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Vogler S, Habimana K, Haasis MA, Fischer S. Pricing, Procurement and Reimbursement Policies for Incentivizing Market Entry of Novel Antibiotics and Diagnostics: Learnings from 10 Countries Globally. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:629-652. [PMID: 38837100 DOI: 10.1007/s40258-024-00888-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Fostering market entry of novel antibiotics and enhanced use of diagnostics to improve the quality of antibiotic prescribing are avenues to tackle antimicrobial resistance (AMR), which is a major public health threat. Pricing, procurement and reimbursement policies may work as AMR 'pull incentives' to support these objectives. This paper studies pull incentives in pricing, procurement and reimbursement policies (e.g., additions to, modifications of, and exemptions from standard policies) for novel antibiotics, diagnostics and health products with a similar profile in 10 study countries. It also explores whether incentives for non-AMR health products could be transferred to AMR health products. METHODS This research included a review of policies in 10 G20 countries based on literature and unpublished documents, and the production of country fact sheets that were validated by country experts. Initial research was conducted in 2020 and updated in 2023. RESULTS Identified pull incentives in pricing policies include free pricing, higher prices at launch and price increases over time, managed-entry agreements, and waiving or reducing mandatory discounts. Incentives in procurement comprise value-based procurement, pooled procurement and models that delink prices from volumes (subscription-based schemes), whereas incentives in reimbursement include lower evidence requirements for inclusion in the reimbursement scheme, accelerated reimbursement processes, separate budgets that offer add-on funding, and adapted prescribing conditions. CONCLUSIONS While a few pull incentives have been piloted or implemented for antibiotics in recent years, these mechanisms have been mainly used to incentivize launch of certain non-AMR health products, such as orphan medicines. Given similarities in their product characteristics, transferability of some of these pull incentives appears to be possible; however, it would be essential to conduct impact assessments of these incentives. Trade-offs between incentives to foster market entry and thus potentially improve access and the financial sustainability for payers need to be addressed.
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Affiliation(s)
- Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich (GÖG/Austrian National Public Health Institute), 1010, Vienna, Austria.
- Department of Health Care Management, Technische Universität Berlin, 10623, Berlin, Germany.
| | - Katharina Habimana
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich (GÖG/Austrian National Public Health Institute), 1010, Vienna, Austria
| | - Manuel Alexander Haasis
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich (GÖG/Austrian National Public Health Institute), 1010, Vienna, Austria
| | - Stefan Fischer
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich (GÖG/Austrian National Public Health Institute), 1010, Vienna, Austria
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Schmidt AJ, Weatherburn P, Wang H, Lutz T, Schewe K, Mauss S, Krznaric I, Baumgarten A, Boesecke C, Rockstroh JK, Christensen S, Ingiliz P. Still trouble with bleeding: Risk factors for HCV transmission in men who have sex with men and behavioural trajectories from 2019 to 2021. HIV Med 2024; 25:976-989. [PMID: 38803112 DOI: 10.1111/hiv.13657] [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: 01/02/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES To identify sexual/sex-associated risk factors for hepatitis C transmission among men who have sex with men (MSM) and visualise behavioural trajectories from 2019 to 2021. METHODS We linked a behavioural survey to a hepatitis C cohort study (NoCo), established in 2019 across six German HIV/hepatitis C virus (HCV) treatment centres, and performed a case-control analysis. Cases were MSM with recent HCV infection, and controls were matched for HIV status (model 1) or proportions of sexual partners with HIV (model 2). We conducted conditional univariable and multivariable regression analyses. RESULTS In all, 197 cases and 314 controls completed the baseline questionnaire and could be matched with clinical data. For regression models, we restricted cases to those with HCV diagnosed since 2018 (N = 100). Factors independently associated with case status included sex-associated rectal bleeding, shared fisting lubricant, anal douching, chemsex, intravenous and intracavernosal injections, with population-attributable fractions of 88% (model 1) and 85% (model 2). These factors remained stable over time among cases, while sexual partner numbers and group sex decreased during COVID-19 measures. CONCLUSIONS Sexual/sex-associated practices leading to blood exposure are key factors in HCV transmission in MSM. Public health interventions should emphasize the importance of blood safety in sexual encounters. Micro-elimination efforts were temporarily aided by reduced opportunities for sexual encounters during the COVID-19 pandemic.
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Affiliation(s)
- Axel Jeremias Schmidt
- Sigma Research, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Weatherburn
- Sigma Research, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Haoyi Wang
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | | | | | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | | | | | - Christoph Boesecke
- Department of Medicine I, University of Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), partner-site Bonn, Bonn, Germany
| | - Jürgen K Rockstroh
- Department of Medicine I, University of Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), partner-site Bonn, Bonn, Germany
| | - Stefan Christensen
- Center for Infectious Diseases, Münster, Germany
- Department of Gastroenterology and Hepatology, University Hospital, Münster, Germany
| | - Patrick Ingiliz
- Center for Infectiology, Berlin, Germany
- Hepatology Department, Henri Mondor Hospital, INSERM U955, Créteil, France
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Miyazaki M, Tachibana Y, Ueda A, Akashi T, Kotoh K. High prevalence of hepatitis C virus among criminals in rehabilitation facilities in Japan. J Infect Chemother 2024:S1341-321X(24)00141-7. [PMID: 38821445 DOI: 10.1016/j.jiac.2024.05.009] [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: 02/29/2024] [Revised: 05/17/2024] [Accepted: 05/27/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVE There is a high prevalence of hepatitis C virus (HCV) carriers in prison in several developed countries, but the situation in Japan has not been well reported. This study aimed to determine the state of HCV infection among criminals in Japan. METHODS We enrolled 533 criminals in rehabilitation facilities (354 men and 179 women) who underwent a medical check-up from April 2014 to March 2022. Their records of blood tests, medical history, and drug injection use were retrospectively analyzed. RESULTS The HCV-antibody positive rate was 11.1 % (59/533), with rates of 8.2 % (29/354) in men and 16.8 % (30/179 in women. Approximately half of the HCV-infected residents had a history of drug injection, and this rate did not vary by age or by sex. Although an opportunity to treat HCV infection with medical assistance from government was provided to all residents who were positive for HCV RNA, 26.5 % of them abandoned the treatment. CONCLUSION In spite of the generous economical support to treat HCV infection by the government and the free access system in Japan, eliminating HCV in criminals appears to be difficult. The reason for this problem might be the criminals' negligent attitude to life.
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Affiliation(s)
- Masayuki Miyazaki
- Department of Hepato-biliary-pancreatic Medicine, Saiseikai Fukuoka General Hospital, Fukuoka, Japan.
| | - Yuichi Tachibana
- Department of Hepato-biliary-pancreatic Medicine, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Akihiro Ueda
- Department of Hepato-biliary-pancreatic Medicine, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Tetsuro Akashi
- Department of Hepato-biliary-pancreatic Medicine, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Kazuhiro Kotoh
- Department of Hepato-biliary-pancreatic Medicine, Hara Sanshin Hospital, Fkuoka, Japan
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De Greve H, Fioravanti A. Single domain antibodies from camelids in the treatment of microbial infections. Front Immunol 2024; 15:1334829. [PMID: 38827746 PMCID: PMC11140111 DOI: 10.3389/fimmu.2024.1334829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/29/2024] [Indexed: 06/04/2024] Open
Abstract
Infectious diseases continue to pose significant global health challenges. In addition to the enduring burdens of ailments like malaria and HIV, the emergence of nosocomial outbreaks driven by antibiotic-resistant pathogens underscores the ongoing threats. Furthermore, recent infectious disease crises, exemplified by the Ebola and SARS-CoV-2 outbreaks, have intensified the pursuit of more effective and efficient diagnostic and therapeutic solutions. Among the promising options, antibodies have garnered significant attention due to their favorable structural characteristics and versatile applications. Notably, nanobodies (Nbs), the smallest functional single-domain antibodies of heavy-chain only antibodies produced by camelids, exhibit remarkable capabilities in stable antigen binding. They offer unique advantages such as ease of expression and modification and enhanced stability, as well as improved hydrophilicity compared to conventional antibody fragments (antigen-binding fragments (Fab) or single-chain variable fragments (scFv)) that can aggregate due to their low solubility. Nanobodies directly target antigen epitopes or can be engineered into multivalent Nbs and Nb-fusion proteins, expanding their therapeutic potential. This review is dedicated to charting the progress in Nb research, particularly those derived from camelids, and highlighting their diverse applications in treating infectious diseases, spanning both human and animal contexts.
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Affiliation(s)
- Henri De Greve
- Structural Biology Brussels, Vrije Universiteit Brussel, Brussels, Belgium
| | - Antonella Fioravanti
- Structural Biology Brussels, Vrije Universiteit Brussel, Brussels, Belgium
- VIB-VUB Center for Structural Biology, Vrije Universiteit Brussel, Brussels, Belgium
- Fondazione ParSeC – Parco delle Scienze e della Cultura, Prato, Italy
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Ezzat S, Gamkrelidze I, Osman A, Gomaa A, Roushdy A, Esmat G, Razavi H, Blach S, Abdel-Razek W, El-Akel W, Waked I. Impacts of the Egyptian national screening and treatment programme for viral hepatitis C: A cost-effectiveness model. Liver Int 2023; 43:1417-1426. [PMID: 37073160 DOI: 10.1111/liv.15584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/20/2023] [Accepted: 04/03/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND & AIMS Egypt used to have one of the highest prevalences of HCV infection worldwide. The Egyptian Ministry of Health launched a national campaign for the detection and management of HCV to reduce its burden. This study aims to carry out a cost-effectiveness analysis to evaluate the costs and benefits of the Egyptian national screening and treatment programme. METHODS A disease burden and economic impact model was populated with the Egyptian national screening and treatment programme data to assess direct medical costs, health effects measured in disability-adjusted life years and the incremental cost-effectiveness ratio. The scenario was compared to a historical base case, which assumed that no programme had been conducted. RESULTS Total number of viremic cases is expected to decrease in 2030 by 86% under the national screening and treatment programme, versus by 41% under the historical base case. Annual discounted direct medical costs are expected to decrease from $178 million in 2018 to $81 million by 2030 under the historical base case, while annual direct medical costs are estimated to have peaked in 2019 at $312 million before declining to $55 million by 2030 under the national screening and treatment programme. Under the programme, annual disability-adjusted life years are expected to decline to 127 647 by 2030, leading to 883 333 cumulative disability-adjusted life years averted over 2018-2030. CONCLUSIONS The national screening and treatment programme is highly cost-effective by the year 2021, cost-saving by 2029 and expected to save about $35 million in direct costs and $4705 million in indirect costs by 2030.
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Affiliation(s)
- Sameera Ezzat
- Epidemiology and Preventive Medicine Department, National Liver Institute, Shibin El Kom, Egypt
| | | | - Alaa Osman
- Epidemiology and Preventive Medicine Department, National Liver Institute, Shibin El Kom, Egypt
| | - Asmaa Gomaa
- Hepatology, National Liver Institute, Shibin El Kom, Egypt
| | - Ayat Roushdy
- Epidemiology and Preventive Medicine Department, National Liver Institute, Shibin El Kom, Egypt
- Family and Community Medicine Department, College of Medicine, Taibah University, Medina, Saudi Arabia
| | - Gamal Esmat
- Endemic Medicine Department, Cairo University Hospitals, Cairo, Egypt
| | - Homie Razavi
- Center for Disease Analysis Foundation, Lafayette, USA
| | - Sarah Blach
- Center for Disease Analysis Foundation, Lafayette, USA
| | | | - Wafaa El-Akel
- Hepatology and Endemic Medicine, Cairo University, Cairo, Egypt
| | - Imam Waked
- Hepatology, National Liver Institute, Shibin El Kom, Egypt
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Genowska A, Zarębska-Michaluk D, Strukcinskiene B, Razbadauskas A, Moniuszko-Malinowska A, Jurgaitis J, Flisiak R. Changing Epidemiological Patterns of Infection and Mortality Due to Hepatitis C Virus in Poland. J Clin Med 2023; 12:3922. [PMID: 37373617 DOI: 10.3390/jcm12123922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/10/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Limited information is available on trends in hepatitis C virus (HCV) infection, particularly in Central Europe. To address this knowledge gap, we analyzed HCV epidemiology in Poland, considering socio-demographic characteristics, changing patterns over time, and the impact of the COVID-19 pandemic. MATERIAL AND METHODS We examined HCV cases (diagnosis and deaths) reported by national registries and used joinpoint analysis to estimate time trajectories. RESULTS Between 2009 and 2021, there were changes in the trends of HCV, shifting from positive to negative in Poland. Among men, there was a significant increase initially in diagnosis rate of HCV in rural areas (annual percent change, APC2009-2016 +11.50%) and urban areas (APC2009-2016 +11.44%) by 2016. In subsequent years until 2019, the trend changed direction, but the reduction was weak (Ptrend > 0.05) in rural areas (-8.66%) and urban areas (-13.63%). During the COVID-19 pandemic, the diagnosis rate of HCV dramatically decreased in rural areas (APC2019-2021 -41.47%) and urban areas (APC2019-2021 -40.88%). Among women, changes in the diagnosis rate of HCV were less pronounced. In rural areas, there was a significant increase (APC2009-2015 +20.53%) followed by no significant change, whereas changes occurred later in urban areas (APC2017-2021 -33.58%). Trend changes in total mortality due to HCV were mainly among men, with a significant decrease in rural (-17.17%) and urban (-21.55%) areas from 2014/2015. CONCLUSIONS The COVID-19 pandemic reduced HCV diagnosis rates in Poland, especially for diagnosed cases. However, further monitoring of HCV trends is necessary, along with national screening programs and improved linkage to care.
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Affiliation(s)
- Agnieszka Genowska
- Department of Public Health, Medical University of Bialystok, 15-295 Bialystok, Poland
| | - Dorota Zarębska-Michaluk
- Department of Infectious Diseases and Allergology, Jan Kochanowski University, 25-317 Kielce, Poland
| | | | | | - Anna Moniuszko-Malinowska
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, 15-540 Bialystok, Poland
| | - Jonas Jurgaitis
- Faculty of Health Sciences, Klaipeda University, LT-92294 Klaipeda, Lithuania
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok, 15-540 Bialystok, Poland
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Woolley AE, Gandhi AR, Jones ML, Kim JJ, Mallidi HR, Givertz MM, Baden LR, Mehra MR, Neilan AAM. The Cost-effectiveness of Transplanting Hearts From Hepatitis C-infected Donors Into Uninfected Recipients. Transplantation 2023; 107:961-969. [PMID: 36525554 PMCID: PMC10065819 DOI: 10.1097/tp.0000000000004378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/29/2022] [Accepted: 08/13/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The DONATE HCV trial demonstrated the safety and efficacy of transplanting hearts from hepatitis C viremic (HCV+) donors. In this report, we examine the cost-effectiveness and impact of universal HCV+ heart donor eligibility in the United States on transplant waitlist time and life expectancy. METHODS We developed a microsimulation model to compare 2 waitlist strategies for heart transplant candidates in 2018: (1) status quo (SQ) and (2) SQ plus HCV+ donors (SQ + HCV). From the DONATE HCV trial and published national datasets, we modeled mean age (53 years), male sex (75%), probabilities of waitlist mortality (0.01-0.10/month) and transplant (0.03-0.21/month) stratified by medical urgency, and posttransplant mortality (0.003-0.052/month). We assumed a 23% increase in transplant volume with SQ + HCV compared with SQ. Costs (2018 United States dollar) included waitlist care ($2200-190 000/month), transplant ($213 400), 4-wk HCV treatment ($26 000), and posttransplant care ($2500-11 300/month). We projected waitlist time, quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs [$/QALY, discounted 3%/year]; threshold ≤$100 000/QALY). RESULTS Compared with SQ, SQ + HCV decreased waitlist time from 8.7 to 6.7 months, increased undiscounted life expectancy from 8.9 to 9.2 QALYs, and increased discounted lifetime costs from $671 400/person to $690 000/person. Four-week HCV treatment comprised 0.5% of lifetime costs. The ICER of SQ + HCV compared with SQ was $74 100/QALY and remained ≤$100 000/QALY with up to 30% increases in transplant and posttransplant costs. CONCLUSIONS Transplanting hearts from HCV-infected donors could decrease waitlist times, increase life expectancy, and be cost-effective. These findings were robust within the context of current high HCV treatment costs.
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Affiliation(s)
- Ann E Woolley
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Aditya R Gandhi
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA
| | - Michelle L Jones
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA
| | - Jane J Kim
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Hari R Mallidi
- Harvard Medical School, Boston, MA
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Michael M Givertz
- Harvard Medical School, Boston, MA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Lindsey R Baden
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Mandeep R Mehra
- Harvard Medical School, Boston, MA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - And Anne M Neilan
- Harvard Medical School, Boston, MA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
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Tskhomelidze I, Shadaker S, Kuchuloria T, Gvinjilia L, Butsashvili M, Nasrullah M, Gabunia T, Gamkrelidze A, Getia V, Sharvadze L, Tsertsvadze T, Zarqua J, Tsanava S, Handanagic S, Armstrong PA, Averhoff F, Vickerman P, Walker JG. Economic evaluation of the Hepatitis C virus elimination program in the country of Georgia, 2015 to 2017. Liver Int 2023; 43:558-568. [PMID: 36129625 PMCID: PMC10227952 DOI: 10.1111/liv.15431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/02/2022] [Accepted: 09/20/2022] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND AIMS In 2015, the country of Georgia launched an elimination program aiming to reduce the prevalence of Hepatitis C virus (HCV) infection by 90% from 5.4% prevalence (~150 000 people). During the first 2.5 years of the program, 770 832 people were screened, 48 575 were diagnosed with active HCV infection, and 41 483 patients were treated with direct-acting antiviral (DAA)-based regimens, with a >95% cure rate. METHODS We modelled the incremental cost-effectiveness ratio (ICER) of HCV screening, diagnosis and treatment between April 2015 and November 2017 compared to no treatment, in terms of cost per quality-adjusted life year (QALY) gained in 2017 US dollars, with a 3% discount rate over 25 years. We compared the ICER to willingness-to-pay (WTP) thresholds of US$4357 (GDP) and US$871 (opportunity cost) per QALY gained. RESULTS The average cost of screening, HCV viremia testing, and treatment per patient treated was $386 to the provider, $225 to the patient and $1042 for generic DAAs. At 3% discount, 0.57 QALYs were gained per patient treated. The ICER from the perspective of the provider including generic DAAs was $2285 per QALY gained, which is cost-effective at the $4357 WTP threshold, while if patient costs are included, it is just above the threshold at $4398/QALY. All other scenarios examined in sensitivity analyses remain cost-effective except for assuming a shorter time horizon to the end of 2025 or including the list price DAA cost. Reducing or excluding DAA costs reduced the ICER below the opportunity-cost WTP threshold. CONCLUSIONS The Georgian HCV elimination program provides valuable evidence that national programs for scaling up HCV screening and treatment for achieving HCV elimination can be cost-effective.
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Affiliation(s)
- Irina Tskhomelidze
- Task Force for Global Health, Tbilisi, Georgia
- Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Shaun Shadaker
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, USA
| | | | | | | | - Muazzam Nasrullah
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, USA
| | - Tamar Gabunia
- Ministry of Internally Displaced Persons from the Occupied Territories, Labour Health and Social Affairs of Georgia, Tbilisi, Georgia
| | | | - Vladimer Getia
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | | | - Shota Tsanava
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Senad Handanagic
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, USA
| | - Paige A. Armstrong
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, USA
| | - Francisco Averhoff
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, USA
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
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Liu Y, Gou L, Guo Z, Wu Z, He Q, Feng H, Hu M. Evaluation of the implementation effect of hepatitis C medical insurance reimbursement policy in China: A RWS based on medical institutions. Front Public Health 2023; 10:1072493. [PMID: 36711333 PMCID: PMC9875004 DOI: 10.3389/fpubh.2022.1072493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
Objectives To evaluate the implementation effect of hepatitis C medical insurance reimbursement policy in China from the view of medical institutions. Methods The electronic medical record of a top tertiary hospital in Chengdu from January 2014 to December 2020 were extracted, and the interrupted time series model was used to analyze the changes in diagnosis and treatment behavior and disease burden of hepatitis C patients after the implementation of HCV insurance reimbursement policy. Results In terms of diagnosis and treatment, the number of visits (β2 = 19.290, P < 0.001) and treatments (β2 = 14.291, P < 0.01) increased instantaneously after the implementation of the outpatient reimbursement policy in Chengdu in 2018, and there was no significant change after the implementation of the single line payment policy for oral direct antiviral (DAA) drugs in 2019 (P > 0.05); in terms of medical expenses, the total treatment cost (β2 = 21439.3, P < 0.001), out-of-pocket expenses (β2 = 6109.44, P < 0.001) and drug expenses (β2 = 21889.8, P < 0.001) of hepatitis C patients have been significantly reduced after the implementation of the single-line payment policy. Conclusion Hepatitis C medical insurance reimbursement policy can promote hepatitis C patients to actively seek medical treatment, promote the widespread use of DAA scheme, reduce the burden of patients, and improve the treatment efficiency of hepatitis C.
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Affiliation(s)
- Yiyao Liu
- West China School of Pharmacy, Sichuan University, Chengdu, China,West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Liangwen Gou
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Zhaoting Guo
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Zhiang Wu
- Yeehong Business School, Shenyang Pharmaceutical University, Beijing, China
| | - Qin He
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Haihuan Feng
- Medical Insurance Office, West China Hospital of Sichuan University, Chengdu, China,Haihuan Feng ✉
| | - Ming Hu
- West China School of Pharmacy, Sichuan University, Chengdu, China,*Correspondence: Ming Hu ✉
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Dahham J, Kremer I, Hiligsmann M, Hamdan K, Nassereddine A, Evers SMAA, Rizk R. Valuation of Costs in Health Economics During Financial and Economic Crises: A Case Study from Lebanon. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:31-38. [PMID: 36287378 PMCID: PMC9596339 DOI: 10.1007/s40258-022-00769-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 05/21/2023]
Abstract
In 2019, we embarked on a study on the economic burden of multiple sclerosis (MS) in Lebanon, in collaboration with a premier Lebanese MS center. This coincided with a triple disaster in Lebanon, comprising the drastic economic and financial crisis, the COVID-19 pandemic, and the consequences of the explosion of Beirut's port. Specifically, the economic and financial turmoil made the valuation of costs challenging. Researchers could face similar challenges, particularly in low- and middle-income countries (LMICs) where economic crises and recessions are recurrent phenomena. This paper aims to discuss steps taken to overcome the fluctuation of the prices of resources to get a valid valuation of societal costs during times of a financial and economic crisis. In the absence of local costing data and guidelines for conducting cost-of-illness (COI) studies, this paper provides empirical recommendations on the valuation of costs that are particularly relevant in LMICs. We recommend (1) clear reporting and justification of the country-specific context, year of costing, assumptions, data sources, and valuation methods, as well as the indicators used to adjust cost for inflation during different periods of fluctuation of prices; (2) collecting prices of each resource from multiple and various sources; (3) conducting a sensitivity analysis; and (4) reporting costs in local currency and Purchasing Power Parity dollars (PPP$). Precision and transparency in reporting prices of resources and their sources are markers of the reliability of the COI studies.
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Affiliation(s)
- Jalal Dahham
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Ingrid Kremer
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Kamal Hamdan
- Consultation and Research Institute, Beirut, Lebanon
| | | | - Silvia M. A. A. Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
- Centre for Economic Evaluations and Machine Learning, Trimbos Institute, Utrecht, The Netherlands
| | - Rana Rizk
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Byblos, Lebanon
- Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie (INSPECT-Lb), Beirut, Lebanon
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11
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Azzeri A, Dahlui M, Mohamed R, McDonald SA, Jaafar H, Shabaruddin FH. Budget impact analysis of two treatment approaches for hepatitis C in Malaysia through the use of voluntary and compulsory licensing options. Front Public Health 2023; 11:1114560. [PMID: 36935675 PMCID: PMC10015636 DOI: 10.3389/fpubh.2023.1114560] [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: 12/02/2022] [Accepted: 02/03/2023] [Indexed: 02/24/2023] Open
Abstract
Introduction A scaled-up treatment cascade with direct-acting antiviral (DAA) therapy is necessary to achieve global WHO targets for hepatitis C virus (HCV) elimination in Malaysia. Recently, limited access to sofosbuvir/daclatasvir (SOF/DAC) is available through compulsory licensing, with access to sofosbuvir/velpatasvir (SOF/VEL) expected through voluntary licensing due to recent agreements. SOF/VEL has superior clinical outcomes but has higher drug acquisition costs compared to SOF/DAC. A stratified treatment cascade might be the most cost-efficient approach for Malaysia whereby all HCV patients are treated with SOF/DAC except for patients with cirrhosis who are treated with SOF/VEL. Methods This study aimed to conduct a 5-year budget impact analysis of the proposed stratified treatment cascade for HCV treatment in Malaysia. A disease progression model that was developed based on model-predicted HCV epidemiology data was used for the analysis, where all HCV patients in scenario A were treated with SOF/DAC for all disease stages while in scenario B, SOF/DAC was used only for non-cirrhotic patients and SOF/VEL was used for the cirrhotic patients. Healthcare costs associated with DAA therapy and disease stage monitoring were included to estimate the downstream cost implications. Results The stratified treatment cascade with 109 in Scenario B was found to be cost-saving compared to Scenario A. The cumulative savings for the stratified treatment cascade was USD 1.4 million over 5 years. Discussion A stratified treatment cascade with SOF/VEL was expected to be cost-saving and can result in a budget impact reduction in overall healthcare expenditure in Malaysia.
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Affiliation(s)
- Amirah Azzeri
- Public Health Unit, Department of Primary Health Care, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Negeri Sembilan, Malaysia
- Department of Research, Development and Innovation, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Maznah Dahlui
- Department of Research, Development and Innovation, University Malaya Medical Centre, Kuala Lumpur, Malaysia
- Centre of Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Rosmawati Mohamed
- Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Scott Alexander McDonald
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Hafiz Jaafar
- Public Health Unit, Department of Primary Health Care, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Negeri Sembilan, Malaysia
| | - Fatiha Hana Shabaruddin
- Faculty of Pharmacy, University Malaya, Kuala Lumpur, Malaysia
- *Correspondence: Fatiha Hana Shabaruddin
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12
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Abdulla M, Al Ghareeb AM, Husain HAHY, Mohammed N, Al Qamish J. Effectiveness and safety of generic and brand direct acting antivirals for treatment of chronic hepatitis C. World J Clin Cases 2022; 10:12566-12577. [PMID: 36579085 PMCID: PMC9791528 DOI: 10.12998/wjcc.v10.i34.12566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/28/2022] [Accepted: 11/08/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Direct acting antivirals (DAAs) are a very effective treatment for hepatitis C virus (HCV). However, brand DAAs are expensive. The licensing of cheaper generic DAAs may address this issue, but there is a lack of clinical studies comparing the efficacy of generic vs brand DAA formulations.
AIM To compare the efficacy and safety of generic against brand DAAs for chronic hepatitis C treatment in Bahrain.
METHODS This was a retrospective observational study involving 289 patients with chronic HCV infection during 2016 to 2018. There were 149 patients who were treated with brand DAAs, while 140 patients were treated with generic DAAs. Commonly used DAAs were Ombitasvir/Paritaprevir/Ritonavir ± Dasabuvir ± Ribavirin, and Sofosbuvir/Daclatasvir ± Ribavirin. SVR at 12 wk post treatment was the main outcome variable.
RESULTS Overall, 87 patients (30.1%) had cirrhosis and 68.2% had genotype 1 HCV infection. At 12 wk post treatment, SVR was achieved by 271 (93.8%) of the patients. In patients who were treated with generic medications, 134 (95.7%) achieved SVR at 12 wk post treatment, compared to 137 (91.9%) among those treated with brand medications (P = 0.19). Having cirrhosis [odds ratio (OR): 9.41, 95% confidence interval (CI): 2.47–35.84] and having HCV genotype 3 (OR: 3.56, 95%CI: 1.03–12.38) were significant independent predictors of not achieving SVR. Alanine transaminase, gamma-glutamyl transpeptidase, and total bilirubin levels decreased significantly following therapy with both generic and brand DAAs.
CONCLUSION Generic and brand DAAs demonstrate comparable effectiveness in the treatment of chronic hepatitis C patients. Both are safe and equally effective in improving biochemical markers of hepatic inflammation.
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Affiliation(s)
- Maheeba Abdulla
- Department of Internal Medicine, Salmaniya Medical Complex, Arabian Gulf University, Manama 2904, Bahrain
| | | | | | - Nafeesa Mohammed
- Department of Internal Medicine, Salmaniya Medical Complex, Manama 2904, Bahrain
| | - Jehad Al Qamish
- Internal Medicine Department, Ibn AlNafees Hospital, Manama 3302, Bahrain
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13
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Kokabisaghi F, Hashemi-Meshkini A, Obewal A, Ghavami V, Javan-Noughabi J, Shabanikiya H, Varmaghani M, Moghri J. Availability and affordability of cardiovascular medicines in a major city of Afghanistan in 2020. Daru 2022; 30:343-350. [PMID: 36385235 PMCID: PMC9715895 DOI: 10.1007/s40199-022-00454-8] [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: 03/15/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Affordable access to quality medicines is a critical target of global efforts to achieve universal health coverage. The aim of this study is to measure the affordability and accessibility of cardiovascular medicines in the city of Herat, Afghanistan. METHODS The price, affordability, and availability data for 18 most sold generic (MSG) and lowest priced generic (LPG) products were collected from public and private pharmacies located in Herat city in Afghanistan in 2020, which in each area, six pharmacies were randomly selected from a combination of public and private ones based on the standardized methodology developed by WHO/HAI. According to this methodology on Medicine Prices, Accessibility, and Affordability, the minimum daily wage of an unskilled governmental worker, and the price of each type of cardiovascular medicines for one-month use were calculated separately. If the cost of the treatment was more than the minimum daily wage, the medicine was considered unaffordable. RESULTS The mean availability score for lowest price generic (LPG) in public and private pharmacies and based on the countries of origin including Iran, Pakistan, and India was 60%, 46%, and 31%, respectively. Of the 18 medicines surveyed, just Atenolol (Iranian brand) was found in all 30 pharmacies on the day of data collection. All Indian- brand medicines were less than fifty percent available in any of the surveyed public and private pharmacies. Among the medicines exported to Afghanistan, the population of Herat used more medicines made by Pakistan compared to India and Iran (MSG). Indian medicines were the most expensive ones and the Iranian medicines were the cheapest. A wage of less than one day was enough to afford one-month supply of generic medicines at the lowest price. CONCLUSION Access of patients to cardiovascular medicines in Afghanistan was 46% in this study which is regarded as low access. Most of available cardiovascular medicines in the market of this country were made in Iran, Pakistan and India. Although the Iranian ones were the cheapest, but people used more Pakistani medicines. LPG products were affordable to the studied population.
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Affiliation(s)
- Fatemeh Kokabisaghi
- Department of Management Sciences and Health Economics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Hashemi-Meshkini
- Department of Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Sciences, Tehran, Iran
| | - Asaad Obewal
- Department of Management Sciences and Health Economics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vahid Ghavami
- Department of Epidemiology and Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Javan-Noughabi
- Department of Management Sciences and Health Economics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamidreza Shabanikiya
- Department of Management Sciences and Health Economics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Varmaghani
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Javad Moghri
- Department of Management Sciences and Health Economics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
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14
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Scheijmans FEV, Zomers ML, Fadaei S, Onrust MR, van der Graaf R, Delden JJMV, van der Pol WL, van Thiel GJMW. The reimbursement for expensive medicines: stakeholder perspectives on the SMA medicine nusinersen and the Dutch Coverage Lock policy. BMC Health Serv Res 2022; 22:1320. [PMID: 36333803 PMCID: PMC9636634 DOI: 10.1186/s12913-022-08690-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/25/2022] [Indexed: 11/06/2022] Open
Abstract
Background The reimbursement for expensive medicines poses a growing challenge to healthcare worldwide. In order to increase its control over the costs of medicines, the Dutch government introduced the Coverage Lock (CL) policy in 2015. The CL postpones decisions regarding reimbursement of expensive medicines until detailed advice on i.e., cost-effectiveness has been given. The CL has been in place for six years, has raised many questions and concerns, but currently, no evaluation is known to the authors. A better understanding of the effects of the CL on all stakeholders involved may contribute to reflections on the CL process and help find ways to improve it. An evaluation of Dutch policy will also be relevant for other countries that aim to optimize reimbursement procedures for expensive treatments. To perform this evaluation, we focused on the CL procedure for the medicine nusinersen. Nusinersen is the first treatment for spinal muscular atrophy (SMA). Following EMA approval in May 2017, it was placed in the CL. The analysis of cost-effectiveness and added therapeutic value resulted in an advice for reimbursement limited to children younger than 9.5 years at the start of treatment; this was implemented from August 2018 onwards. Methods Qualitative stakeholder perspective analysis of the CL procedure focusing on nusinersen with 15 stakeholders. Results Stakeholders raised key issues of the CL based on their experience with nusinersen: emotional impact of the CL, duration of the CL procedure, appropriateness of the CL procedure for different types of medicines, transparency of the CL, a wish for patient-centred decision-making and the lack of uniformity of access to expensive treatments. Discussion Stakeholders supported measures to control healthcare expenses and to ensure reasonable pricing. They considered the delay in access to therapies and lack of procedural transparency to be the main challenges to the CL. Stakeholders also agreed that the interests of patients deserve more attention in the practical implementation of the reimbursement decision. Stakeholders suggested a number of adjustments to improve the CL, such as a faster start with conditional reimbursement programs to ensure access and intensify European collaboration to speed up the assessment of the medicine. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08690-z.
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15
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Vogler S. Prices of new medicines: International analysis and policy options. ZEITSCHRIFT FÜR EVIDENZ, FORTBILDUNG UND QUALITÄT IM GESUNDHEITSWESEN 2022; 175:96-102. [DOI: 10.1016/j.zefq.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/16/2022] [Indexed: 11/12/2022]
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16
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Karmarkar T, Rodriguez-Watson CV, Watson E, Zheng H, Gaskin DJ, Padula WV. Value of Triage Treatment Strategies to Distribute Hepatitis C Direct-Acting Antiviral Agents in an Integrated Healthcare System: A Cost-Effectiveness Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1499-1509. [PMID: 35484030 DOI: 10.1016/j.jval.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/11/2022] [Accepted: 03/06/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to assess the cost-effectiveness of fibrosis-based direct-acting antiviral treatment policies for patients with chronic hepatitis C virus at the Kaiser Permanente Mid-Atlantic States health system. METHODS We used a Markov model to compare the lifetime costs and effects of treating patients with chronic hepatitis C virus at different stages of disease severity, or all stages simultaneously, based on a fibrosis score from the US healthcare sector perspective and societal perspective. The initial distribution of patients across fibrosis scores, the effectiveness of direct-acting antiviral therapy, and follow-up and monitoring protocols were specific to the Kaiser Permanente Mid-Atlantic States health system. Direct and indirect costs, transition probabilities, and utilities were derived from the literature. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of our results. RESULTS The "Treat All" option was dominant from both the societal and healthcare sector perspectives. The conclusion was robust in deterministic sensitivity analysis. The range of incremental costs between the less restrictive policies was small-the difference between the "Treat F1+" and the "Treat All" option was only $111 per person. Probabilistic sensitivity analyses showed, at both the $100 000/quality-adjusted life-year and $150 000/quality-adjusted life-year thresholds, there was a 70% chance that the "Treat All" option was more cost-effective than the "Treat F1+" option. CONCLUSIONS We found that expanded treatment access is cost-effective and, in many cases, cost saving. Although our results are primarily applicable to a regional integrated healthcare system, it offers some direction to any healthcare setting faced with resource constraints in the face of highly priced drugs.
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Affiliation(s)
- Taruja Karmarkar
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carla V Rodriguez-Watson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; The Reagan-Udall Foundation for the Food and Drug Administration, Washington, DC, USA
| | - Eric Watson
- Research Data Analytics, Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
| | - Hanke Zheng
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA
| | - Darrell J Gaskin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - William V Padula
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA; The Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA.
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17
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Country versus pharmaceutical company interests for hepatitis C treatment. Health Care Manag Sci 2022; 25:725-749. [PMID: 36001218 PMCID: PMC9399601 DOI: 10.1007/s10729-022-09607-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 07/06/2022] [Indexed: 11/04/2022]
Abstract
Hepatitis C virus (HCV) is one of the leading causes of liver disease and is responsible for massive health and economic burden worldwide. The disease is asymptomatic in its early stages, but it can progress over time to fatal end-stage liver disease. Thus, the majority of individuals infected with HCV are unaware of their chronic condition. Recent treatment options for HCV can completely cure the infection but are costly. We developed a game model between a pharmaceutical company (PC) and a country striving to maximize its citizens' utility. First, the PC determines the price of HCV treatment; then, the country responds with corresponding screening and treatment strategies. We employed an analytical framework to calculate the utility of the players for each selected strategy. Calibrated to detailed HCV data from Israel, we found that the PC will gain higher revenue by offering a quantity discount rather than using standard fixed pricing per treatment, by indirectly forcing the country to conduct more screening than it desired. By contrast, risk-sharing agreements, in which the country pays only for successful treatments are beneficial for the country. Our findings underscore that policy makers worldwide should prudently consider recent offers by PCs to increase screening either directly, via covering HCV screening, or indirectly, by providing discounts following a predetermined volume of sales. More broadly, our approach is applicable in other healthcare settings where screening is essential to determine treatment strategies.
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Prinja S, Kumar S, Sharma A, Kar SS, Tripathi N, Dumka N, Sharma S, Mukhopadhyay I, Rana SK, Garg S, Kotwal A, Aggarwal AK. What is the Out-of-Pocket Expenditure on Medicines in India? An Empirical Assessment using a Novel Methodology. Health Policy Plan 2022; 37:1116-1128. [PMID: 35862250 DOI: 10.1093/heapol/czac057] [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: 08/05/2021] [Revised: 07/09/2022] [Accepted: 07/20/2022] [Indexed: 11/14/2022] Open
Abstract
The share of expenditure on medicines as part of the total out-of-pocket (OOP) expenditure on healthcare services has been reported to be much higher in India than in other countries. This study was conducted to ascertain the extent of this share of medicines expenditure using a novel methodology. OOP expenditure data were collected through exit-interviews with 5252 out-patient department (OPD) patients in three states of India. Follow-up interviews were conducted after day 1 and 15 of the baseline to identify any additional expenditure incurred. In addition, medicine prescription data were collected from the patients through prescription audits. Self-reported expenditure on medicines was compared with the amount imputed using local market prices based on prescription data. The results were also compared with the mean expenditure on medicines per spell of ailment among non-hospitalized cases from National Sample Survey (NSS) 75th round for the corresponding states and districts, which is based on household survey methodology. The share of medicines in OOP expenditure did not change significantly for organized private hospitals using patient-reported versus imputation-based method (30.74% to 29.61%). Large reductions were observed for single-doctor clinics, especially in case of Ayurvedic (64.51% to 36.51%) and Homeopathic (57.53% to 42.74%) practitioners. After adjustment for socio-demographic factors and types of ailments, we found that household data collection as per NSS methodology leads to an increase of 25% and 26% in reported share of medicines for public and private sector out-patient consultations respectively, as compared to facility based exit interviews with imputation of expenditure for medicines as per actual quantity and price data. The nature of health care transactions at single-doctor clinics in rural India leads to an over-reporting of expenditure on medicines by patients. While household surveys are valid to provide total expenditure, these are less likely to correctly estimate the share of medicines expenditure.
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Affiliation(s)
- Shankar Prinja
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Sumit Kumar
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Atul Sharma
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | | | | | - Neha Dumka
- National Health Systems Resource Centre, Ministry of Health and Family Welfare, New Delhi, India
| | - Sandeep Sharma
- National Health Systems Resource Centre, Ministry of Health and Family Welfare, New Delhi, India
| | - Indranil Mukhopadhyay
- School of Government and Public Policy, OP Jindal Global University, Sonipat, Haryana, India
| | - Saroj Kumar Rana
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Samir Garg
- State Health Resource Centre, Raipur, Chhattisgarh, India
| | - Atul Kotwal
- National Health Systems Resource Centre, Ministry of Health and Family Welfare, New Delhi, India
| | - Arun Kumar Aggarwal
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
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Matthews DW, Coleman S, Razavi H, Izaret J. The Payer License Agreement, or "Netflix model," for hepatitis C virus therapies enables universal treatment access, lowers costs and incentivizes innovation and competition. Liver Int 2022; 42:1503-1516. [PMID: 35289467 PMCID: PMC9314612 DOI: 10.1111/liv.15245] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/18/2022] [Accepted: 03/10/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS High unit prices of treatments limit access. For epidemics like that of hepatitis C virus (HCV), reduced treatment access increases prevalence and incidence, making the infectious disease increasingly difficult to manage. The objective of the current study was to construct and test an alternative pricing model, the Payer License Agreement (PLA), and determine whether it could improve outcomes, cut costs and incentivize innovation versus the current unit-based pricing model. METHODS We built and used computational models of hepatitis C disease progression, treatment, and pricing in historical and future scenarios and quantitatively analyzed their economic and epidemiological impact in three high-income countries. RESULTS This study had three key results regarding HCV treatment. First, if the PLA model had been implemented when interferon-free direct-acting antiviral (DAA) combinations launched, the number of patients treated and cured would have more than doubled in the first three years, while the liver-related deaths (LRDs) would have decreased by around 40%. Second, if the PLA model had been implemented beginning in 2018, the year that several Netflix-like payment models were under implementation, the number of treated and cured patients would nearly double, and the LRDs would decline by more than 55%. Third, implementing the PLA model would result in a decline in total payer costs of more than 25%, with an increase to pharmaceutical manufacturer revenues of 10%. These results were true across the three healthcare landscapes studied, the USA, the UK and Italy, and were robust against variations to critical model parameters through sensitivity analysis. CONCLUSIONS AND RELEVANCE These results suggest that implementation of the PLA model in high-income countries across a variety of health system contexts would improve patient outcomes at lower payer cost with more stable revenue for pharmaceutical manufacturers. Health policy-makers in high-income countries should consider the PLA model for application to more cost-effective management of HCV, and explore its application for other infectious diseases with curative therapies available now or soon.
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Affiliation(s)
- David W. Matthews
- The Boston Consulting GroupBostonMassachusettsUSA,The Bruce Henderson InstituteNew YorkNew YorkUSA
| | | | - Homie Razavi
- The Center for Disease Analysis (CDA)LafayetteColoradoUSA
| | - Jean‐Manuel Izaret
- The Boston Consulting GroupBostonMassachusettsUSA,The Bruce Henderson InstituteNew YorkNew YorkUSA
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20
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Patient access to and ethical considerations of the application of the European Union hospital exemption rule for advanced therapy medicinal products. Cytotherapy 2022; 24:686-690. [DOI: 10.1016/j.jcyt.2022.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/17/2022] [Accepted: 03/20/2022] [Indexed: 11/21/2022]
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Kovács S, Németh B, Erdősi D, Brodszky V, Boncz I, Kaló Z, Zemplényi A. Should Hungary Pay More for a QALY Gain than Higher-Income Western European Countries? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:291-303. [PMID: 35041177 PMCID: PMC9021143 DOI: 10.1007/s40258-021-00710-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Cost-effectiveness thresholds (CETs) play a particularly important role in the reimbursement decisions of health technologies in countries with limited healthcare resources. Our goal is to develop a scientifically solid proposal for a revised cost-effectiveness threshold, as part of the planned review of the Hungarian health economic guidance. METHODS The Threshold Working Group of the Hungarian Health Economics Association performed a targeted review on CETs in European countries. International trends on CETs served as a basis for our recommendation, which was discussed at the Association's workshop and deliberated at an expert committee meeting with representatives from the national health technology assessment (HTA) and healthcare payer bodies, and academic HTA centres. RESULTS The current Hungarian CET is one of the highest among European countries relative to GDP per capita, and even higher in nominal value than the CET applied by NICE. As opposed to the current, single Hungarian threshold, other European countries apply multiple thresholds. The Working Group recommends that Hungary should also apply multiple CETs in the range of 1.5-3 times GDP per capita with stratification according to the relative quality-adjusted life-year (QALY) gain of the new technology. In addition, multiple CETs in the range of 3-10 times GDP per capita is recommended for technologies in rare diseases. CONCLUSIONS CETs should be aligned with the country's economic performance and should reflect societal preferences. Our recommendation may increase the efficiency of healthcare resource allocation in Hungary by strengthening the role of HTA in the reimbursement decisions and favouring new technologies with higher QALY gain.
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Affiliation(s)
- Sándor Kovács
- Division of Pharmacoeconomics, Faculty of Pharmacy, University of Pécs, Pecs, Hungary
- Syreon Research Institute, Budapest, Hungary
| | | | - Dalma Erdősi
- Division of Pharmacoeconomics, Faculty of Pharmacy, University of Pécs, Pecs, Hungary
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Imre Boncz
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, Pecs, Hungary
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary
- Centre for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Antal Zemplényi
- Division of Pharmacoeconomics, Faculty of Pharmacy, University of Pécs, Pecs, Hungary.
- Syreon Research Institute, Budapest, Hungary.
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22
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Vogler S. "Ready for the future?" - Status of national and cross-country horizon scanning systems for medicines in European countries. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2022; 20:Doc05. [PMID: 35465640 PMCID: PMC9006311 DOI: 10.3205/000307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/14/2022] [Indexed: 11/30/2022]
Abstract
Background: Horizon scanning aims to systematically identify upcoming health technologies and thus allows policy-makers to be better prepared for the entry of new medicines with possibly high price tags into the national health system. The aim of this study is to survey the existence of national and cross-national horizon scanning systems for medicines in European countries. Methods: Experts working in public authorities (members of the Pharmaceutical Pricing and Reimbursement Information/PPRI network) in the WHO European region participated in surveys in 2014 and 2019 and informed about the status of horizon scanning in their country (response rate: 14 and 44 countries, respectively). Identified advanced horizon scanning systems as of 2019 were further investigated based on a literature review. Results: In 2019, six countries (Iceland, Italy, the Netherlands, Norway, Sweden, United Kingdom) reported systematic use of horizon scanning for some new medicines, and four countries (Austria, Denmark, France, Ireland) had some horizon scanning activities ongoing. No systematic use of horizon scanning was reported from the remaining 34 countries. The findings of the survey undertaken five years earlier were similar, with even fewer systems in place. A recent development is the establishment of cross-country initiatives of governments that aim, among others, to jointly perform horizon scanning; the International Horizon Scanning Initiative (IHSI) initiated by the Beneluxa collaboration is the most advanced undertaking in this respect. Countries with systematic use tend to have horizon scanning fully integrated in a system for the management of new medicines, and they use horizon scanning outcomes to inform decisions as to whether or not a Health Technology Assessment will be conducted and price negotiations be started. Differences between existing horizon scanning systems mainly concern the timings of scanning and reporting, the sources for the inputs and the accessibility of the findings. Conclusion: There appears to be a discrepancy between the perceived importance of horizon scanning based on some eye-opening examples in the past and its actual implementation in European health systems. The latter is likely attributable to horizon scanning being resource-intensive. The establishment of new national and international horizon scanning systems offers the opportunity to investigate their impact on sustainable access to affordable medicines from the start.
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Affiliation(s)
- Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich (GÖG/Austrian National Public Health Institute), Vienna, Austria
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Faleiros DR, Nunes da Silva E, Santos AC, Godman BB, Goncalves Pereira R, Guerra Junior AA. Adoption of new therapies in the treatment of Hepatitis: a verification of the accuracy of budget impact analysis to guide investment decisions. Expert Rev Pharmacoecon Outcomes Res 2022; 22:927-939. [PMID: 35320682 DOI: 10.1080/14737167.2022.2057950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES While there are good Budget Impact Analysis (BIA) guidelines, studies still register potential bias. To do this, we compared the results between theoretical and real-world evidence (RWE) expenditures for medicines for Hepatitis C: boceprevir (BOC) and telaprevir (TVR). While both are not currently recommended in treatment guidelines following recent developments, this is an emblematic case because for 4 years these medicines consumed considerable resources. METHODS Theoretical results and RWE expenditures were compared regarding the incorporation of BOC and TVR in 2013-2014 into the Brazilian Public Health System. Theoretical values were extracted from Commission for Technology Incorporation Report and RWE expenditures were extracted from the administrative data records using deterministic-probabilistic linkage. RESULTS The estimated number of patients treated (BOC+TVR) was 13,012 versus 7,641 (real). The estimated purchase price for BOC was US$6.20 versus US$11.07 (real) and for TVR was US$42.21 versus US$84.09 (average/real). The estimated budget impact was US$285.16 million versus US$128.58 million (real). CONCLUSION This study demonstrates appreciable divergence (US$156.58 million) between the theoretical budget impact and RWE expenditures due to underestimated purchase prices and overestimated populations. The greater the degree of accuracy the more reliable and usable BIAs become for decision-making.
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Affiliation(s)
- Daniel Resende Faleiros
- Nucleus Infectious and Parasitic Diseases, Tropical Medicine Centre, University of Brasilia, Brasília, Brazil
| | | | - Andreia C Santos
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Brian B Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates.,Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Ramon Goncalves Pereira
- Faculty of Pharmacy, Federal University of Minas Gerais,Belo Horizonte, Minas Gerais, Brazil
| | - Augusto A Guerra Junior
- Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais. Belo Horizonte, Minas Gerais, Brazil
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Chan HK, Hassali MA, Mohammed NS, Azlan A, Hassan MRA. Barriers to scaling up hepatitis C treatment in Malaysia: a qualitative study with key stakeholders. BMC Public Health 2022; 22:371. [PMID: 35189876 PMCID: PMC8860373 DOI: 10.1186/s12889-022-12786-w] [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: 07/04/2021] [Accepted: 02/15/2022] [Indexed: 11/15/2022] Open
Abstract
Background While the availability of generic direct-acting antivirals (DAAs) opens the door for large-scale treatment, the care for people living with hepatitis C virus (HCV) in Malaysia is shifting toward a tripartite partnership between the public health system, correctional settings and civil society organizations (CSOs). This study aimed to explore the barriers to scaling up HCV treatment in Malaysia from the perspective of key stakeholders. Methods Eighteen focus-group discussions (FGDs) were conducted with 180 individuals, who actively engaged in coordinating, executing or supporting the implementation of the national strategic plan for HCV. An analytical framework was adapted to guide the data collection and thematic analysis. It covered four key aspects of HCV treatment: geographical accessibility, availability, affordability and acceptability. Results Movement restrictions in times of coronavirus disease 2019 (COVID-19) outbreaks and being marginalized translated into barriers to treatment access in people living with HCV. Barriers to treatment initiation in health and correctional settings included limited staffing and capacity; disruption in material supply; silos mentality and unintegrated systems; logistical challenges for laboratory tests; and insufficient knowledge of care providers. Although no-cost health services were in place, concerns over transportation costs and productivity loss also continued to suppress the treatment uptake. Limited disease awareness, along with the disease-related stigma, further lowered the treatment acceptability. Conclusions This study disclosed a series of supply- and demand-side barriers to expanding the treatment coverage among people living with HCV in Malaysia. The findings call for strengthening inter-organizational collaborations to overcome the barriers.
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Affiliation(s)
- Huan-Keat Chan
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, Malaysia. .,Clinical Research Center, Sultanah Bahiyah Hospital, Alor Setar, 05460, Alor Setar, Kedah, Malaysia.
| | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, Malaysia
| | - Noor Syahireen Mohammed
- Clinical Research Center, Sultanah Bahiyah Hospital, Alor Setar, 05460, Alor Setar, Kedah, Malaysia
| | - Azlina Azlan
- Public Health Division, State Health Department, Alor Setar, Kedah, Malaysia
| | - Muhammad Radzi Abu Hassan
- Clinical Research Center, Sultanah Bahiyah Hospital, Alor Setar, 05460, Alor Setar, Kedah, Malaysia.,Medical Department, Sultanah Bahiyah Hospital, Alor Setar, Kedah, Malaysia
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25
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Kouroumalis E, Voumvouraki A. Hepatitis C virus: A critical approach to who really needs treatment. World J Hepatol 2022; 14:1-44. [PMID: 35126838 PMCID: PMC8790391 DOI: 10.4254/wjh.v14.i1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/14/2021] [Accepted: 12/31/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction of effective drugs in the treatment of hepatitis C virus (HCV) infection has prompted the World Health Organization to declare a global eradication target by 2030. Propositions have been made to screen the general population and treat all HCV carriers irrespective of the disease status. A year ago the new severe acute respiratory syndrome coronavirus 2 virus appeared causing a worldwide pandemic of coronavirus disease 2019 disease. Huge financial resources were redirected, and the pandemic became the first priority in every country. In this review, we examined the feasibility of the World Health Organization elimination program and the actual natural course of HCV infection. We also identified and analyzed certain comorbidity factors that may aggravate the progress of HCV and some marginalized subpopulations with characteristics favoring HCV dissemination. Alcohol consumption, HIV coinfection and the presence of components of metabolic syndrome including obesity, hyperuricemia and overt diabetes were comorbidities mostly responsible for increased liver-related morbidity and mortality of HCV. We also examined the significance of special subpopulations like people who inject drugs and males having sex with males. Finally, we proposed a different micro-elimination screening and treatment program that can be implemented in all countries irrespective of income. We suggest that screening and treatment of HCV carriers should be limited only in these particular groups.
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Affiliation(s)
- Elias Kouroumalis
- Department of Gastroenterology, University of Crete Medical School, Heraklion 71500, Crete, Greece
| | - Argyro Voumvouraki
- First Department of Internal Medicine, AHEPA University Hospital, Thessaloniki 54621, Greece
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26
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Mormina M, Istratii R. 'Capacity for what? Capacity for whom?' A decolonial deconstruction of research capacity development practices in the Global South and a proposal for a value-centred approach. Wellcome Open Res 2022; 6:129. [PMID: 35028423 PMCID: PMC8729187 DOI: 10.12688/wellcomeopenres.16850.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 11/20/2022] Open
Abstract
Whilst North to South knowledge transfer patterns have been extensively problematised by Southern and decolonial perspectives, there is very little reflection on the practice of research capacity development (RCD), still strongly focused on technoscientific solutionism, yet largely uncritical of its underlying normative directions and power asymmetries. Without making transparent these normative and epistemological dimensions, RCD practices will continue to perpetuate approaches that are likely to be narrow, technocratic and unreflexive of colonial legacies, thus failing to achieve the aims of RCD, namely, the equitable and development-oriented production of knowledge in low- and middle-income societies. Informed by the authors’ direct experience of RCD approaches and combining insights from decolonial works and other perspectives from the margins with Science and Technology Studies, the paper undertakes a normative and epistemological deconstruction of RCD mainstream practice. Highlighting asymmetries of power and material resources in knowledge production, the paper’s decolonial lens seeks to aid the planning, implementation and evaluation of RCD interventions. Principles of cognitive justice and epistemic pluralism, accessibility enabled by systems thinking and sustainability grounded on localisation are suggested as the building blocks for more reflexive and equitable policies that promote research capacity
for the purpose of creating social value and not solely for the sake of perpetuating technoscience.
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Affiliation(s)
- Maru Mormina
- Ethox Centre and Wellcome Centre for Ethics and Humanities, Big Data Institute, University of Oxford, Li Ka Shing Centre for Health Information and Discovery, Oxford, OX3 7LF, UK
| | - Romina Istratii
- Department of Religions and Philosophies, School of History, Religions and Philosophies, School of Oriental and African Studies (SOAS), University of London, Thornhaugh Street, Russell Square, London, WC1H 0XG, UK
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27
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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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28
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Karlsen TH, Sheron N, Zelber-Sagi S, Carrieri P, Dusheiko G, Bugianesi E, Pryke R, Hutchinson SJ, Sangro B, Martin NK, Cecchini M, Dirac MA, Belloni A, Serra-Burriel M, Ponsioen CY, Sheena B, Lerouge A, Devaux M, Scott N, Hellard M, Verkade HJ, Sturm E, Marchesini G, Yki-Järvinen H, Byrne CD, Targher G, Tur-Sinai A, Barrett D, Ninburg M, Reic T, Taylor A, Rhodes T, Treloar C, Petersen C, Schramm C, Flisiak R, Simonova MY, Pares A, Johnson P, Cucchetti A, Graupera I, Lionis C, Pose E, Fabrellas N, Ma AT, Mendive JM, Mazzaferro V, Rutter H, Cortez-Pinto H, Kelly D, Burton R, Lazarus JV, Ginès P, Buti M, Newsome PN, Burra P, Manns MP. The EASL-Lancet Liver Commission: protecting the next generation of Europeans against liver disease complications and premature mortality. Lancet 2022; 399:61-116. [PMID: 34863359 DOI: 10.1016/s0140-6736(21)01701-3] [Citation(s) in RCA: 258] [Impact Index Per Article: 129.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/10/2021] [Accepted: 07/15/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Tom H Karlsen
- Department of Transplantation Medicine and Research Institute for Internal Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital Rikshospitalet and University of Oslo, Oslo, Norway.
| | - Nick Sheron
- Institute of Hepatology, Foundation for Liver Research, Kings College London, London, UK
| | - Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Patrizia Carrieri
- Aix-Marseille University, Inserm, Institut de recherche pour le développement, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale (SESSTIM), ISSPAM, Marseille, France
| | - Geoffrey Dusheiko
- School of Medicine, University College London, London, UK; Kings College Hospital, London, UK
| | - Elisabetta Bugianesi
- Department of Medical Sciences, Division of Gastroenterology, University of Torino, Torino, Italy
| | | | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Clinical and Protecting Health Directorate, Public Health Scotland, Glasgow, UK
| | - Bruno Sangro
- Liver Unit, Clinica Universidad de Navarra-IDISNA and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Pamplona, Spain
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA; Population Health Sciences, University of Bristol, Bristol, UK
| | - Michele Cecchini
- Health Division, Organisation for Economic Co-operation and Development, Paris, France
| | - Mae Ashworth Dirac
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA; Department of Family Medicine, University of Washington, Seattle, WA, USA; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Annalisa Belloni
- Health Economics and Modelling Division, Public Health England, London, UK
| | - Miquel Serra-Burriel
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Cyriel Y Ponsioen
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Brittney Sheena
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alienor Lerouge
- Health Division, Organisation for Economic Co-operation and Development, Paris, France
| | - Marion Devaux
- Health Division, Organisation for Economic Co-operation and Development, Paris, France
| | - Nick Scott
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; Department of Infectious Diseases, Alfred Hospital, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Henkjan J Verkade
- Paediatric Gastroenterology and Hepatology, Department of Paediatrics, University Medical Centre Groningen, University of Groningen, Netherlands; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Ekkehard Sturm
- Division of Paediatric Gastroenterology and Hepatology, University Children's Hospital Tübingen, Tübingen, Germany; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | | | | | - Chris D Byrne
- Department of Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK; Southampton National Institute for Health Research, Biomedical Research Centre, University Hospital Southampton and Southampton General Hospital, Southampton, UK
| | - Giovanni Targher
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, University of Verona, Verona, Italy
| | - Aviad Tur-Sinai
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Yezreel Valley, Israel
| | - Damon Barrett
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Tatjana Reic
- European Liver Patients Organization, Brussels, Belgium; Croatian Society for Liver Diseases-Hepatos, Split, Croatia
| | | | - Tim Rhodes
- London School of Hygiene & Tropical Medicine, London, UK
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Claus Petersen
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Christoph Schramm
- Martin Zeitz Center for Rare Diseases, Hamburg Center for Translational Immunology (HCTI), and First Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, Poland
| | - Marieta Y Simonova
- Department of Gastroenterology, HPB Surgery and Transplantation, Clinic of Gastroentrology, Military Medical Academy, Sofia, Bulgaria
| | - Albert Pares
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBEREHD, Madrid, Spain
| | - Philip Johnson
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Isabel Graupera
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBEREHD, Madrid, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Christos Lionis
- Clinic of Social and Family Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Elisa Pose
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Núria Fabrellas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBEREHD, Madrid, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Ann T Ma
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Juan M Mendive
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Madrid, Spain; La Mina Health Centre, Catalan Institute of Health (ICS), Barcelona, Spain
| | - Vincenzo Mazzaferro
- HPB Surgery and Liver Transplantation, Istituto Nazionale Tumori IRCCS Foundation (INT), Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Helena Cortez-Pinto
- Clínica Universitária de Gastrenterologia and Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Deirdre Kelly
- Liver Unit, Birmingham Women's and Children's Hospital and University of Birmingham, UK
| | - Robyn Burton
- Alcohol, Drugs, Tobacco and Justice Division, Public Health England, London, UK
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, Barcelona, Spain
| | - Pere Ginès
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBEREHD, Madrid, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Maria Buti
- CIBEREHD del Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Hospital Universitario Valle Hebron, Barcelona, Spain
| | - Philip N Newsome
- National Institute for Health Research Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK
| | - Patrizia Burra
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
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Charlton V. The ethics of aggregation in cost-effectiveness analysis or, "on books, bookshelves, and budget impact". FRONTIERS IN HEALTH SERVICES 2022; 2:889423. [PMID: 36925796 PMCID: PMC10012697 DOI: 10.3389/frhs.2022.889423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 09/14/2022] [Indexed: 03/18/2023]
Abstract
In deciding how to allocate resources, healthcare priority-setters are increasingly paying attention to an intervention's budget impact alongside its cost-effectiveness. Some argue that approaches that use budget impact as a substantive consideration unfairly disadvantage individuals who belong to large patient groups. Others reject such claims of "numerical discrimination" on the grounds that consideration of the full budget impact of an intervention's adoption is necessary to properly estimate opportunity cost. This paper summarizes this debate and advances a new argument against modifying the cost-effectiveness threshold used for decision-making based on a technology's anticipated budget impact. In making this argument, the paper sets out how the apparent link between budget impact and opportunity cost is largely broken if the effects of a technology's adoption are disaggregated, while highlighting that the theoretical aggregation of effects during cost-effectiveness analysis likely only poorly reflects the operation of the health system in practice. As such, it identifies a need for healthcare priority-setters to be cognizant of the ethical implications associated with aggregating the effects of a technology's adoption for the purpose of decision-making. Throughout the paper, these arguments are illustrated with reference to a "bookshelf" analogy borrowed from previous work.
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Affiliation(s)
- Victoria Charlton
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
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30
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Teaima MH, Al-Nuseirat A, Abouhussein D, Badary OA, El-Nabarawi MA. Pharmaceutical policies and regulations of oral antiviral drugs for treatment of hepatitis C in Egypt-case study. J Pharm Policy Pract 2021; 14:106. [PMID: 34915937 PMCID: PMC8674831 DOI: 10.1186/s40545-021-00389-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 12/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are limited studies on the role of efficient regulatory mechanisms in facilitating greater access to Hepatitis C virus (HCV) treatment. Evidence to support the importance of effective pharmaceutical policies and regulations in improving access to oral viral drugs towards the elimination of HCV is needed. This study aims to explore the adequacy of the implemented pharmaceutical policies and regulations in Egypt and their role to improve the availability and affordability of direct-acting antivirals (DAAs) to achieve universal access to the treatment of HCV. METHODS The study adopts a qualitative methodology using desk review of regulatory and legislative information, literature review, and semi-structured interviews with key experts from the concerned governmental regulatory agencies, pharmaceutical industries, academic organizations, professional associations, civil society organizations, and clinicians who are working in researching treatments for hepatitis C. FINDINGS The common DAAs available in the market are Daclatasvir, Sofosbuvir, and Sofosbuvir-based direct-acting antiviral combinations. Fast-track medicines registration pathway for marketing authorization of DAAs is used to reduce market access time frames. The pricing policies are supplemented using price negotiation to set up affordable prices that led to a reasonable price for DAAs. Using Trade-Related Aspects of Intellectual Property Rights (TRIPs) flexibility and local production of quality generics DAAs at lower prices. In addition, political will and collaboration between the government, civil society, and pharmaceutical companies improved patients' access to affordable DAAs and succeeding hepatitis C treatment in Egypt. CONCLUSIONS The study findings indicated that the implemented pharmaceutical policies and regulations have an immense role in enhancing access to medicines towards the elimination of hepatitis C in Egypt.
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Affiliation(s)
- Mahmoud H Teaima
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Adi Al-Nuseirat
- Access to Medicines and Health Technologies Unit, World Health Organization Office for the Eastern Mediterranean Region, Cairo, Egypt.
| | - Dalia Abouhussein
- Pharmaceutics Department, Egyptian Drug Authority (EDA), Cairo, Egypt
| | - Osama A Badary
- Department of Clinical Pharmacy Practice, Faculty of Pharmacy, The British University in Egypt, Cairo, Egypt
| | - Mohamed A El-Nabarawi
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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31
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Ross PE, Young JR, O'Connor CM, Anoushiravani AA, DiCaprio MR. Perioperative Management of Hepatitis C in Patients Undergoing Total Joint Arthroplasty. JBJS Rev 2021; 9:01874474-202111000-00004. [PMID: 34757978 DOI: 10.2106/jbjs.rvw.20.00223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
» A small yet growing subset of total joint arthroplasty (TJA) candidates are diagnosed with the hepatitis C virus (HCV), which is a known risk factor for periprosthetic joint infections. Given the poor outcomes associated with TJA infection, we recommend that candidates with HCV receive treatment prior to elective TJA. » Interferon and ribavirin have historically been the standard treatment regimen for the management of HCV; however, adverse events and an inconsistent viral response have limited the efficacy of these therapies. The advent of direct-acting antivirals has resolved many of the issues associated with interferon and ribavirin regimens. » Despite the success of direct-acting antivirals, there are still barriers to seeking treatment for TJA candidates with HCV. Many patients are faced with financial burdens, as insurance coverage of direct-acting antiviral therapies is inconsistent and varies by the patient's state of residence and specific treatment regimen. » TJA candidates with HCV present health-care providers with a unique set of challenges, often encompassing economic, psychosocial, and complex medical concerns. Multidisciplinary care teams can be beneficial when caring for and optimizing this patient cohort. » Management of HCV prior to elective TJA is associated with higher up-front costs but ultimately reduces long-term patient morbidity as well as associated direct and indirect health-care expenditures.
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Affiliation(s)
- Phillip E Ross
- Department of Orthopaedic Surgery, Albany Medical Center, Albany, New York
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Tsou AY, Graf WD, Russell JA, Epstein LG. Ethical Perspectives on Costly Drugs and Health Care. Neurology 2021; 97:685-692. [DOI: 10.1212/wnl.0000000000012571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/16/2021] [Indexed: 11/15/2022] Open
Abstract
High drug prices have created substantial challenges for patients, physicians, health systems, and payers. High drug prices can affect patient care in many ways, including limiting access to treatment, increasing the burden of administrative tasks, and contributing to physician burnout. Exorbitant drug pricing poses direct challenges for distributive justice, which is concerned with fairly distributing benefits and burdens across society. In this position statement, we discuss ethical concerns raised by high drug costs, primarily focusing on concerns around distributive justice. We consider forms of rationing, approaches to allocation, potential complexities in real-life application, and structural forces contributing to high drug costs. Finally, we consider potential policy solutions and ramifications for individual clinicians.
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Pharmaceutical drug development: high drug prices and the hidden role of public funding. Biol Futur 2021; 72:129-138. [PMID: 34554467 DOI: 10.1007/s42977-020-00025-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
In 2019, the record for the most expensive drug was broken at US$2.1 million per patient. The high costs of new drugs are justified by the pharmaceutical industry as the expense required for maintaining research and development (R&D) pipelines. However, this does not take into account that globally the public pays for between one to two-thirds of upfront R&D costs through taxpayers or charitable donations. Governments are effectively paying twice for medicines; first through R&D, and then paying the high prices upon approval. High drug prices distort research priorities, emphasising financial gains and not health gains. In this manuscript, issues surrounding the current patent-based drug development model, public funding of research and pharmaceutical lobbying will be addressed. Finally, innovations in drug development to improve public health needs and guaranteeing medication access to patients will be explored.
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Kraef C, Bentzon A, Skrahina A, Mocroft A, Peters L, Lundgren JD, Chkhartishvili N, Podlekareva D, Kirk O. Improving healthcare for patients with HIV, tuberculosis and hepatitis C in eastern Europe: a review of current challenges and important next steps. HIV Med 2021; 23:48-59. [PMID: 34468073 DOI: 10.1111/hiv.13163] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In some eastern European countries, serious challenges exist to meet the HIV-, tuberculosis (TB)- and hepatitis-related target of the United Nations Sustainable Development Goals. Some of the highest incidence rates for HIV and the highest proportion of multi-drug-resistant (MDR) tuberculosis worldwide are found in the region. The purpose of this article is to review the challenges and important next steps to improve healthcare for people living with TB, HIV and hepatitis C (HCV) in eastern Europe. METHODS References for this narrative review were identified through systematic searches of PubMed using pre-idientified key word for articles published in English from January 2000 to August 2020. After screening of titles and abstracts 37 articles were identified as relevant for this review. Thirty-eight further articles and sources were identified through searches in the authors' personal files and in Google Scholar. RESULTS Up to 50% of HIV/MDR-TB-coinfected individuals in the region die within 2 years of treatment initiation. Antiretroviral therapy (ART) coverage for people living with HIV (PLHIV) and the proportion virological suppressed are far below the UNAIDS 90% targets. In theory, access to various diagnostic tests and treatment of drug-resistant TB exists, but real-life data point towards inadequate testing and treatment. New treatments could provide elimination of viral HCV in high-risk populations but few countries have national programmes. CONCLUSION Some eastern European countries face serious challenges to achieve the sustainable development goal-related target of 3.3 by 2030, among others, to end the epidemics of AIDS and tuberculosis. Better integration of healthcare systems, standardization of health care, unrestricted substitution therapy for all people who inject drugs, widespread access to drug susceptibility testing, affordable medicines and a sufficiently sized, well-trained health workforce could address some of those challenges.
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Affiliation(s)
- Christian Kraef
- CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Adrian Bentzon
- CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Alena Skrahina
- Republican Scientific and Practical Center for Pulmonology and Tuberculosis, Minsk, Belarus
| | - Amanda Mocroft
- CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Lars Peters
- CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens D Lundgren
- CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nikoloz Chkhartishvili
- Infectious Diseases, AIDS & Clinical Immunology Research Center, Tbilisi, Georgia.,Caucasus International University, Tbilisi, Georgia
| | - Daria Podlekareva
- CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ole Kirk
- CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Pochopień M, Qiu T, Aballea S, Clay E, Toumi M. Considering potential solutions for limitations and challenges in the health economic evaluation of gene therapies. Expert Rev Pharmacoecon Outcomes Res 2021; 21:1145-1158. [PMID: 34407704 DOI: 10.1080/14737167.2021.1969229] [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] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The limited evidence in the clinical trials of gene therapies (GTs) posed substantial challenges for a reliable health technology assessment (HTA). This paper provides insights into the relationship between the background of diseases and the health economics assessment of GTs.Areas covered: The impacts of differentiated severity and unmet needs of genetic diseases, on the economic analysis of GTs, were discussed.Expert opinion: GTs offer a potential cure or significant clinical improvement, while limitations in clinical evidence constitute major obstacles for a robust assessment of clinical effectiveness and economic outcomes. This uncertainty may be balanced by the severity of the targeted condition and the associated unmet needs, thus leading to a relatively higher acceptance for GTs. Overtime, HTA agencies will become more demanding on comprehensive evidence of long-term effectiveness. With a growing number of GTs on the horizon, to what extent the unmet needs of previously devastating diseases will be fulfilled remain unclear. Nonetheless, comparative studies, either with a historical control group or existing treatments, will be necessary to demonstrate the additional benefits associated with GTs.
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Affiliation(s)
- Michał Pochopień
- Public health department, Aix-Marseille University, Marseille, France.,Department of health economics and outcomes research, Creativ-Ceutical, Kraków, Poland
| | - Tingting Qiu
- Public health department, Aix-Marseille University, Marseille, France
| | - Samuel Aballea
- Public health department, Aix-Marseille University, Marseille, France
| | - Emilie Clay
- Department of health economics and outcomes research, Creativ-Ceutical, Paris, France
| | - Mondher Toumi
- Public health department, Aix-Marseille University, Marseille, France
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Ali S, Ur-Rehman T, Ali M, Haque S, Rasheed F, Lougher E, Nawaz MS, Paudyal V. Improving access to the treatment of hepatitis C in low- and middle-income countries: evaluation of a patient assistance programme. Int J Clin Pharm 2021; 43:958-968. [PMID: 33247820 PMCID: PMC8352841 DOI: 10.1007/s11096-020-01202-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/12/2020] [Indexed: 12/15/2022]
Abstract
Background Modern antiviral treatments have high cure rates against the hepatitis C virus however, the high cost associated with branded medicines and diagnostic tests, have resulted in poor access for many low-income patients residing in low-and-middle-income countries. Objective This study aimed to evaluate the role of a patient assistance programme and generic medicines in improving access to treatment of low-income hepatitis C patients in a low-and-middle-income country. Setting A major teaching public hospital in Islamabad, Pakistan. Methods Hepatitis C patients who presented and enrolled for the patient assistance programme during 12 months (1st July 2015 and 30th June 2016) were included. Demography, prescription characteristics, the total costs of Hepatitis C treatment, medicine cost supported by the programme, out-of-pocket cost borne by the patient and average cost effectiveness ratio per sustained virologic response were calculated and compared for different generic and branded regimens. Main outcome measure cost contribution of patient assistance programme. Results A total of 349 patients initiated the treatment through the programme and of those 334 (95.7%) completed the prescribed treatment. There were 294 (88.02%) patients who achieved sustained virologic response. Patient assistance programme contributed medicines cost averaging 60.28-86.26% of the total cost of treatment ($1634.6) per patient. The mean (SE) cost per patient for generic option (Sofosbuvir/Ribavirin) was the lowest [$658.36 (22.3) per patient, average cost effectiveness ratio = $720.1/SVR] than branded option (Sovaldi/Ribavirin) [$2218.66 (37.6) per patient, average cost effectiveness ratio = $2361.8/SVR] of the three available treatment regimens. From patients' perspectives, the mean (SE) out-of-pocket cost was $296.9 (6.7) which primarily included diagnostic cost (69.9%) of the total cost. Conclusions Patient assistance programme, combined with generic brands of newer hepatitis C treatment offered a significant reduction in cost and widens access to hepatitis C treatment in low-and middle-income countries. However, substantial out-of-pocket costs of the treatment presents an important barrier for service access. There is a scope to widen such financial assistance programme to offer other costs attributed to patients, specifically for diagnosis, to widen service use in low-and-middle-income countries.
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Affiliation(s)
- Salamat Ali
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Tofeeq Ur-Rehman
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Mashhood Ali
- Department of Gastroenterology, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan
| | - Sayeed Haque
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Faisal Rasheed
- UBT Laboratory, Nuclear Medicines, Oncology and Radiotherapy Institute, Islamabad, Pakistan
| | - Eleri Lougher
- Abertawe Bro Morgannwg University Health Board, Princess of Wales Hospital, Bridgend, UK
| | | | - Vibhu Paudyal
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
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Janssen Daalen JM, den Ambtman A, Van Houdenhoven M, van den Bemt BJF. Determinants of drug prices: a systematic review of comparison studies. BMJ Open 2021; 11:e046917. [PMID: 34266841 PMCID: PMC8287090 DOI: 10.1136/bmjopen-2020-046917] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE In this systematic review on drug price comparison studies, we report on recent determinants of drug prices in a national and international context to facilitate regulation of drug prices by purchasers and policymakers worldwide. Determinants of drug prices were divided into non-modifiable and modifiable and were categorised as pertaining to a country's income level, pharmaceutical market system and its policies and government. PRIMARY OUTCOME Determinants of drug prices or price variance. DESIGN We systematically searched PubMed, EMBASE, Web of Science and Cochrane Library for peer-reviewed articles published between 2004 and 22 July 2020 that reported an association of the primary outcome with one or more determinants. We performed a best-evidence synthesis of these associations for determinants covered in at least three studies. RESULTS 31 publications were included. Only one publication described net drug prices and 30 described retail drug prices. Five modifiable determinants were associated with lower retail prices: generic market portion, discounts, tendering policies, central (governmental) purchasing and pricing regulation schemes. The originators market portion and a system in which mark-ups are common were associated with higher retail prices. Retail prices were highest in the USA, even compared with other high-income countries. A positive association between national income level and drug retail prices could not be established among middle-income and high-income countries. Retail prices were highest in low-income countries when adjusted for purchasing power parity. CONCLUSIONS Literature on determinants of net drug prices is extremely sparse. Various healthcare system interventions, market-specific and governmental regulations are consistently associated with lower retail prices. Some interventions are easily implementable in developing or middle-income countries, such as tendering, central purchasing and fixed pricing regulation schemes. Net drug price comparison studies are needed to overcome the lack of price transparency and to quantify the effectiveness of policy measures on net drug prices.
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Affiliation(s)
- Jules M Janssen Daalen
- Faculty of Medical Sciences, Radboud University, Nijmegen, The Netherlands
- Staff Board of Directors, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Anouk den Ambtman
- Staff Board of Directors, Sint Maartenskliniek, Nijmegen, The Netherlands
- Institute for Management Research, Radboud University, Nijmegen, The Netherlands
| | - Mark Van Houdenhoven
- Staff Board of Directors, Sint Maartenskliniek, Nijmegen, The Netherlands
- Institute for Management Research, Radboud University, Nijmegen, The Netherlands
| | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +, Maastricht, Netherlands
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Fatouh AM, Elshafeey AH, Abdelbary A. Liver targeting of ledipasvir via galactosylated chitosan-coated spanlastics: chemical synthesis, statistical optimization, in vitro, and pharmacokinetic evaluation. Drug Deliv Transl Res 2021; 12:1161-1174. [PMID: 33948896 DOI: 10.1007/s13346-021-00993-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Ledipasvir is an effective direct acting antiviral agent used in the treatment of hepatitis C virus. The high price of ledipasvir was a reason for its limited provision to wide population of HCV patients. OBJECTIVES Our objective is the formulation of liver targeted drug delivery system that can increase the amount of ledipasvir delivered to liver and prolong its liver residence in an attempt to reduce its recommended dose and its costing in the treatment of HCV. METHODS Different ledipasvir-loaded spanlastic formulations were prepared using the ethanol injection method and evaluated with respect to the particle size, zeta potential, polydispersity index, and entrapment efficiency %. Using Design-Expert ® software, the optimum spanlastics formulation was selected; then, it was coated by synthesized galactosylated chitosan. A pharmacokinetic study was carried out to evaluate the ability of the prepared galactosylated chitosan-coated spanlastics formulation to enhance ledipasvir liver bioavailability when it was administrated via the oral route. RESULTS The pharmacokinetic study revealed that the optimized galactosylated chitosan-coated spanlastics exhibited significantly higher liver peak concentration (Cmax) and area under liver concentration versus time curve (AUC0-72 h) and significant prolongation in the liver terminal half life (t½) and mean residence time (MRT) compared to the free ledipasvir dispersion with values of 6270 ng/g, 61,706.3 ng.h/g, 15.85 h, and 24.66 h, respectively. CONCLUSIONS Enhanced liver bioavailability of ledipasvir has been accomplished using the developed galactosylated chitosan-coated spanlastics which can be a base for probable reduction in the required dose of ledipasvir in HCV treatment.
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Affiliation(s)
- Ahmed M Fatouh
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Aini St, Cairo, 11562, Egypt.
| | - Ahmed H Elshafeey
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Aini St, Cairo, 11562, Egypt
| | - Ahmed Abdelbary
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Aini St, Cairo, 11562, Egypt
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Hassanin A, Kamel S, Waked I, Fort M. Egypt's Ambitious Strategy to Eliminate Hepatitis C Virus: A Case Study. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:187-200. [PMID: 33795369 PMCID: PMC8087425 DOI: 10.9745/ghsp-d-20-00234] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 02/10/2021] [Indexed: 12/24/2022]
Abstract
A national hepatitis C virus elimination strategy rooted in mass screening and treatment can be effective in many middle-income countries. A strong public health infrastructure, political commitment, and technological advances are essential to such initiatives. Introduction: Chronic hepatitis C virus (HCV) infection is a major public health problem in many low- and middle-income countries. In 2015, Egypt's HCV infection prevalence of 7% among adults was among the highest in the world and accounted for 7.6% of the country's mortality. In 2014, Egypt embarked on an aggressive screening and treatment program that evolved into a national strategy to eliminate HCV as a public health threat by 2021. Methods: In this qualitative case study, we analyzed Egypt's HCV control strategy using the Kingdon framework to understand how the problem, policy, and political streams merged to create an opportunity to achieve an ambitious elimination goal. We describe key aspects of the implementation, identify lessons learned, and provide recommendations for other low- and middle-income countries aiming to eliminate HCV. Results: Between 2014 and 2020, Egypt screened more than 50 million and treated more than 4 million residents for HCV. Five key elements contributed to Egypt's successful HCV elimination program: (1) sufficient and reliable epidemiologic data to quantify and monitor public health threats; (2) a robust public health care infrastructure; (3) inclusive care that reached all sectors of society; (4) political commitment to public health through increased health care spending and a comprehensive long-term national control strategy; and (5) innovative scientific research and use of information technology. Conclusion: Egypt conducted a successful HCV screening program that covered more than 50 million residents and treated more than 4 million. It is poised to be the first country in the world to eliminate HCV within its borders. The lessons learned from this experience can inform the elimination plans of other low- and middle-income countries with high HCV burden.
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Affiliation(s)
- Ahmed Hassanin
- Westchester Medical Center/New York Medical College, NY USA.
| | | | - Iman Waked
- National Liver Institute, Shebeen El Kom, Egypt
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Affordability of Adult Tuberculosis Vaccination in India and China: A Dynamic Transmission Model-Based Analysis. Vaccines (Basel) 2021; 9:vaccines9030245. [PMID: 33799544 PMCID: PMC7998179 DOI: 10.3390/vaccines9030245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/25/2021] [Accepted: 03/06/2021] [Indexed: 11/30/2022] Open
Abstract
New tuberculosis vaccines have made substantial progress in the development pipeline. Previous modelling suggests that adolescent/adult mass vaccination may cost-effectively contribute towards achieving global tuberculosis control goals. These analyses have not considered the budgetary feasibility of vaccine programmes. We estimate the maximum total cost that the public health sectors in India and China should expect to pay to introduce a M72/AS01E-like vaccine deemed cost-effective at country-specific willingness to pay thresholds for cost-effectiveness. To estimate the total disability adjusted life years (DALYs) averted by the vaccination programme, we simulated a 50% efficacy vaccine providing 10-years of protection in post-infection populations between 2027 and 2050 in India and China using a dynamic transmission model of M. tuberculosis. We investigated two mass vaccination strategies, both delivered every 10-years achieving 70% coverage: Vaccinating adults and adolescents (age ≥10y), or only the most efficient 10-year age subgroup (defined as greatest DALYs averted per vaccine given). We used country-specific thresholds for cost-effectiveness to estimate the maximum total cost (Cmax) a government should be willing to pay for each vaccination strategy. Adult/adolescent vaccination resulted in a Cmax of $21 billion (uncertainty interval [UI]: 16–27) in India, and $15B (UI:12–29) in China at willingness to pay thresholds of $264/DALY averted and $3650/DALY averted, respectively. Vaccinating the highest efficiency age group (India: 50–59y; China: 60–69y) resulted in a Cmax of $5B (UI:4–6) in India and $6B (UI:4–7) in China. Mass vaccination against tuberculosis of all adults and adolescents, deemed cost-effective, will likely impose a substantial budgetary burden. Targeted tuberculosis vaccination, deemed cost-effective, may represent a more affordable approach.
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CD8 + T Cell Responses during HCV Infection and HCC. J Clin Med 2021; 10:jcm10050991. [PMID: 33801203 PMCID: PMC7957882 DOI: 10.3390/jcm10050991] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/12/2021] [Accepted: 02/22/2021] [Indexed: 12/15/2022] Open
Abstract
Chronic hepatitis C virus (cHCV) infection is a major global health burden and the leading cause of hepatocellular carcinoma (HCC) in the Western world. The course and outcome of HCV infection is centrally influenced by CD8+ T cell responses. Indeed, strong virus-specific CD8+ T cell responses are associated with spontaneous viral clearance while failure of these responses, e.g., caused by viral escape and T cell exhaustion, is associated with the development of chronic infection. Recently, heterogeneity within the exhausted HCV-specific CD8+ T cells has been observed with implications for immunotherapeutic approaches also for other diseases. In HCC, the presence of tumor-infiltrating and peripheral CD8+ T cell responses correlates with a favorable prognosis. Thus, tumor-associated and tumor-specific CD8+ T cells are considered suitable targets for immunotherapeutic strategies. Here, we review the current knowledge of CD8+ T cell responses in chronic HCV infection and HCC and their respective failure with the potential consequences for T cell-associated immunotherapeutic approaches.
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Roberts MH, Ferguson GT. Real-World Evidence: Bridging Gaps in Evidence to Guide Payer Decisions. PHARMACOECONOMICS - OPEN 2021; 5:3-11. [PMID: 32557235 PMCID: PMC7895868 DOI: 10.1007/s41669-020-00221-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Randomized controlled trials (RCTs) are preferred by payers for health technology assessments and coverage decisions. However, the inclusion of a highly selective patient population and the rigorously controlled conditions in RCTs may not be reflective of real-world clinical practice. Real-world evidence (RWE) obtained from an analysis of real-world data (RWD) from observational studies can bridge gaps in evidence not addressed by RCTs and is thus valuable to public and private payers for decision-making. Through a broad literature search to obtain insights into payers' experience, we found that payers have concerns about real-world studies with respect to data quality, poor internal validity, potential bias, and lack of meaningful endpoints. However, they valued RWE to fill evidence gaps not addressed by RCTs, such as high-quality, real-world, long-term effectiveness and safety data; head-to-head drug comparisons; cost analyses for tiering formulary placement; medication use and adherence patterns; identification of relevant responder and non-responder patient subpopulations; and patient-reported outcomes (PROs). RWE can be used to assess clinically meaningful endpoints and gauge the impact of interventions on the quality of healthcare. Here, we review how payers use or can use RWD on the comparative effectiveness and safety of treatments, PROs, medication adherence and persistence, prescribing patterns, healthcare resource utilization, and patient characteristics and/or biomarkers associated with treatment response when making health technology assessments and payer coverage decisions across therapeutic areas.
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Affiliation(s)
- Melissa H Roberts
- Department of Pharmacy Practice and Administrative Sciences, MSC09 5360, The University of New Mexico College of Pharmacy, University of New Mexico, Albuquerque, NM, 87131, USA.
| | - Gary T Ferguson
- Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI, 48336, USA
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Fabbiani M, Lombardi A, Colaneri M, Del Poggio P, Perini P, D'Ambrosio R, Degasperi E, Dibenedetto C, Giorgini A, Pasulo L, Maggiolo F, Castelli F, Brambilla P, Spinelli O, Re T, Lleo A, Rumi M, Uberti-Foppa C, Soria A, Aghemo A, Lampertico P, Baiguera C, Schiavini M, Fagiuoli S, Bruno R. High rates of sustained virological response despite premature discontinuation of directly acting antivirals in HCV-infected patients treated in a real-life setting. J Viral Hepat 2021; 28:558-568. [PMID: 33306247 DOI: 10.1111/jvh.13454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/21/2020] [Accepted: 11/18/2020] [Indexed: 01/08/2023]
Abstract
In routine clinical practice, hepatitis C virus-infected patients can prematurely discontinue the prescribed regimen for several reasons. The aim of our study was to investigate sustained virological response (SVR12) rates in patients who prematurely discontinued directly acting antiviral (DAA) regimens and to assess the shortest effective duration of DAA able to lead to SVR12. We retrospectively collected the SVR rates of patients, registered in the NAVIGATORE-Lombardia Network database from January 2015, who discontinued DAAs before the predefined end of treatment. Overall, we included 365 patients, males were the majority (213, 58.4%), mean age was 60.5 years, and 53 (14.5%) patients were HIV-co-infected. Liver cirrhosis was observed in 251 (68.8%) subjects, and the most represented genotypes were 1b (n = 168, 46%) and 3 (n = 59, 16.2%). DAA was discontinued a median of 1 (IQR 1-4) weeks before the predefined EOT, with 164 (44.9%) patients stopping DAAs at least 2 weeks before the planned schedule. In patients with F0-F3 liver fibrosis, lower rates of SVR12 were observed in patients treated for <4 weeks: 50% (n = 2/4) vs. 99.1% (n = 109/110) for ≥4 weeks, p = 0.003. In patients with liver cirrhosis, lower rates of SVR12 were observed in patients treated <8 weeks: 83.3% (n = 25/30) vs. 94.6% (n = 209/221) for ≥8 weeks, p = 0.038. Despite premature discontinuation of DAA, high SVR12 rates were observed in a real-life setting for treatment lasting at least 4 weeks in patients with liver fibrosis F0-F3 and 8 weeks in those with liver cirrhosis. On this basis, feasibility of reducing DAA treatment duration should be explored in randomized clinical trials.
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Affiliation(s)
- Massimiliano Fabbiani
- U.O. Malattie Infettive e Tropicali, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Andrea Lombardi
- U.O. Malattie Infettive e Tropicali, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marta Colaneri
- U.O. Malattie Infettive e Tropicali, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Paolo Perini
- Divisione di Medicina, Policlinico San Pietro, Bergamo, Italy
| | - Roberta D'Ambrosio
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,UOC Gastroenterologia ed Epatologia, CRC 'AM e A Migliavacca' per lo studio e la cura delle malattie del fegato, Milan, Italy
| | - Elisabetta Degasperi
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,UOC Gastroenterologia ed Epatologia, CRC 'AM e A Migliavacca' per lo studio e la cura delle malattie del fegato, Milan, Italy
| | - Clara Dibenedetto
- Unità di Epatologia e Gastroenterologia, Ospedale San Paolo, Milan, Italy
| | - Alessia Giorgini
- Unità di Epatologia e Gastroenterologia, Ospedale San Paolo, Milan, Italy
| | - Luisa Pasulo
- Unità di Gastroenterologia, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Franco Maggiolo
- U.O. Malattie Infettive, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Paola Brambilla
- U.O. Malattie Infettive, Istituti Ospitalieri, Cremona, Italy
| | | | - Tiziana Re
- U.O. Malattie Infettive, ASST Ovest Milanese, Legnano, Italy
| | - Ana Lleo
- Medicina Interna ed Epatologia, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Mariagrazia Rumi
- U.O. Epatologia, Ospedale San Giuseppe Multimedica, Università degli Studi di Milano, Milan, Italy
| | - Caterina Uberti-Foppa
- Division of Infectious Diseases, Vita-Salute San Raffaele University Milan, Milan, Italy.,Division of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Soria
- UO Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Alessio Aghemo
- Medicina Interna ed Epatologia, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Pietro Lampertico
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,UOC Gastroenterologia ed Epatologia, CRC 'AM e A Migliavacca' per lo studio e la cura delle malattie del fegato, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Chiara Baiguera
- UO Malattie Infettive, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Monica Schiavini
- Dipartimento di Malattie Infettive, Ospedale Luigi Sacco, Milan, Italy
| | - Stefano Fagiuoli
- Unità di Gastroenterologia, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Raffaele Bruno
- U.O. Malattie Infettive e Tropicali, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Mafirakureva N, Lim AG, Khalid GG, Aslam K, Campbell L, Zahid H, Van den Bergh R, Falq G, Fortas C, Wailly Y, Auat R, Donchuk D, Loarec A, Coast J, Vickerman P, Walker JG. Cost-effectiveness of screening and treatment using direct-acting antivirals for chronic Hepatitis C virus in a primary care setting in Karachi, Pakistan. J Viral Hepat 2021; 28:268-278. [PMID: 33051950 PMCID: PMC7821258 DOI: 10.1111/jvh.13422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 09/07/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022]
Abstract
Despite the availability of effective direct-acting antiviral (DAA) treatments for Hepatitis C virus (HCV) infection, many people remain undiagnosed and untreated. We assessed the cost-effectiveness of a Médecins Sans Frontières (MSF) HCV screening and treatment programme within a primary health clinic in Karachi, Pakistan. A health state transition Markov model was developed to estimate the cost-effectiveness of the MSF programme. Programme cost and outcome data were analysed retrospectively. The incremental cost-effectiveness ratio (ICER) was calculated in terms of incremental cost (2016 US$) per disability-adjusted life year (DALY) averted from the provider's perspective over a lifetime horizon. The robustness of the model was evaluated using deterministic and probabilistic sensitivity analyses (PSA). The ICER for implementing testing and treatment compared to no programme was US$450/DALY averted, with 100% of PSA runs falling below the per capita Gross Domestic Product threshold for cost-effective interventions for Pakistan (US$1,422). The ICER increased to US$532/DALY averted assuming national HCV seroprevalence (5.5% versus 33% observed in the intervention). If the cost of liver disease care was included (adapted from resource use data from Cambodia which has similar GDP to Pakistan), the ICER dropped to US$148/DALY, while it became cost-saving if a recently negotiated reduced drug cost of $75/treatment course was assumed (versus $282 in base-case) in addition to cost of liver disease care. In conclusion, screening and DAA treatment for HCV infection are expected to be highly cost-effective in Pakistan, supporting the expansion of similar screening and treatment programmes across Pakistan.
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Affiliation(s)
| | - Aaron G. Lim
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | | | - Khawar Aslam
- Operational Center BrusselsMédecins Sans FrontièresIslamabadPakistan
| | - Linda Campbell
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Hassaan Zahid
- Operational Center BrusselsMédecins Sans FrontièresIslamabadPakistan
| | | | | | | | - Yves Wailly
- Operational Center BrusselsMédecins Sans FrontièresBrusselsBelgium
| | - Rosa Auat
- Operational Center BrusselsMédecins Sans FrontièresBrusselsBelgium
| | - Dmytro Donchuk
- Operational Center BrusselsMédecins Sans FrontièresBrusselsBelgium
| | | | - Joanna Coast
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Peter Vickerman
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK,NIHR Health Protection Research Unit in Behavioural Science and EvaluationUniversity of BristolBristolUK
| | - Josephine G. Walker
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
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45
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Xu C, Zhu D. On Conflicts between Pharmaceutical Patent Protection and the Right to Life and Health Based on a Stackelberg Game. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031119. [PMID: 33513961 PMCID: PMC7908086 DOI: 10.3390/ijerph18031119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/15/2021] [Accepted: 01/20/2021] [Indexed: 12/28/2022]
Abstract
To solve the conflict between pharmaceutical patent protection and the right to life, health and increased patient satisfaction, drug prices can be regulated by levying an excess profit tax. An optimal tax strategy was formulated that not only could lower drug prices and improve public health and welfare, but also considers companies’ earnings. The strategy was based on the Stackelberg game theory as a bi-level mathematical model. In the model, the government is the leader, with patient satisfaction as the main goal, and pharmaceutical companies are the followers, with maximum drug revenue as the goal. The results show that under the premise of ensuring sufficient incentives for patent holders, the optimized tax on excess profit can effectively compensate for the shortcomings of pharmaceutical patent protection, alleviate the failure of market regulation of drug prices, improve patient satisfaction, and increase total social welfare.
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Affiliation(s)
- Chunming Xu
- Shanghai International College of Intellectual Property, Tongji University, Shanghai 200092, China;
| | - Debao Zhu
- School of Management, Shanghai University, Shanghai 200444, China
- Correspondence: ; Tel.: +86-139-1665-5770
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46
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International Price Comparisons of Anticancer Drugs: A Scheme for Improving Patient Accessibility. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020670. [PMID: 33466893 PMCID: PMC7830510 DOI: 10.3390/ijerph18020670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
Abstract
Background: The demand for implementing a new listing scheme to expedite patient access to novel oncology drugs has increased in South Korea. This study was conducted to compare the prices of anticancer drugs between eight countries and to explore the feasibility of a ‘pre-listing and post-evaluation’ scheme to expedite patient access to oncology drugs. Methods: This study included 34 anticancer drugs, which were reimbursed between 1 January 2007 and 31 December 2017. The unit price and sales volume of the study drugs were collected from eight countries and IQVIA data, respectively. The prices were adjusted to estimate the ex-factory prices using the discount/rebate rate suggested by the Health Insurance Review Agency (HIRA). The four price indices of Laspeyres, Paasche, Fisher, and the unweighted index were calculated using the price in each country, the average price, and lowest price among the study countries. Each currency was converted using the currency exchange rate and purchasing power parity (PPP). The budget impact of implementing the proposed pre-listing and post-evaluation scheme on payers was calculated. Results: Based on the currency exchange rate, anticancer drug prices were higher in other countries (index range: 1.05–2.78) compared to Korea. The prices in Korea were similar to countries with the lowest prices. When the PPP was applied, prices were higher in the US, Germany, Italy, and Japan than in Korea (range: 1.10–2.13); however, the prices were lower in the UK, France, and Switzerland than in Korea (range: 0.72–0.99). The financial burden of implementing the pre-listing and post-evaluation scheme was calculated at 0.83% of the total anticancer drug sales value in Korea from 2013–2017. Conclusions: The prices of anticancer drugs in Korea were similar to the lowest prices among the seven other study countries. A pre-listing and post-evaluation scheme should be considered to improve patient access to novel anticancer drugs by reducing the reimbursement review time and uncertainties.
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47
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Lu YM, Yang WL, Chang CY, Ling SM, Liu CY, Wei J, Yang HS. Clinical Experience of Patients With Hepatitis C Treated With Direct-Acting Antivirals After Heart Transplantation. Transplant Proc 2020; 53:665-672. [PMID: 33341262 DOI: 10.1016/j.transproceed.2020.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/20/2020] [Accepted: 10/30/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hepatitis C increases the mortality and morbidity of patients after heart transplant. Direct-acting antivirals (DAAs) are the primary drugs for hepatitis C treatment. However, such drugs are expensive and frequently unaffordable for patients. In DAA treatment, the assessment of drug interaction is crucial. METHODS We investigated a retrospective case series study from January 2017 to December 2019. Sustained virologic response 12 (SVR12) was used to assess the effectiveness of DAA treatment. Data on patients' demographic information, timing of hepatitis C virus (HCV) infection (before or after heart transplant), HCV genotypes and viral loads, DAAs used (branded drugs or generic drugs), and drug interaction assessments were collected. RESULTS Fifteen heart transplant patients received hepatitis C treatments during the study period, 11 of whom were infected because their donors had hepatitis C. After DAA treatment, HCV was undetectable in all patients, and 93.3% of them achieved SVR12. Nine patients used the generic sofosbuvir/velpatasvir, and 88.9% of them achieved SVR12. A total of 256 drugs were used with DAAs; 51 records of drug interactions were noted, 3 of which were contraindications, and the remaining records were potential interactions. Patients who used sofosbuvir or elbasvir/grazoprevir experienced fewer drug interactions. CONCLUSIONS DAA treatment is effective for hepatitis C treatment in patients after heart transplant. Patients who cannot afford branded drugs because of their prices can use generic drugs as an alternative. Drug interactions must be surveyed during DAA treatment.
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Affiliation(s)
- You-Min Lu
- Division of Pharmacy, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Wei-Ling Yang
- Undergraduate student, School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chung-Yi Chang
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Sheng-Ming Ling
- Division of Pharmacy, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Chia-Ying Liu
- Division of Pharmacy, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Jeng Wei
- Office of the Superintendent, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Hou-Sheng Yang
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.
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48
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Dhiman RK, Premkumar M. Hepatitis C Virus Elimination by 2030: Conquering Mount Improbable. Clin Liver Dis (Hoboken) 2020; 16:254-261. [PMID: 33489098 PMCID: PMC7805299 DOI: 10.1002/cld.978] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/28/2020] [Accepted: 04/22/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Radha K. Dhiman
- Department of HepatologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
- Mukh‐Mantri Punjab Hepatitis C Relief FundPunjab GovernmentPunjabIndia
- Ministry of Health and Family WelfareNew DelhiIndia
- Injection Safety Project, Punjab GovernmentPunjabIndia
| | - Madhumita Premkumar
- Department of HepatologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
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49
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Angelis A, Naci H, Hackshaw A. Recalibrating Health Technology Assessment Methods for Cell and Gene Therapies. PHARMACOECONOMICS 2020; 38:1297-1308. [PMID: 32960434 DOI: 10.1007/s40273-020-00956-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Recently licensed cell and gene therapies have promising but highly uncertain clinical benefits. They are entering the market at very high prices, with the latest entrants costing hundreds of thousands of dollars. The significant long-term uncertainty posed by these therapies has already complicated the use of conventional economic evaluation approaches such as cost-effectiveness and cost-utility analyses, which are widely used for assessing the value of new health interventions. Cell and gene therapies also risk jeopardising healthcare systems' financial sustainability. As a result, there is a need to recalibrate the current health technology assessment methods used to measure and compensate their value. In this paper, we outline a set of technical adaptations and methodological refinements to address key challenges in the appraisal of cell and gene therapies' value, including the assessment of efficiency and affordability. We also discuss the potential role of alternative financing mechanisms. Ultimately, uncertainties associated with cell and gene therapies can only be meaningfully addressed by improving the evidence base supporting their approval and adoption in healthcare systems.
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Affiliation(s)
- Aris Angelis
- Department of Health Policy, London School of Economics and Political Science, Cowdray House, Portugal Street, London, UK.
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, Cowdray House, Portugal Street, London, UK
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
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50
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van Boemmel-Wegmann S, Lo Re V, Park H. Early Treatment Uptake and Cost Burden of Hepatitis C Therapies Among Newly Diagnosed Hepatitis C Patients with a Particular Focus on HIV Coinfection. Dig Dis Sci 2020; 65:3159-3174. [PMID: 31938995 PMCID: PMC7358122 DOI: 10.1007/s10620-019-06037-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/30/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite the high efficacy and safety associated with direct-acting antivirals (DAAs), access to HCV treatment has been frequently restricted because of the high DAA drug costs. OBJECTIVES To (1) compare HCV treatment initiation rates between HCV monoinfected and HCV/HIV coinfected patients before (pre-DAA period) and after (post-DAA period) all-oral DAAs became available; and to (2) estimate the HCV treatment costs for payers and patients. RESEARCH DESIGN AND METHODS A retrospective analysis of the MarketScan® Databases (2009-2016) was conducted for newly diagnosed HCV patients. Multivariable logistic regression was used to estimate the odds ratio (OR) of initiating HCV treatments during the pre-DAA and post-DAA periods. Kruskal-Wallis test was used to compare drug costs for dual, triple and all-oral therapies. RESULTS A total of 15,063 HCV patients [382 (2.5%) HIV coinfected] in the pre-DAA period and 14,896 [429 (2.9%) HIV coinfected] in the post-DAA period were included. HCV/HIV coinfected patients had lower odds of HCV treatment uptake compared to HCV monoinfected patients during the pre-DAA period [OR, 0.59; 95% confidence interval (CI), 0.45-0.78], but no significant difference in odds of HCV treatment uptake was observed during the post-DAA period (OR, 1.08; 95% CI, 0.87-1.33). From 2009 to 2016, average payers' treatment costs (dual, $20,820; all-oral DAAs, $99,661; p < 0.001) as well as average patients' copayments (dual, $593; all-oral DAAs $933; p < 0.001) increased significantly. CONCLUSIONS HCV treatment initiation rates increased, especially among HCV/HIV coinfected patients, from the pre-DAA to the post-DAA period. However, payers' expenditures per course of therapy saw an almost fivefold increase and patients' copayments increased by 55%.
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Affiliation(s)
- Sascha van Boemmel-Wegmann
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, HPNP Building Room 3325, 1225 Center Drive, Gainesville, FL, 32610, USA
| | - Vincent Lo Re
- Division of Infectious Diseases, Department of Medicine and Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Haesuk Park
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, HPNP Building Room 3325, 1225 Center Drive, Gainesville, FL, 32610, USA.
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