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Marin GH. [High-cost medicines: the difficult balance between individual and collective rightsMedicamentos de alto custo: o difícil equilíbrio entre direitos individuais e coletivos]. Rev Panam Salud Publica 2024; 48:e76. [PMID: 39139469 PMCID: PMC11321442 DOI: 10.26633/rpsp.2024.76] [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: 05/04/2024] [Accepted: 06/26/2024] [Indexed: 08/15/2024] Open
Abstract
Medicines are special goods that cover the health needs of the population. In recent decades, the pharmaceutical industry has changed its research and development strategy, shifting its focus from the exploration of medicines for chronic diseases affecting a large part of the population to the search for drugs for rare diseases that affect a small number of people.This lack of a mass consumer base is reflected in a selective offer of a few very high-cost products aimed at certain diseases, which hinders both patient access and financial coverage.This article reviews the issue of high-cost medicines, including its cultural, legal, political, economic, and health aspects. It emphasizes the differences between various medicines in terms of their efficacy in changing the natural course of diseases, their market price, the consequences of their cost for healthcare funders, and the cost-opportunity ratio of having to pay for them at the expense of other essential resources.Finally, the article reflects on the legitimate rights of each individual to claim access to high-cost medicines when they are considered essential to recover a person's health, and on how guaranteeing such coverage can affect the collective rights of the population. Concrete examples that illustrate this situation are provided.
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Affiliation(s)
- Gustavo H. Marin
- Centro Universitario de FarmacologíaUniversidad Nacional de La PlataCentro Colaborador OPS-OMSLa PlataArgentinaCentro Universitario de Farmacología, Universidad Nacional de La Plata, Centro Colaborador OPS-OMS, La Plata, Argentina
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Ivama-Brummell AM, Marciniuk FL, Wagner AK, Osorio-de-Castro CG, Vogler S, Mossialos E, Tavares-de-Andrade CL, Naci H. Marketing authorisation and pricing of FDA-approved cancer drugs in Brazil: a retrospective analysis. LANCET REGIONAL HEALTH. AMERICAS 2023; 22:100506. [PMID: 37235087 PMCID: PMC10206192 DOI: 10.1016/j.lana.2023.100506] [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: 01/07/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023]
Abstract
Background Most cancer drugs enter the US market first. US Food and Drug Administration (FDA) approvals of new cancer drugs may influence regulatory decisions in other settings. The study examined whether characteristics of available evidence at FDA approval influenced time-to-marketing authorisation (MA) in Brazil, and price differences between the two countries. Methods All new FDA-approved cancer drugs from 2010 to 2019 were matched to drugs with MA and prices approved in Brazil by December 2020. Characteristics of main studies, availability of randomised controlled trials (RCTs), overall survival (OS) benefit, added therapeutic benefit, and prices were compared. Findings Fifty-six FDA-approved cancer drugs with matching indications received a MA at the Brazilian Health Regulatory Agency (Anvisa) after a median of 522 days following US approval (IQR: 351-932). Earlier authorisation in Brazil was associated with availability of RCT (median: 506 vs 760 days, p = 0.031) and evidence of OS benefit (390 vs 543 days, p = 0.019) at FDA approval. At Brazilian marketing authorisation, a greater proportion of cancer drugs had main RCTs (75% vs 60.7%) and OS benefit (42.9% vs 21.4%) than that in the US. Twenty-eight (50%) drugs did not demonstrate added therapeutic benefit over drugs for the same indication in Brazil. Median approved prices of new cancer drugs were 12.9% lower in Brazil compared to the US (adjusted by Purchasing Power Parity). However, for drugs with added therapeutic benefit median prices were 5.9% higher in Brazil compared to the US, while 17.9% lower for those without added benefit. Interpretation High-quality clinical evidence accelerated the availability of cancer medicines in Brazil. The combination of marketing and pricing authorisation in Brazil may favour the approval of cancer drugs with better supporting evidence, and more meaningful clinical benefit albeit with variable degree of success in achieving lower prices compared to the US. Funding None.
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Affiliation(s)
- Adriana M. Ivama-Brummell
- Department of Health Policy, London School of Economics and Political Science, Cowdray House, Houghton Street, London, WC2A 2AE, United Kingdom
- Office of Assessment of Safety and Efficacy, General Office of Medicines, Brazilian Health Regulatory Agency, SIA, Trecho 05, Área Especial 57, Brasília-DF CEP 71.205-050, Brazil
| | - Fernanda L. Marciniuk
- Executive Secretariat of the Drug Market Regulation Chamber, Brazilian Health Regulatory Agency, SIA, Trecho 05, Área Especial 57, Brasília-DF CEP 71.205-050, Brazil
| | - Anita K. Wagner
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - Claudia G.S. Osorio-de-Castro
- Department of Medicines Policy and Pharmaceutical Services, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, sala 632, Manguinhos, Rio de Janeiro, RJ, 21041-210, Brazil
| | - Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Austrian National Public Health Institute, Stubenring 6, Vienna, 1010, Austria
- Department of Health Care Management, Technical University of Berlin, Berlin, 10623, Germany
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, Cowdray House, Houghton Street, London, WC2A 2AE, United Kingdom
| | - Carla L. Tavares-de-Andrade
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, sala 727A, Manguinhos, Rio de Janeiro, RJ, 21041-210, Brazil
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, Cowdray House, Houghton Street, London, WC2A 2AE, United Kingdom
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Eadie A, MacGregor A, Wallach J, Ross J, Herder M. US Food and Drug Administration regulatory reviewer disagreements and postmarket safety actions among new therapeutics. BMJ Evid Based Med 2023; 28:151-156. [PMID: 36944478 DOI: 10.1136/bmjebm-2022-112005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 03/23/2023]
Abstract
OBJECTIVES To examine the association between regulatory reviewer disagreements and postmarket safety actions among novel therapeutics approved by the US Food and Drug Administration (FDA) between 2011 and 2015. Disagreements among FDA reviewers regarding the recommendation for a novel therapeutic's approval, its safety, the indicated patient population and/or other parameters of the drug's approval are common. However, the implications of such disagreements-particularly with respect to postmarket safety actions-are poorly understood. DESIGN Cross-sectional study. SETTING All novel therapeutics approved by the FDA between January 2011 and December 2015. PARTICIPANTS None. MAIN OUTCOME MEASURES Postmarket safety actions defined as new label warnings/increased warning severity, FDA safety communications and safety-related therapeutic withdrawals after the original regulatory approval. RESULTS Among 174 novel therapeutics approved by the FDA between 2011 and 2015, 42 (24%) had at least one regulatory reviewer disagreement. Altogether, 156 instances of disagreement were observed. Following market approval, a total of 253 postmarket safety actions were taken by the FDA among all new therapeutics, with at least one postmarket safety action identified for 98 (56.3%) of the 174 novel therapeutic approvals. Overall, therapeutics that were the subject of disagreement during the FDA's review had fewer safety actions following approval compared with therapeutics in which no disagreement was observed (38.1% vs 62.1%; RR 0.61, 95% CI 0.41 to 0.92; p=0.006). Therapeutic approvals containing at least one reviewer disagreement also more often carried a black box warning at the point of approval (47.7% vs 31.1%; RR 1.53, 95% CI 1.02 to 2.30; p=0.05). CONCLUSIONS This investigation of regulatory reviewer disagreements and postmarket safety actions among new therapeutics suggests that disagreements among regulatory reviewers may lead to important pre-emptive actions, potentially mitigating the need for postmarket safety actions to be taken.
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Affiliation(s)
- Ashley Eadie
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Joshua Wallach
- Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Joseph Ross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Perehudoff K, Durán C, Demchenko I, Mazzanti V, Parwani P, Suleman F, de Ruijter A. Impact of the European Union on access to medicines in low- and middle-income countries: A scoping review. THE LANCET REGIONAL HEALTH. EUROPE 2021; 9:100219. [PMID: 34693391 PMCID: PMC8513155 DOI: 10.1016/j.lanepe.2021.100219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This Scoping Review synthesises evidence of the impacts of European Union (EU) law, regulation, and policy on access to medicines in in non-EU low- and middle-income countries (LMICs), and the mechanisms and nature of those impacts. We searched eight scholarly databases and grey literature published between 1995-2021 in four languages. The EU exerts global influence on pharmaceuticals in LMICs in three ways: explicit agreements between EU-LMICs (ex. accession, trade, and economic agreements); LMICs' reliance on EU internal regulation, standards, or methods (ex. market authorisation); 'soft' forms of EU influence (ex. research funding, capacity building). This study illustrates that EU policy makers adopt measures with the potential to influence medicines in LMICs despite limited evidence of their positive and/or negative impact(s). The EU's fragmented internal and external actions in fields related to pharmaceuticals reveal the need for principles for global equitable access to medicines to guide EU policy.
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Affiliation(s)
- Katrina Perehudoff
- Law Centre for Health & Life, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, 1105 BP Amsterdam, Netherlands
- Amsterdam Centre for European Law and Governance, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
- WHO Collaborating Centre for Governance, Accountability, and Transparency in the Pharmaceutical Sector, University of Toronto, Canada
- Medicines Law & Policy, Amsterdam, the Netherlands
- Department of Public Health & Primary Care, Ghent University, Ghent, Belgium
| | - Carlos Durán
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, Netherlands
| | - Ivan Demchenko
- Department of Forensic Medicine and Medical Law, Bogomolets National Medical University, st. Mechnikova, 5, Kyiv, 01133, Ukraine
| | - Valentina Mazzanti
- Department of Public Health & Primary Care, Ghent University, Ghent, Belgium
| | - Pramiti Parwani
- Law Centre for Health & Life, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, 1105 BP Amsterdam, Netherlands
- Amsterdam Centre for European Law and Governance, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Campus Westville, Durban, 4041, South Africa
- WHO Collaborating Centre for Pharmaceutical Policy and Evidence Based Practice, University of KwaZulu-Natal, Campus Westville, Durban, 4041, South Africa
| | - Anniek de Ruijter
- Law Centre for Health & Life, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, 1105 BP Amsterdam, Netherlands
- Amsterdam Centre for European Law and Governance, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
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