We searched PubMed (last updated April 2010) for cost-effectiveness analysis studies in which at least one strategy involved the Pap test for cervical cancer. We assessed the baseline assumed diagnostic sensitivity and specificity of the Pap test in each study and the association of these values with three levels of manufacturer involvement in the study. RESULTS Among 88 analyzed cost-effectiveness analysis studies, the assumed sensitivity of the Pap test was lower in studies with manufacturer-affiliated authors, manufacturer funding or manufacturer-related competing interests versus studies without (mean sensitivity 60% v. 70%, p < 0.001). The assumed specificity of the Pap test was lower in cost-effectiveness analyses involving new screening tests (mean 93% v. 96%, p = 0.016). The assumed specificity did not differ between trials with manufacturer involvement versus those without (mean 95% v. 95%, p = 0.755). INTERPRETATION The results of cost-effectiveness analyses may be affected by a downgrading of the assumed diagnostic accuracy of the standard Pap test against which newer tests or interventions are compared. New technology then seems to have more favourable results against a straw-man comparator.
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Affiliation(s)
- Nikolaos P Polyzos
- Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
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Yothasamut J, Tantivess S, Teerawattananon Y. Using economic evaluation in policy decision-making in Asian countries: mission impossible or mission probable? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12 Suppl 3:S26-S30. [PMID: 20586976 DOI: 10.1111/j.1524-4733.2009.00623.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES AND METHODS This article provides an extensive review of literature and an in-depth analysis aimed at introducing potential applications of economic evaluation and at addressing the barriers that could prohibit the use or diminish the usefulness of economic evaluation in Asian settings. It also proposes the probable solutions to overcome these barriers. RESULTS Potential uses of economic evaluation include the development of public reimbursement lists, price negotiation, the development of clinical practice guidelines, and communicating with prescribers. Two types of barriers to using economic evaluation, namely barriers relating to the production of economic evaluation data and decision context-related barriers, are identified. For the first sort of barrier, the development of the national guidelines, the development of economic evaluation database, planning and use of economic evaluation in a systematic manner, and prioritization of topics for assessment are recommended. Furthermore, educating potential users and the public, making the economic evaluation process transparent and participatory, and incorporating other health preferences into the decision-making framework have been promoted to conquer decision context-related barriers. CONCLUSIONS It seems practically impossible to adopt other countries' approaches using economic evaluation for priority setting because of several constraints specifically related to the context of each setting. Nevertheless, given a better understanding of its resistance, and proper policies and strategies to overcome the barriers applied, it is more than probable that a method with system/mechanisms specifically designed to fit particular settings will be used.
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Affiliation(s)
- Jomkwan Yothasamut
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand.
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Husereau D, Morrison A, Battista R, Goeree R. Health technology assessment: a review of international activity and examples of approaches with computed tomographic colonography. J Am Coll Radiol 2009; 6:343-52. [PMID: 19394575 DOI: 10.1016/j.jacr.2009.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 01/22/2009] [Indexed: 11/25/2022]
Abstract
The growth of health technology assessment (HTA) internationally is currently reflected in the growing membership of the International Network of Agencies for Health Technology Assessment. Many national and regional HTA institutions emerged in the 1980s and 1990s, and more recently, HTA has emerged in newly industrialized countries and in European Union member states in transition. Health technology assessment activities are becoming an increasingly important part of health care culture, with the appearance of HTA units in hospitals and hospital departments. This article provides a brief overview of who conducts HTA internationally and looks at how HTA is conducted and how this information is used. To highlight the different structures, processes, and methods available, a portion of this article is dedicated to describing different approaches that have been observed with respect to the assessment of computed tomographic colonography in North America for population-based colorectal cancer screening.
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Affiliation(s)
- Don Husereau
- Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada.
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Syrett K, Quick O. Pedagogical promise and problems: teaching public health law. Public Health 2009; 123:222-31. [PMID: 19243797 PMCID: PMC7118742 DOI: 10.1016/j.puhe.2008.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Accepted: 12/19/2008] [Indexed: 11/27/2022]
Abstract
This article considers the case for teaching public health law as a distinct subject of study within the academic curriculum. It offers proposals on syllabus design, assessment and objectives by reference to the authors' own teaching experience, and also seeks to serve as a resource for those considering the introduction of a course in this field. There is consideration of the conceptual analysis of public health law, and an exploration of the obstacles and opportunities involved in teaching public health law in higher education. To date, issues of public health law have received coverage, if at all, almost exclusively in the context of existing medical or healthcare law modules. Although difficult obstacles remain to be surmounted before the subject can be fully embraced, its marginalization appears to be increasingly misplaced in light of growing awareness of the policy challenges presented by public health and the potential for law to function as a valuable tool to assist in addressing such challenges. There are also potent pedagogical arguments for the teaching of public health law on a liberal academic curriculum.
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Affiliation(s)
- K Syrett
- School of Law, University of Bristol, Wills Memorial Building, Queens Road, Bristol BS8 1RJ, UK.
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The Australian funding debate on quadrivalent HPV vaccine: A case study for the national pharmaceutical policy. Health Policy 2008; 88:250-7. [DOI: 10.1016/j.healthpol.2008.03.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Revised: 03/28/2008] [Accepted: 03/28/2008] [Indexed: 11/23/2022]
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Mackenzie R, Chapman S, Salkeld G, Holding S. Media influence on Herceptin subsidization in Australia: application of the rule of rescue? J R Soc Med 2008; 101:305-12. [PMID: 18515778 DOI: 10.1258/jrsm.2008.070289] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In August 2006, the Australian government announced that Herceptin (Trastuzumab) would be added to the national Pharmaceutical Benefits Scheme (PBS) of government-subsidized drugs, for treatment with adjuvant chemotherapy of HER2 breast cancer. Following initial reticence, the health minister responded to a campaign by patients and patient advocacy groups by announcing PBS subsidization which lowered the cost of a weekly dose from A$1000 to A$30. The cost to the government would be A$470 million over three years for treatment of an estimated 2100 women annually. DESIGN We analysed the news frames used in all direct and attributed statements (n=239) in television news coverage of the discourse preceding the Herceptin decision by the Australian government. SETTING Five Sydney free-to-air channels between October 2005 and August 2006. MAIN OUTCOME MEASURES News frames or themes. RESULTS Of five news frames identified, one ('desperate, sick women in double jeopardy because of callous government/incompetent bureaucracy') accounted for 54% of all reported statements. Government financial parsimony was framed as responsible for the women's plight, with drug industry pricing never mentioned. Claimed benefits of Herceptin often conflated cancer non-recurrence and survival and favoured quantification rhetoric which emphasized percentage increases in improvement rather than the more modest increases in absolute survival. CONCLUSIONS News frames invoking key tenets of the 'rule of rescue' dominated television discourse on Herceptin. Clinicians, patients, their families and patient advocacy groups invoking the rule of rescue can increase the likelihood of achieving their objective of gaining access to expensive healthcare such as pharmaceuticals. Rational, criteria-based public health policy will find it hard to resist the rule of rescue imperative.
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Affiliation(s)
- Ross Mackenzie
- School of Public Health, University of Sydney 2006, Australia
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Lewison G, Sullivan R. The impact of cancer research: how publications influence UK cancer clinical guidelines. Br J Cancer 2008; 98:1944-50. [PMID: 18521087 PMCID: PMC2441955 DOI: 10.1038/sj.bjc.6604405] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
There has been a substantially increased interest in biomedical research impact assessment over the past 5 years. This can be studied by a number of methods, but its influence on clinical guidelines must rank as one of the most important. In cancer, there are 43 UK guidelines (and associated Health Technology Assessments) published (up to October 2006) across three series, each of which has an evidence base in the form of references, many of which are papers in peer-reviewed journals. These have all been identified and analysed to determine their geographical provenance and type of research, in comparison with overall oncology research published in the peak years of guideline references (1999–2001). The UK papers were cited nearly three times as frequently as would have been expected from their presence in world oncology research (6.5%). Within the United Kingdom, Edinburgh and Glasgow stood out for their unexpectedly high contributions to the guidelines' scientific base. The cited papers from the United Kingdom acknowledged much more explicit funding from all sectors than did the UK cancer research papers at the same research level.
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Affiliation(s)
- G Lewison
- School of Library, Archive & Information Studies, University College London, Gower Street, London WC1E 6BT, UK
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Kaltenthaler E, Tappenden P, Booth A, Akehurst R. Comparing methods for full versus single technology appraisal: a case study of docetaxel and paclitaxel for early breast cancer. Health Policy 2008; 87:389-400. [PMID: 18387689 DOI: 10.1016/j.healthpol.2008.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Revised: 02/13/2008] [Accepted: 02/14/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study is to compare and contrast the reports of the rapid National Institute for Health and Clinical Excellence (NICE) single technology (STA) process with the full Health Technology Assessment Report (TAR) for the same technologies (docetaxel and paclitaxel for the adjuvant treatment of early breast cancer). METHODS Documentary analysis was used to compare three reports. A data extraction form was developed to record information on the decision problem addressed in each report, literature searching methods, the clinical effectiveness review, cost-effectiveness analysis, conclusions and issues of concern. RESULTS The decision problems and search strategies for the STAs differed from those reported in the TAR. Not all trials of clinical effectiveness included in the TAR were reported by manufacturers. The methods and assumptions used to assess the cost-effectiveness of the technologies were generally similar between reports, although only one common health economic comparison was presented across the three reports. The TAR supports the STA results for docetaxel but suggested that the manufacturer's cost-effectiveness estimates for paclitaxel were highly optimistic. CONCLUSIONS Although the STA process provides the opportunity for rapid appraisal of new technologies, there remains uncertainty concerning the extent to which STAs adequately address the specific decision problem under consideration.
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Affiliation(s)
- Eva Kaltenthaler
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
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Wilson PM, Booth AM, Eastwood A, Watt IS. Deconstructing media coverage of trastuzumab (Herceptin): an analysis of national newspaper coverage. J R Soc Med 2008; 101:125-32. [PMID: 18344469 PMCID: PMC2270248 DOI: 10.1258/jrsm.2007.070115] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To explore and critically describe the content and main narratives of UK national daily newspaper coverage of trastuzumab (Herceptin). DESIGN We used the NewsBank database to search eight national daily newspapers, and their Sunday equivalents, retrospectively from 19 February 2006 back to the earliest mention of trastuzumab or Herceptin (19 May 1998). Setting UK national newspapers. MAIN OUTCOME MEASURES To be eligible for inclusion, articles had to contain at least three sentences about trastuzumab. Articles that focused on the financial performance of companies associated with the drug were excluded from the analysis. For each included article, we extracted bibliographic details and data, and independently rated the reporting slant towards trastuzumab and, where relevant, the reporting slant towards access to treatment. RESULTS We identified 361 articles that met the study inclusion criteria. The proprietary name of Herceptin was always used, with only eight articles mentioning the generic alternative. 294/361 included articles (81.5%) were rated as being positive towards trastuzumab, the remainder rated as neutral. Access to trastuzumab treatment was the main narrative running across included articles and reports of individual patients seeking treatment featured prominently throughout. In 208/361 of included articles (57%) the reporting slant towards access to trastuzumab treatment was rated as negative. 178/361 of included articles (49.3%) mentioned licensing, but rarely mentioned that licensing processes can only occur when the manufacturer applies for a licence. Only a minority of articles mentioned that the drug had to be licensed before it could be subject to the NICE approval process. CONCLUSIONS Newspaper coverage of trastuzumab has been characterized by uncritical reporting. Journalists (and consumers) should be more questioning when confronted with information about new drugs and of the motives of those who seek to set the news agenda.
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Affiliation(s)
- Paul M Wilson
- Centre for Reviews and Dissemination, University of York, UK.
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The role of users in innovation in the pharmaceutical industry. Drug Discov Today 2008; 13:353-9. [PMID: 18405849 DOI: 10.1016/j.drudis.2007.12.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 12/19/2007] [Accepted: 12/20/2007] [Indexed: 11/20/2022]
Abstract
Traditionally, innovation in the pharmaceutical industry is organised according to the linear model. Over the past two decades this model lost its meaning as a result of rising costs, increased competition, new scientific developments and better-informed, more demanding users. The linear model is not well equipped to involve these new actors and to include their feedback. Starting from a systemic approach, the involvement of actors in pharmaceutical innovation processes, more in particular users, is put central. It is discussed and illustrated with three cases why a systemic model may be more effective to cope with present developments and why users should be involved. To wind up, conclusions are drawn regarding the implications of a systemic approach for policymakers, researchers and firms.
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External influences and priority-setting for anti-cancer agents: a case study of media coverage in adjuvant trastuzumab for breast cancer. BMC Cancer 2007; 7:110. [PMID: 17598896 PMCID: PMC1925109 DOI: 10.1186/1471-2407-7-110] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 06/28/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Setting priorities for the funding of new anti-cancer agents is becoming increasingly complex. The funding of adjuvant trastuzumab for breast cancer has brought this dilemma to the fore. In this paper we review external factors that may influence decision-making bodies and present a case study of media response in Ontario, Canada to adjuvant trastuzumab for breast cancer. METHODS A comprehensive search of the databases of Canadian national and local newspapers and television was performed. Articles pertaining to trastuzumab in adjuvant breast cancer as well as 17 other anti-cancer drugs and indications were retrieved. The search period was from the date when individual trial results were announced to the date funding was made available in Ontario. RESULTS During the 2.6 months between the release of the trastuzumab results to funding approval in Ontario, we identified 51 episodes of media coverage. For the 17 other drugs/indications (7 breast and 10 non-breast), the median time to funding approval was 31 months (range 14-46). Other recent major advances in oncology such as adjuvant vinorelbine/cisplatin for resected NSCLC and docetaxel for advanced prostate cancer received considerably less media attention (17 media reports for each) than trastuzumab. The median number of media reports for breast cancer drugs was 4.5 compared to 2.5 for non-breast cancer drugs (p = 0.56). CONCLUSION Priority-setting for novel anti-cancer agents is a complex process that tries to ensure fair use of constrained resources to fund therapies with the best evidence of clinical benefit. However, this process is subject to external factors including the influence of media, patient advocates, politicians, and industry. The data in this case study serve to illustrate the significant involvement one (or all) of these external factors may play in the debate over priority-setting.
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Chauhan D, Miners AH, Fischer AJ. Exploration of the difference in results of economic submissions to the National Institute of Clinical Excellence by manufacturers and assessment groups. Int J Technol Assess Health Care 2007; 23:96-100. [PMID: 17234022 DOI: 10.1017/s0266462307051628] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objectives:A recent study showed that estimates of cost-effectiveness submitted to National Institute for Health and Clinical Excellence (NICE) by manufacturers had significantly lower incremental cost-effectiveness ratios (ICERs) than those submitted by university-based Assessment Groups. This study extends that analysis.Methods:Data were abstracted from relevant NICE documentation for thirty-two of eighty-two possible appraisals.Results:The results from the analysis showed that sources of the difference in ICERs appear to be the effectiveness estimates relating to the comparator technology and the cost estimates relating to the technology under evaluation. That is, manufacturers estimated lower average benefits for the comparator technology and lower costs relating to the technology under evaluation compared with estimates submitted by the Assessment Groups.Conclusions:These findings may be particularly important, given the introduction of the “Single Technology Appraisal.” Considerable difficulties were encountered when undertaking this study, highlighting, above all else, the complexity of explaining why results from economic evaluations purporting to answer the same question diverge.
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Affiliation(s)
- Deven Chauhan
- Office of Health Economics, 12 Whitehall, London, UK.
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Gazarian M, Kelly M, McPhee JR, Graudins LV, Ward RL, Campbell TJ. Off‐label use of medicines: consensus recommendations for evaluating appropriateness. Med J Aust 2006; 185:544-8. [PMID: 17115966 DOI: 10.5694/j.1326-5377.2006.tb00689.x] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Accepted: 09/04/2006] [Indexed: 11/17/2022]
Abstract
Off-label prescribing is the prescription of a registered medicine for a use that is not included in the product information. The practice is common, with rates up to 40% in adults and up to 90% in paediatric patients. Off-label prescribing is not illegal and may sometimes be clinically appropriate, but is associated with a number of clinical, safety and ethical issues. To date, no explicit guidance has been available to help clinicians assess appropriateness in off-label prescribing. We describe the development of a guide for clinicians, policymakers and funders of health care in evaluating the appropriateness of medicines proposed for off-label use. Three broad categories of appropriate off-label use are identified:off-label use justified by high-quality evidence; use within the context of a formal research proposal; and exceptional use, justified by individual clinical circumstances. An appropriate process for informed consent is proposed for each category. If there is no high-quality evidence supporting off-label use, and the medicine is not suitable for exceptional or research indications, its use is generally not recommended. This will reduce inappropriate use, enhance patient safety by reducing exposure to unnecessary risk, and may stimulate more clinically relevant medicines research.
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Shuster S. NICE work: nice try. BMJ 2006; 332:1394. [PMID: 16763270 PMCID: PMC1476742 DOI: 10.1136/bmj.332.7554.1394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Minhas R. NICE work: level playing field requires transparency. BMJ 2006; 332:1394. [PMID: 16763269 PMCID: PMC1476771 DOI: 10.1136/bmj.332.7554.1394-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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