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Yang Y, Liu Y, Mao Z, Mao J, Jin Y. The impact of Chinese volume-based procurement on pharmaceutical market concentration. Front Pharmacol 2024; 15:1386533. [PMID: 38895618 PMCID: PMC11183305 DOI: 10.3389/fphar.2024.1386533] [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: 02/15/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024] Open
Abstract
Objectives Optimizing the pharmaceutical industrial structure is the key mission of China's healthcare reform. From the industrial structure perspective, this study empirically evaluated the impact of China's national volume-based procurement (NVBP) policy on market concentration in the hospital-end drug market. Methods This study used drug procurement data of China's public medical institutions which obtained from the national database. A quasi-natural experiment was designed involving eleven pairs of matched treatment-control region combinations, with NVBP policy as the intervention measure. The market was defined by drug name (molecular boundary) and city/province (geographical boundary). Market changes were measured from three dimensions: the number of enterprises and products, market share, and Herfindahl-Hirschman index (HHI). Dual comparison approach and difference-in-difference (DID) method with fixed effect model were applied to quantify policy impacts. Results The number of enterprises and products decreased by 18 and 83 in pilot regions after NVBP policy, far more than the decreases in control regions (6 and 21). The accumulative market share of 15 bid-winning enterprises increased by 53.67% in volume and 18.79% in value, among which the increment of enterprises with low baseline market share was more prominent (66.64% and 36.40%). Among three enterprise types, the market share of generic consistency evaluation (GCE) certificated generics significantly increased, GCE uncertificated generics significantly decreased, and originators slightly decreased. DID models indicated significantly positive impact of NVBP policy on market concentration, with HHI-volume and HHI-value increasing by 49.33% (β = 0.401, p < 0.01) and 21.05% (β = 0.191, p < 0.01). Conclusion The implementation of NVBP promoted the intensive drug circulation and supply of Chinese public hospitals, intensifying the exit of GCE uncertificated generics from the hospital-end market. NVBP combined with GCE standards significantly improved market concentration, which brought a positive signal of pharmaceutical industrial structure optimization in China. In the future context of normalized and institutionalized NVBP, the balance should be further sought between low drug prices and reliable hospital drug supply, sustainable industry development.
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Affiliation(s)
- Ying Yang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Yuxin Liu
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zongfu Mao
- Global Health Institute, Wuhan University, Wuhan, China
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
| | - Jing Mao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yalei Jin
- Department of General Practice, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
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2
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Németh G, Mágó ML, Kaló Z, Lám J, Balogh T, Brodszky V. A concept for multi-winner tenders for medicinal products with balancing between efficient prices, long-term competition and sustainability of supply. Front Med (Lausanne) 2023; 10:1282698. [PMID: 37964880 PMCID: PMC10642851 DOI: 10.3389/fmed.2023.1282698] [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: 08/24/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023] Open
Abstract
Achieving price efficiency via tenders, the sustainability of competition, and the prevention of shortages are hot topics in the debates about shaping the pharmaceutical markets. Single-winner tenders receive growing criticism for concentrating on achieving low prices at the expense of the long-term maintenance of a competitive pharmaceutical industry, the security of continuous supply, and disregarding the therapeutic needs of patient populations with specific conditions. This paper aims at drafting a concept to assist the design of multi-winner tenders for medicinal products with a focus on supply and sales guarantees, price efficiency, and equity in access. The concept shall be generally applicable to all kinds of medicinal products including generics, biosimilars, and on-patent products in the out- and in-patient sector. Principles for multi-winner tenders for medicinal products are set and a number of delimitations are made in order to get rid of factors that prevent clairvoyance amid the various pricing and reimbursement systems when designing a concept. The steps to plan and implement a multi-winner tendering procedure are drafted on the basis of the defined principles. The tender should consist of planning, bidding, preparation, sales, and evaluation phases. Pharmaceutical companies shall make bids with price and quantity pairs, which shall be ranked by prices and if applicable then taking into account other factors. The tenderer shall predefine market shares to the various places of the ranking. A double ceiling shall be applicable for the sales of the winners: their sales must not exceed their quantity offer and the predefined market share applicable to their place in the ranking. The implementation of the concept will require the careful adjustment of the tender conditions to the specificities of the pharmaceutical market concerned on the one hand and to the local pricing and reimbursement system on the other hand.
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Affiliation(s)
- Gergely Németh
- Data-Driven Health Division of National Laboratory for Health Security, Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
- Department of Reimbursement, National Institute of Health Insurance Fund Management, Budapest, Hungary
| | - Mánuel László Mágó
- Institute of Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Judit Lám
- Data-Driven Health Division of National Laboratory for Health Security, Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
| | - Tamás Balogh
- Department of Reimbursement, National Institute of Health Insurance Fund Management, Budapest, Hungary
| | - Valentin Brodszky
- Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary
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Aronson JK, Heneghan C, Ferner RE. Drug shortages. Part 2: Trends, causes and solutions. Br J Clin Pharmacol 2023; 89:2957-2963. [PMID: 37455465 DOI: 10.1111/bcp.15853] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/10/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Drug shortages make it difficult or impossible to meet the therapeutic needs of individual patients or populations. In the first part of this review we proposed an operational definition that incorporates the processes by which products are manufactured, the causes of shortages and stock-outs (local shortages), and the contributory factors. Here we discuss causes and possible solutions. Drug shortages have complex causes, and a single cause cannot always be identified. Reasons include lack or shortage of raw materials, manufacturing difficulties, regulatory and political actions, voluntary recalls, just-in-time inventory systems, halts in production for financial or other business reasons, low demand (eg, orphan products, reduced usage), mergers, market shifts (eg, diversion to home markets) and unexpected increases in demand (eg, improved diagnosis, new trial information, epidemics and pandemics, inappropriate use, off-label use). Potential solutions are as diverse as the potential causes. Prevention is hard, because shortages are not easily predicted. Everyone in the supply chain is involved in anticipating and managing shortages, with responsibilities for preventing them or at least trying to mitigate their effects. This includes manufacturers and suppliers, particularly of generic formulations, pharmacists, prescribers, patients and governments. Solutions can therefore be linked to the causes and classified according to where the responsibility for implementing them lies.
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Affiliation(s)
- Jeffrey K Aronson
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Carl Heneghan
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Robin E Ferner
- West Midlands Centre for Adverse Drug Reactions, City Hospital, Birmingham, UK
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
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Zhang W, Xu Q, Peng J, Zhang X, Chen L, Wu Y, Yang K, Luan J, Liu X. Problems and challenges encountered by Chinese medical institutions in implementing the national centralized drug procurement. Front Pharmacol 2023; 14:1233491. [PMID: 37745061 PMCID: PMC10513935 DOI: 10.3389/fphar.2023.1233491] [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: 06/02/2023] [Accepted: 08/17/2023] [Indexed: 09/26/2023] Open
Abstract
Objective: The problems and challenges encountered by Chinese medical institutions in implementing the national centralized drug procurement was investigated and analyzed in order to provide reference for the regulatory agencies to formulate policies. Methods: A questionnaire survey was conducted to collect the problems encountered by 329 Chinese medical institutions in implementing the national centralized drug procurement and the corresponding suggestions provided by relevant experts. Statistical analysis was performed to identify differences in the themes and the number of collected problems, further revealing the relevance to the region in which the medical institutions is located. Result: 1360 problems and suggestions were collected from 329 Chinese medical institutions that located in North (19.15%), Northeast (5.78%), East (33.43%), Central (10.03%), South (9.73%), Southwest (14.89%), and Northwest China (6.99%). There was statistically significant difference in the number of collected problems and suggestions between regions (p < 0.001). Furthermore, the content of gathered problems and suggestions involves in 15 themes including system construction, organizational system and work responsibilities, reasonable measurement and reporting of procurement volume et al. These themes that these medical institutions are focusing on are mainly centered on the supply guarantee (15%), reasonable measurement and reporting of procurement volume (11.40%) and guarantee measures for clinical priority use (9.48%) of drugs with national centralized procurement. Meanwhile, we found that problems regarding the supply guarantee of drugs with national centralized procurement displayed significant difference between regions (p = 0.0096). Conclusion: Chinese medical institutions are facing great challenges in implementing the national centralized drug procurement. The scientific study and judgment of the current situation and the construction of corresponding solution require a precise classification of the problems encountered by medical institutions in the process of implementing the national centralized drug procurement policy, which is of great practical significance for deepening the reform of the medical and health system.
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Affiliation(s)
| | | | | | | | | | | | | | - Jiajie Luan
- The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, Anhui, China
| | - Xiaoyun Liu
- The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, Anhui, China
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Antoñanzas F, Juárez-Castelló C, Rodríguez-Ibeas R. Tenders for generics and biosimilars: a challenging purchasing policy. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:485-487. [PMID: 36943538 DOI: 10.1007/s10198-023-01580-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 05/12/2023]
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Barbier L, Vandenplas Y, Boone N, Huys I, Janknegt R, Vulto AG. How to select a best-value biological medicine? A practical model to support hospital pharmacists. Am J Health Syst Pharm 2022; 79:2001-2011. [PMID: 36002245 PMCID: PMC9452170 DOI: 10.1093/ajhp/zxac235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE With the growing availability of biosimilars on the global market, clinicians and pharmacists have multiple off-patent biological products to choose from. Besides the competitiveness of the product's price, other criteria should be considered when selecting a best-value biological. This article aims to provide a model to facilitate transparent best-value biological selection in the off-patent biological medicines segment. SUMMARY The presented model was developed on the basis of established multicriteria decision analysis tools for rational and transparent medicine selection, ie, the System of Objectified Judgement Analysis and InforMatrix. Criteria for the model were informed by earlier research, a literature search, and evaluation by the authors. The developed model includes up-to-date guidance on criteria that can be considered in selection and provides background on the allocation of weights that may aid hospital pharmacists and clinicians with decision-making in practice. Three main categories of criteria besides price were identified and included in the model: (1) product-driven criteria, (2) service-driven criteria, and (3) patient-driven criteria. Product-driven criteria include technical product features and licensed therapeutic indications. Service-driven criteria consist of supply conditions, value-added services, and environment and sustainability criteria. Patient-driven criteria contain product administration elements such as ease of use and service elements such as patient support programs. Relative weighting of the criteria is largely context dependent and should in a given setting be determined at the beginning of the process. CONCLUSION The practical model described here may support hospital pharmacists and clinicians with transparent and evidence-based best-value biological selection in clinical practice.
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Affiliation(s)
- Liese Barbier
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Yannick Vandenplas
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Niels Boone
- Hospital Pharmacy, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | | | - Arnold G Vulto
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.,Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
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Menter A, Cohen S, Kay J, Strand V, Gottlieb A, Hanauer S, Eduru SK, Buschke S, Lang B, Liesenfeld KH, Schaible J, McCabe D. Switching Between Adalimumab Reference Product and BI 695501 in Patients with Chronic Plaque Psoriasis (VOLTAIRE-X): A Randomized Controlled Trial. Am J Clin Dermatol 2022; 23:719-728. [PMID: 35934770 PMCID: PMC9464749 DOI: 10.1007/s40257-022-00708-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/26/2022]
Abstract
Background BI 695501 is an FDA-approved biosimilar to adalimumab reference product (RP). VOLTAIRE-X was a randomized clinical trial to assess outcomes with a biosimilar monoclonal antibody in line with the FDA requirements for designation as an ‘interchangeable’ biosimilar. Objective The aim of this study was to assess whether multiple switches between adalimumab RP and BI 695501 lead to equivalent pharmacokinetics and a similar safety and immunogenicity profile compared with continuous adalimumab RP. Methods We conducted a phase III, double-blind, randomized controlled trial between July 19, 2017, and April 16, 2019. There were 49 investigational sites across Europe and North America. Of 323 screened patients with moderate-to-severe chronic plaque psoriasis, 259 were treated with adalimumab RP during the run-in period. Of these, 118 and 120 were randomized to the continuous or switching arms, respectively. Interventions consisted of a run-in period with adalimumab RP 80 mg subcutaneously (SC) on Day 1, then 40 mg SC every other week (EOW) Weeks 2–12. Patients were then randomized to receive adalimumab RP 40 mg EOW Weeks 14–48 (continuous arm) or BI 695501 40 mg Weeks 14 and 16, adalimumab RP 40 mg Weeks 18 and 20, and BI 695501 40 mg EOW Weeks 22 to 48 (switching arm); all interventions were given SC. Primary endpoints were pharmacokinetics parameters, area under the plasma concentration–time curve (AUCτ,30–32) and maximum observed drug plasma concentration (Cmax,30–32), measured after the third switch during the Week 30–32 dosing interval. Results 238 patients (mean [standard deviation] age 44.9 [13.8]; 66.0% male) were treated in the switching (n = 118) or continuous arms (n = 120). Adjusted mean Cmax,30–32 was 7.08 and 7.00 μg/mL in the switching and continuous treatment arms, respectively; adjusted mean AUCτ,30–32 was 2025.8 and 1925.9 μg h/mL. Point estimate for mean ratio for AUCτ,30–32 was 105.2% (90.2% confidence interval [CI] 96.6–114.6), and 101.1% (90.2% CI 93.3–109.7) for Cmax,30–32. Both CIs were within a predefined bioequivalence range of 80.0–125.0%. Treatment-emergent adverse events led to discontinuation in 0.8% and 1.7% of patients in the switching and continuous treatment arms, and Psoriasis Area and Severity Index (PASI) scores were highly similar in the two arms across the entire trial period. Conclusions Pharmacokinetic equivalence was demonstrated, with highly similar efficacy and immunogenicity, and comparable safety observed in patients with chronic plaque psoriasis who received either adalimumab RP continuously or who switched between adalimumab RP and BI 695501. Trial Registration ClinicalTrials.gov: NCT03210259 (registered July 2017); Eudract.ema.europa.eu: 2016-002254-20. Video abstract Switching between adalimumab reference product and BI 695501 in patients with chronic plaque psoriasis (VOLTAIRE-X): a randomized controlled trial (MP4 9244 kb)
Supplementary Information The online version contains supplementary material available at 10.1007/s40257-022-00708-w.
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Affiliation(s)
- Alan Menter
- Baylor Scott & White, 3900 Junius Street, suite 125, Dallas, TX, 75246, USA.
| | | | - Jonathan Kay
- UMass Memorial Medical Center and UMass Chan Medical School, Worcester, MA, USA
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, CA, USA
| | - Alice Gottlieb
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stephen Hanauer
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Susanne Buschke
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Benjamin Lang
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | | | | | - Dorothy McCabe
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
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Chhabra H, Mouslim MC, Kashiramka S, Rathore AS. Dynamics of biosimilar uptake in emerging markets. Expert Opin Biol Ther 2022; 22:679-688. [PMID: 35535988 DOI: 10.1080/14712598.2022.2076557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Globally, biosimilars are expected to play a key role in lowering healthcare costs and providing increased patient access to biological therapies. Given this, and in line with the European Union and World Health Organization, many emerging nations have adapted and established biosimilar regulatory guidelines. Emerging nations present a lucrative market for biosimilar development and commercialization, yet they also pose unique challenges. A thorough understanding of the unique attributes of emerging markets in relation to biosimilars is needed to promote their successful uptake in low- and middle-income countries. AREAS COVERED This article highlights the opportunities and challenges that emerging markets represent in terms of biosimilar uptake. A comprehensive analysis of biosimilar uptake in European countries, where biosimilars have gained significant market share, was carried out to identify policies that can enhance market penetration in emerging nations. EXPERT OPINION Implementation of pricing and procurement policies, as well as provider and patient confidence in biosimilar efficacy, are key factors in their uptake. Due to the high cost of biosimilar development, incentivizing domestic companies with the biosimilar manufacturing capability to produce these drugs will be helpful in ensuring a sustainable biosimilar market and a steady supply chain.
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Affiliation(s)
- Hemlata Chhabra
- Department of Chemical Engineering, Indian Institute of Technology, Delhi, India
| | - Morgane C Mouslim
- The Hilltop Institute, University of Maryland Baltimore County, Baltimore MD
| | - Smita Kashiramka
- Department of Management Studies, Indian Institute of Technology, Delhi, India
| | - Anurag S Rathore
- Department of Chemical Engineering, Indian Institute of Technology, Delhi, India
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9
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Hanauer S, Liedert B, Balser S, Brockstedt E, Moschetti V, Schreiber S. Safety and efficacy of BI 695501 versus adalimumab reference product in patients with advanced Crohn's disease (VOLTAIRE-CD): a multicentre, randomised, double-blind, phase 3 trial. Lancet Gastroenterol Hepatol 2021; 6:816-825. [PMID: 34388360 DOI: 10.1016/s2468-1253(21)00252-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND BI 695501 is a biosimilar that has demonstrated similar efficacy, safety, and immunogenicity to adalimumab reference product in patients with rheumatoid arthritis and chronic plaque psoriasis. The VOLTAIRE-CD study aimed to compare the efficacy and safety of BI 695501 with adalimumab reference product in patients with Crohn's disease. METHODS This phase 3, randomised, double-blind study was done at 92 centres in 12 countries across Europe and the USA in patients aged 18-80 years with moderately to severely active Crohn's disease (Crohn's Disease Activity Index [CDAI] score 220-450). Patients were randomly assigned 1:1 using an interactive response technology system to the BI 695501 group or adalimumab reference product group, stratified by previous exposure to infliximab (yes vs no) and simple endoscopic score for Crohn's disease at screening (<16 vs ≥16). All investigators involved in trial assessments or procedures and all patients were masked to treatment allocation until week 24. Patients received BI 695501 (40 mg/0·8 mL formulation) or adalimumab reference product (either 40 mg/0·4 mL citrate-free or 40 mg/0·8 mL) 160 mg on day 1 and 80 mg on day 15, followed by 40 mg every 2 weeks, via subcutaneous injection. The primary endpoint was the proportion of patients with clinical response (CDAI decrease ≥70 points) at week 4, with an exploratory non-inferiority margin of 0·76 for the lower limit of the two-sided 90% CI of the risk ratio (RR). The primary analysis was done in a modified full analysis set of all patients who received at least one dose of study medication and had a baseline and at least one post-baseline CDAI assessment. Safety was assessed in all patients who received at least one dose of study medication. After week 4, responders were treated until week 46; those randomly assigned to adalimumab reference product switched to BI 695501 at week 24. This study is registered at ClinicalTrials.gov (NCT02871635) and EudraCT (2016-000612-14). FINDINGS Between Jan 4, 2017, and April 5, 2018, 147 patients were enrolled and randomly assigned to BI 695501 (n=72) or adalimumab reference product (n=75). At week 4, 61 (90%) of 68 patients in the BI 695501 group and 68 (94%) of 72 in the adalimumab reference product group had a clinical response (adjusted RR 0·945 [90% CI 0·870-1·028]). In the safety analysis set, 45 (63%) of 72 patients in the BI 695501 group and 42 (56%) of 75 in the adalimumab reference product group had an adverse event during weeks 0-24; 31 (43%) and 34 (45%) had adverse events during weeks 24-56. The most common drug-related treatment-emergent adverse events during weeks 0-24 were weight increase (three [4%] patients in the BI 695501 group) and injection-site erythema and upper respiratory tract infection (three [4%] patients for each event) in the adalimumab reference product group. The only drug-related TEAEs reported in two or more patients during weeks 24-56 were weight increase and increased γ-glutamyltransferase, which occured in two (3%) patients each in the BI 695501 group. No drug-related TEAEs were reported in two or more patients during weeks 24-56 in the adalimumab reference product followed by BI 699501 group. Serious adverse events occurred in six (8%) patients in the BI 695501 group and eight (11%) in the adalimumab reference group between weeks 0-24, and two (3%) and nine (12%) patients between weeks 24-56. Adverse events of special interest occurred in two (3%) patients in each treatment group during weeks 0-24 (acute sinusitis and pulmonary tuberculosis in the BI 695501 group and anal abscess and postoperative wound infection in the adalimumab reference product group) and two (3%) patients in each group during weeks 24-56 (psoas abscess and hypersensitivity in the BI 695501 group and pulmonary tuberculosis and erythematous rash in the adalimumab reference product followed by BI 699501 group). INTERPRETATION Safety and efficacy were similar in patients with Crohn's disease treated with BI 695501 or adalimumab reference product. Treatment benefits were maintained in patients receiving adalimumab reference product who switched to BI 695501. These results further support the existing licensure of BI 695501 as an alternative to adalimumab reference product for patients with Crohn's disease, as well as the other indications for which BI 695501 is approved. FUNDING Boehringer Ingelheim.
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Affiliation(s)
- Stephen Hanauer
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | | | - Sigrid Balser
- Boehringer Ingelheim Pharma, Biberach an der Riss, Germany
| | | | | | - Stefan Schreiber
- Klinik für Innere Medizin I, Universitaetsklinikum Schleswig-Holstein, Kiel University, Kiel, Germany
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Shukar S, Zahoor F, Hayat K, Saeed A, Gillani AH, Omer S, Hu S, Babar ZUD, Fang Y, Yang C. Drug Shortage: Causes, Impact, and Mitigation Strategies. Front Pharmacol 2021; 12:693426. [PMID: 34305603 PMCID: PMC8299364 DOI: 10.3389/fphar.2021.693426] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Drug shortage is a global issue affecting low, middle, and high-income countries. Many countries have developed various strategies to overcome the problem, while the problem is accelerating, affecting the whole world. All types of drugs, such as essential life-saving drugs, oncology medicines, antimicrobial drugs, analgesics, opioids, cardiovascular drugs, radiopharmaceutical, and parenteral products, are liable to the shortage. Among all pharmaceutical dosage forms, sterile injectable products have a higher risk of shortage than other forms. The causes of shortage are multifactorial, including supply issues, demand issues, and regulatory issues. Supply issues consist of manufacturing problems, unavailability of raw materials, logistic problems, and business problems. In contrast, demand issues include just-in-time inventory, higher demand for a product, seasonal demand, and unpredictable demand. For regulatory issues, one important factor is the lack of a unified definition of drug shortage. Drug shortage affects all stakeholders from economic, clinical, and humanistic aspects. WHO established global mitigation strategies from four levels to overcome drug shortages globally. It includes a workaround to tackle the current shortage, operational improvements to reduce the shortage risk and achieve early warning, changes in governmental policies, and education and training of all health professionals about managing shortages.
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Affiliation(s)
- Sundus Shukar
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Fatima Zahoor
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
- Yusra Institute of Pharmaceutical Sciences, Islamabad, Pakistan
| | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Amna Saeed
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Ali Hassan Gillani
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Sumaira Omer
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Shuchen Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
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Off-Patent Biologicals and Biosimilars Tendering in Europe-A Proposal towards More Sustainable Practices. Pharmaceuticals (Basel) 2021; 14:ph14060499. [PMID: 34073861 PMCID: PMC8225063 DOI: 10.3390/ph14060499] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 01/21/2023] Open
Abstract
Background: In Europe, off-patent biologicals and biosimilars are largely procured by means of tender procedures. The organization and design of tenders may play a key role in the evolving biosimilar market, and currently, it is not fully elucidated how tenders for off-patent biologicals and biosimilars are designed and if approaches are aligned with sustaining market competition and societal savings for healthcare systems over the long term. This study aims to (i) explore the design and implementation of tender procedures for off-patent biologicals and biosimilars in Europe, (ii) identify learnings for sustainable tender approaches from purchasers and suppliers, and (iii) formulate recommendations in support of competitive and sustainable tender practices in the off-patent biologicals market. Methods: A mixed methods design was applied. A quantitative web-survey was conducted with hospital pharmacists and purchasers (N = 60, of which 47 completed the survey in full), and qualitative expert-interviews with purchasers and suppliers (N = 28) were carried out. Results: The web survey results showed that the organization and design of tenders for off-patent biologicals and biosimilars, and the experience of hospital pharmacists and purchasers with this, considerably varies on several elements across European countries. From the qualitative interviews, signals emerged across the board that some of the current tender approaches might negatively affect market dynamics for off-patent biologicals and biosimilars. The focus on generating short-term savings and existence of originator favouring tender practices were identified as elements that may limit timely competition from and market opportunity for biosimilar suppliers. The need to optimize tender processes, considering a more long-term strategic and sustainable view, was expressed. In addition, challenges appear to exist with differentiating between products beyond price, showing the need and opportunity to guide stakeholders with the (appropriate) inclusion of award criteria beyond price. Due to the variety in tender organization in Europe, a ‘one size fits all’ tendering framework is not possible. However, on an overarching level, it was argued that tender procedures must aim to (i) ensure market plurality and (ii) include award criteria beyond price (warranted that criteria are objectively and transparently defined, scored and competitively rewarded). Depending on the market (maturity), additional actions may be needed. Conclusions: Findings suggest the need to adjust tender procedures for off-patent biologicals and biosimilars, considering a more long-term strategic and market sustainable view. Five main avenues for optimization were identified: (i) safeguarding a transparent, equal opportunity setting for all suppliers with an appropriate use of award criteria; (ii) fostering a timely opening of tender procedures, ensuring on-set competition; (iii) ensuring and stimulating adherence to laws on public procurement; (iv) securing an efficient process, improving plannability and ensuring timely product supply and (v) safeguarding long-term sustainable competition by stimulating market plurality.
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Vandenplas Y, Simoens S, Van Wilder P, Vulto AG, Huys I. Off-Patent Biological and Biosimilar Medicines in Belgium: A Market Landscape Analysis. Front Pharmacol 2021; 12:644187. [PMID: 33953678 PMCID: PMC8091126 DOI: 10.3389/fphar.2021.644187] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/02/2021] [Indexed: 12/14/2022] Open
Abstract
Background and objective: Best-value biological medicines may generate competition in the off-patent biologicals market, resulting in having more resources available to provide patients with access to necessary medicines while maintaining high-quality care. Belgium is a country known to have low biosimilar market shares, suggesting a malfunctioning market for off-patent biologicals. This study aims to gain an in-depth understanding of the Belgian off-patent biologicals market, by looking at the evolution in volumes and costs of the relevant products in the market. Methods: This study included a combination of quantitative and qualitative research methods. The quantitative part of this study consisted of the analysis of market data obtained by the National Institute for Health and Disability Insurance (NIHDI) for all relevant products in the Belgian off-patent biologicals market (i.e. TNF-inhibitors, insulins, granulocyte colony-stimulating factors, epoetins, rituximab, trastuzumab). In addition, for the qualitative part of this study, semi-structured interviews with Belgian stakeholders were conducted between December 2019 and March 2020. Results: Belgian market data and stakeholder perceptions suggest a suboptimal market environment for off-patent biological and biosimilar medicines. Shifts are observed after loss of exclusivities of originator biologicals toward second-generation products or new therapeutic class products, at a higher cost and often limited added value. Moreover, cost reductions for off-patent biologicals after biosimilar market entry are mainly determined by mandatory price reductions applicable to both originator and biosimilar products, and not by lower prices induced by competition. For products used in the retail setting, significant mandatory price reductions for both originator and reference products with low biosimilar volumes were pointed out as the main reasons for the lack of price competition. For products dispensed in hospitals, the hospital financing system is important. First, it does not always encourage the use of lower cost alternatives. Second, competition mainly takes place at the level of confidential discounts in tenders. Most interviewees acknowledged the lack of a competitive environment, which is not supportive of a sustainable Belgian off-patent biologicals market. Conclusion: Market data and stakeholder perceptions indicate that the sustainability of the Belgian market for off-patent biologicals is challenged. A sustainable market ensures access to biological therapies now and in the future.
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Affiliation(s)
- Yannick Vandenplas
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Philippe Van Wilder
- Ecole de Santé Publique, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Arnold G Vulto
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium.,Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
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Thaver T, Padayachee N, Bangalee V. A comparison study between public and private healthcare sector medicine prices in South Africa. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmaa016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objectives
The objectives of the study were to compare price trends, determine price differentials, and equate the average price index of a basket of medicines between the public and private healthcare sectors in South Africa.
Methods
A price list consisting of 32 essential medicines available in both the public and private healthcare systems of South Africa was chosen for this study. The price of medicines for the private sector were obtained from the Medicine Price Registry-Open Up website for the period 2014–2018. Public sector medicine prices were obtained from the Department of Health website for the corresponding period. Observations and price trends were identified and analyzed using Microsoft Excel version 2016.
Key findings
A total of 74 medicine brands were analyzed in the study. It was found that the prices across both sectors had increased over time, however, the majority of brands (87%) displayed higher prices in the private sector in comparison to the public sector. On average, the price differential between the private and public sector medicines were 395.47%.
Conclusions
The study found varying price differences between medicines in the public and private sectors because of the different methodologies used in each. The reasons for changes in medicine prices across the years in both sectors, could not always be clearly determined as both sectors lacked complete transparency in the processes applied to establish medicine prices. Therefore, more transparent medicine price systems need to be considered for the future of South Africa’s healthcare system as the country transitions toward universal health coverage.
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Affiliation(s)
- Tarryn Thaver
- College of Health Sciences, Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, KwaZulu Natal, South Africa
| | - Neelaveni Padayachee
- Faculty of Health Sciences, Pharmacy and Pharmacology, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Varsha Bangalee
- College of Health Sciences, Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, KwaZulu Natal, South Africa
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Goldschmidt J, Hanes V. The Totality of Evidence and Use of ABP 215, a Biosimilar to Bevacizumab. Oncol Ther 2020; 9:213-223. [PMID: 33336310 PMCID: PMC8140169 DOI: 10.1007/s40487-020-00133-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/24/2020] [Indexed: 11/29/2022] Open
Abstract
ABP 215 (MVASI™, Amgen, Thousand Oaks, CA; MVASI™, Amgen Europe B.V., Netherlands) is a biosimilar to bevacizumab (Avastin®, Genentech, South San Francisco, CA) reference product (RP), a monoclonal antibody targeting vascular endothelial growth factor A (VEGF-A). Here we provide a brief overview of the totality of evidence that supported the approval of ABP 215, along with practical considerations to ensure safe and effective administration. ABP 215 has been shown to be highly similar to the RP, with similar mechanism of action, analytical (structural and functional) characteristics, binding, and potency. The similarity of PK parameters of ABP 215 and bevacizumab RP has been confirmed in healthy volunteers. In a comparative clinical trial, patients with stage IV or recurrent non-squamous non-small cell lung cancer receiving carboplatin and paclitaxel were randomized to ABP 215 or bevacizumab RP. No clinically meaningful differences were found between ABP 215 and RP. The objective response rate (ORR) was 39% for ABP 215 and 41.7% for bevacizumab RP. The risk ratio for the ORR was 0.93 [90% confidence interval (CI), 0.80–1.09], which fell within the prespecified margin for equivalence of 0.67–1.5, indicating similar clinical efficacy. Similar to bevacizumab RP, ABP 215 is supplied as a clear to slightly opalescent, colorless to pale yellow, sterile solution in a glass vial. It should be diluted in 0.9% sodium chloride in polyvinylchloride or polyolefin bags before administering as an intravenous infusion. The ABP 215 solution should be stored at 2–8 °C (36–46°F) prior to use. Physicochemical stability studies showed that there were no meaningful changes in purity or potency and no loss of protein after storage at 2–8 °C for 35 days followed by storage at 30 °C for 48 h.
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Affiliation(s)
- Jerome Goldschmidt
- Oncology and Hematology Associates of Southwest Virginia, US Oncology Research, McKesson Specialty Health, Blacksburg, VA, USA.
| | - Vladimir Hanes
- Amgen Inc., 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA
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Moorkens E, Barcina Lacosta T, Vulto AG, Schulz M, Gradl G, Enners S, Selke G, Huys I, Simoens S. Learnings from Regional Market Dynamics of Originator and Biosimilar Infliximab and Etanercept in Germany. Pharmaceuticals (Basel) 2020; 13:E324. [PMID: 33096709 PMCID: PMC7590006 DOI: 10.3390/ph13100324] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/17/2020] [Accepted: 10/17/2020] [Indexed: 12/05/2022] Open
Abstract
Drug budget and prescription control measures are implemented regionally in Germany, meaning that the uptake of pharmaceuticals, including biosimilars, can vary by region. We examine regional market dynamics of tumor necrosis factor alpha (TNFα) inhibitor originators and biosimilars in Germany and studied the influence of biosimilar policies on these dynamics. This study is based on: (1) a literature review in which German biosimilar policies are identified, (2) the analysis of dispensing data (2010-2018) for the class of TNFα inhibitors, and (3) ten semi-structured interviews investigating prescribers' and insurers' views on factors potentially influencing biosimilar uptake. The analysis of biosimilar market shares of infliximab and etanercept revealed wide variations across the 17 German Regional Associations of Statutory Health Insurance Accredited Physicians (PA regions). Quantitative analyses indicated that biosimilar market shares for infliximab and etanercept were significantly lower in former East Germany when compared to former West Germany regions. Through qualitative interview analyses, this study showed that the use of infliximab and etanercept biosimilars across Germany is primarily influenced by (1) the regional-level implementation of biosimilar quotas and the presence of monitoring/sanctioning mechanisms to ensure adherence to these quotas, (2) the different insurer-manufacturer discount contracts, and (3) gainsharing arrangements established at the insurer-prescriber level.
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Affiliation(s)
- Evelien Moorkens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium; (E.M.); (T.B.L.); (I.H.); (S.S.)
| | - Teresa Barcina Lacosta
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium; (E.M.); (T.B.L.); (I.H.); (S.S.)
| | - Arnold G. Vulto
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium; (E.M.); (T.B.L.); (I.H.); (S.S.)
- Hospital Pharmacy, Erasmus University Medical Center, 3015 Rotterdam, The Netherlands
| | - Martin Schulz
- Institute of Pharmacy, Freie Universität Berlin, 14195 Berlin, Germany
- Department of Medicine, ABDA—Federal Union of German Associations of Pharmacists, 10557 Berlin, Germany
- Deutsches Arzneiprüfungsinstitut e. V. (DAPI), 10557 Berlin, Germany; (M.S.); (G.G.); (S.E.)
| | - Gabriele Gradl
- Deutsches Arzneiprüfungsinstitut e. V. (DAPI), 10557 Berlin, Germany; (M.S.); (G.G.); (S.E.)
| | - Salka Enners
- Deutsches Arzneiprüfungsinstitut e. V. (DAPI), 10557 Berlin, Germany; (M.S.); (G.G.); (S.E.)
| | - Gisbert Selke
- AOK Research Institute (WIdO), 10178 Berlin, Germany;
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium; (E.M.); (T.B.L.); (I.H.); (S.S.)
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium; (E.M.); (T.B.L.); (I.H.); (S.S.)
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Baker JF, Leonard CE, Lo Re V, Weisman MH, George MD, Kay J. Biosimilar Uptake in Academic and Veterans Health Administration Settings: Influence of Institutional Incentives. Arthritis Rheumatol 2020; 72:1067-1071. [PMID: 32253823 DOI: 10.1002/art.41277] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/27/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare uptake in the ordering of biosimilars at a Veterans Affairs Medical Center (VAMC) to that at an academic medical center, where institutional incentives for infused medications differ. METHODS We performed a cross-sectional study of medical record data and estimated institutional financial incentives at 2 medical centers in Philadelphia: 1) the University of Pennsylvania Health System (UPHS), and 2) the local VAMC. All ordering events for filgrastim or infliximab products were quantified over time and stratified according to product (biosimilar versus reference product) and center. Financial incentives to the institutions over time were determined based on actual drug costs for the VAMC and average sales prices (ASPs) and Medicare Part B reimbursement rates for UPHS. RESULTS There were 15,761 infusions of infliximab at UPHS, of which 99% were for the reference product. There was a sharper decline in the use of reference products at the VAMC; 62% of the 446 infliximab infusions ordered at the VAMC were for the reference product. ASPs were consistently lower for biosimilar infliximab products, but the estimated institutional financial incentives remained similar over time for biosimilar and reference infliximab at UPHS. At the VAMC, the costs for 100-mg vials of reference infliximab and infliximab-abda were $623.48 and $115.58, respectively: a $507.90 (81%) savings per vial. CONCLUSION The uptake of infliximab biosimilars has been slow at an academic medical center compared to a nearby VAMC, where financial savings are realized by the institution from its use. Slow adoption of biosimilar medications may impact the rates of decline in costs.
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Affiliation(s)
- Joshua F Baker
- Corporal Michael J. Crescenz VA Medical Center and University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Charles E Leonard
- University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Vincent Lo Re
- University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | - Michael D George
- University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Jonathan Kay
- University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester
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The 'Netflix plus model': can subscription financing improve access to medicines in low- and middle-income countries? HEALTH ECONOMICS POLICY AND LAW 2020; 16:113-123. [PMID: 32122423 DOI: 10.1017/s1744133120000031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
At present, pay for prescription models are insufficient at containing costs and improving access to medicines. Subscription financing through tenders, licensing fees and unrestricted or fixed volumes can benefit stakeholders across the supply chain. Pharmaceutical manufacturers can reduce the need for marketing expenses and gain certainty in revenue. This will decrease costs, improve predictability in budget expenditure for payers and remove price as a barrier of access from patients. Inherently, low- and middle-income countries lack the purchasing power to leverage price discounts through typical price arrangements. These markets can realise substantial savings for branded and generic medicines through subscription financing. Procuring of on-patent and off-patent drugs requires separate analysis for competition effects, the length of contract and encouraging innovation in the medicine pipeline. Prices of competitive on-patent medicines and orphan drugs can be reduced through increased competition and volume. Furthermore, pooling expertise and resources through joint procurement has the potential for greater savings. Incentivising research and development within the pharmaceutical industry is essential for sustaining a competitive market, preventing monopolies and improving access to expensive treatments. However, technical capacity, forecasting demand and the quality of generic medicines present limitations which necessitate government support and international partnerships. Ultimately, improving access requires progressive financing mechanisms with patients and cost containment in mind.
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Simoens S, Cheung R. Tendering and biosimilars: what role for value-added services? JOURNAL OF MARKET ACCESS & HEALTH POLICY 2020; 8:1705120. [PMID: 32002174 PMCID: PMC6968494 DOI: 10.1080/20016689.2019.1705120] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 11/06/2019] [Accepted: 11/19/2019] [Indexed: 05/12/2023]
Abstract
Background: Access to biologic medicines (including biosimilars) across Europe is largely governed by a process of tendering conducted by health authorities. Over-reliance on treatment costs in awarding tenders has the potential to hinder competition and undermine the long-term sustainability of biosimilars. Objective: To assess the extent and impact of consideration of 'value-added services' (VAS) in tendering for biosimilars, we conducted a narrative review of published literature. Results: Findings from survey-based publications indicated that tendering practices for biosimilars are widely used, with cost being the main determinant of success and little detail being available on other criteria where these apply. Criteria (of therapeutic and technical interest) beyond price were included in one tendering specification for infliximab (originator and biosimilars), while a separate tender for the same product included VAS in the form of therapeutic drug monitoring, measurement of antibodies and calprotectin. Conclusions: Published evidence concerning inclusion of VAS in tendering for biosimilars is lacking. Development and implementation of standardized criteria and methods of assessment for tenders may avoid manufacturers facing segmented markets, encourage competition and the longer-term sustainability of biosimilars, and realize the healthcare system and patient benefits these treatments can bring.
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Affiliation(s)
- Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- CONTACT Steven Simoens Department of Pharmaceutical & Pharmacological Sciences, Campus Gasthuisberg O&N2, Herestraat 49 Box 521, LeuvenBE-3000, Belgium
| | - Raymond Cheung
- Medical Affairs, Inflammation and Immunology, Innovative Medicines Business, Pfizer Inc, New York, NY, USA
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Larsen LK, Outzen EM, Gazerani P, Plet H. Complexity of Drug Substitutions Caused by Drug Tenders: A Mixed-Methods Study in Denmark. Hosp Pharm 2019; 56:314-320. [PMID: 34381267 DOI: 10.1177/0018578719894980] [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: 11/15/2022]
Abstract
Objective: The objective of this study was to investigate factors influencing the complexity of drug substitutions caused by drug tenders in a Danish hospital setting. Methods: A sequential explanatory mixed-methods approach was employed. In the first phase, a custom-made, self-administered questionnaire was distributed to 58 pharmacists and pharmaconomists employed at the Hospital Pharmacy in the North Denmark Region. The questionnaire consisted of 13 questions, which helped to obtain quantitative information on factors complicating drug substitutions. The results were used to inform the construction of an interview guide for a focus group interview held in the following qualitative second phase of the study. The focus group included 11 pharmacists and pharmaconomists from the Hospital Pharmacy in the North Denmark Region working with drug substitutions. The focus group interview was conducted to facilitate validation of results from the questionnaire survey and to add further perspectives on identified factors influencing the complexity of drug substitutions. Results: Findings from both phases of the study revealed that implementation of drug substitutions is more complex when drug strength or pharmaceutical form of a drug changes, compared with changes of drug trade name or package size. Furthermore, it was established that Anatomical Therapeutic Chemical classification codes could be used to identify drug substitutions that are typically complex, for example, L01 and N05. Several external factors were also found to influence implementation of drug substitutions, for example, related to drug usage, number of end users, and hospital wards. Conclusions: From a hospital pharmacy point of view, multiple factors were identified that could influence and complicate the implementation of drug substitutions with different impact size. Those factors included both changed characteristics of drugs, Anatomical Therapeutic Chemical classification codes involved in substitution, and external factors.
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Affiliation(s)
- Lina Klitgaard Larsen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
| | | | - Parisa Gazerani
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
| | - Hanne Plet
- Hospital Pharmacy of the North Denmark Region, Aalborg, Denmark
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Gleeson D, Lexchin J, Labonté R, Townsend B, Gagnon MA, Kohler J, Forman L, Shadlen KC. Analyzing the impact of trade and investment agreements on pharmaceutical policy: provisions, pathways and potential impacts. Global Health 2019; 15:78. [PMID: 31775767 PMCID: PMC6882307 DOI: 10.1186/s12992-019-0518-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Trade and investment agreements negotiated after the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) have included increasingly elevated protection of intellectual property rights along with an expanding array of rules impacting many aspects of pharmaceutical policy. Despite the large body of literature on intellectual property and access to affordable medicines, the ways in which other provisions in trade agreements can affect pharmaceutical policy and, in turn, access to medicines have been little studied. There is a need for an analytical framework covering the full range of provisions, pathways, and potential impacts, on which to base future health and human rights impact assessment and research. A framework exploring the ways in which trade and investment agreements may affect pharmaceutical policy was developed, based on an analysis of four recently negotiated regional trade agreements. First a set of core pharmaceutical policy objectives based on international consensus was identified. A systematic comparative analysis of the publicly available legal texts of the four agreements was undertaken, and the potential impacts of the provisions in these agreements on the core pharmaceutical policy objectives were traced through an analysis of possible pathways. Results An analytical framework is presented, linking ten types of provisions in the four trade agreements to potential impacts on four core pharmaceutical policy objectives (access and affordability; safety, efficacy, and quality; rational use of medicines; and local production capacity and health security) via various pathways. Conclusions The analytical framework highlights provisions in trade and investment agreements that need to be examined, pathways that should be explored, and potential impacts that should be taken into consideration with respect to pharmaceutical policy. This may serve as a useful checklist or template for health and human rights impact assessments and research on the implications of trade agreements for pharmaceuticals.
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Affiliation(s)
- Deborah Gleeson
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Joel Lexchin
- School of Health Policy & Management, York University, Toronto, Canada
| | - Ronald Labonté
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Belinda Townsend
- School of Regulation and Global Governance, Australian National University, Canberra, Australia
| | - Marc-André Gagnon
- School of Public Policy & Administration, Carleton University, Ottawa, Canada
| | - Jillian Kohler
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Lisa Forman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Kenneth C Shadlen
- Department of International Development, London School of Economics and Political Science, London, UK
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Cuellar S, McBride A, Medina P. Pharmacist perspectives and considerations for implementation of therapeutic oncology biosimilars in practice. Am J Health Syst Pharm 2019; 76:1725-1738. [DOI: 10.1093/ajhp/zxz190] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Abstract
Purpose
An overview of therapeutic oncology biosimilars, the U.S. biosimilars regulatory pathway, and the clinical development of selected biosimilar products is provided, including discussion of considerations in adopting biosimilars into oncology practice.
Summary
Biosimilars are biologic agents that are highly similar to and have no clinically meaningful differences from an approved reference product in terms of safety, purity, and potency. There is a large market for cancer biologics, and approval of biosimilars has the potential to increase access to care and reduce costs. An abbreviated regulatory pathway for the development and approval of biosimilars defines a stepwise approach to demonstrating biosimilarity and conducting clinical comparative trials to confirm equivalent pharmacokinetics, efficacy, safety, and immunogenicity to the reference product. Three therapeutic biologics (bevacizumab, trastuzumab, and rituximab) have been used extensively in the treatment of a variety of cancers and are targets for biosimilar product development. Preclinical and clinical experience with 2 recently approved biosimilars to bevacizumab and trastuzumab is reviewed. Challenges faced by pharmacy and therapeutics committees when considering oncology biosimilars for formulary inclusion are discussed.
Conclusion
Increased adoption of biosimilars could potentially lower treatment costs and improve access to biologics for patients with cancer. Key considerations in formulary review of biosimilars include the quality and quantity of data from comparative clinical trials, economic factors, manufacturer reliability, and challenges associated with incorporating biosimilars into practice.
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Affiliation(s)
- Sandra Cuellar
- University of Illinois at Chicago, College of Pharmacy, Chicago, IL
| | - Ali McBride
- University of Arizona Cancer Center, Tucson, AZ
| | - Patrick Medina
- University of Oklahoma Stephenson Cancer Center, Oklahoma City, OK
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Poulsen JH, Rishøj RM, Fischer H, Kart T, Nørgaard LS, Sevel C, Dieckmann P, Clemmensen MH. Drug change: 'a hassle like no other'. An in-depth investigation using the Danish patient safety database and focus group interviews with Danish hospital personnel. Ther Adv Drug Saf 2019; 10:2042098619859995. [PMID: 31321023 PMCID: PMC6628512 DOI: 10.1177/2042098619859995] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/28/2019] [Indexed: 11/15/2022] Open
Abstract
Background: Drug change (DC) is a common challenge in Danish hospitals. It affects the
work of hospital personnel and has potentially serious patient safety
consequences. Focus on medication safety is becoming increasingly important
in the prevention of adverse events. The aim of this study is to identify
and describe patient safety challenges related to DCs, and to explore
potential facilitators to improve patient safety in the medication process
in Danish hospital setting. Method: Two qualitative methods were combined. Data were obtained from the Danish
Patient Safety Database (DPSD) containing incidents reports of adverse
events related to DCs. Additionally, five semi-structured focus group
interviews with hospital personnel (doctors, nurses, pharmacists and
pharmacy technicians) from the five regions of Denmark were held. Results: The DPSD search identified 88 incidents related to DCs due to tender or drug
shortage. The incidents were linked to prescribing errors, incorrect dose
being dispensed/administered, and delayed/omitted treatment. Four themes
from the interviews emerged: (1) challenges related to the drug itself; (2)
situational challenges; (3) challenges related to the organization/IT
systems/personnel; (4) facilitators/measures to ensure patient safety. Conclusion: DC is as a complex challenge, especially related to drug shortage. The
results allow for a deeper understanding of the challenges and possible
facilitators of DCs on the individual and organizational level. Pharmacy
personnel were identified to play a key role in ensuring patient safety of
DCs in hospitals. Indeed, this emphasizes that pharmacy personnel should be
engaged in developing patient safety strategies and support hospital
personnel around drug changes.
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Affiliation(s)
- Joo Hanne Poulsen
- Social and Clinical Pharmacy, University of Copenhagen, Universitetsparken 2, DK-2100 Copenhagen Ø, Denmark
| | - Rikke Mie Rishøj
- The Danish Research Unit for Hospital Pharmacy, Amgros I/S, Copenhagen Ø, Denmark
| | - Hanne Fischer
- The Danish Research Unit for Hospital Pharmacy, Amgros I/S, Copenhagen Ø, Denmark
| | - Trine Kart
- The Danish Research Unit for Hospital Pharmacy, Amgros I/S, Copenhagen Ø, Denmark
| | - Lotte Stig Nørgaard
- Social and Clinical Pharmacy, University of Copenhagen, Copenhagen Ø, Denmark
| | - Christian Sevel
- The Danish Research Unit for Hospital Pharmacy, Amgros I/S, Copenhagen Ø, Denmark
| | - Peter Dieckmann
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources, Capital Region of Denmark, Herlev Hospital, Herlev, Denmark
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23
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Videau M, Chemali L, Stucki C, Saavedra-Mitjans M, Largana S, Guerin A, Bonnabry P, Delhauteur B, Van Hees T, Lebel D, Bussières JF. Drug Shortages in Canada and Selected European Countries: A Cross-Sectional, Institution-Level Comparison. Can J Hosp Pharm 2019; 72:7-15. [PMID: 30828089 PMCID: PMC6391245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Drug shortages represent a complex global problem affecting patients and health care professionals on a daily basis. OBJECTIVES To identify, describe, and compare drug shortages in health care facilities in Canada and 4 European countries in early 2018. METHODS A descriptive cross-sectional study was conducted in 1 hospital in each of 5 countries: Canada, France, Belgium, Spain, and Switzerland. Over a 4-week period, shortage data were collected daily by each hospital using a standardized grid and a standard process. RESULTS From January 8 to February 2, 2018, there were a total of 84 shortages (median duration 32 days) in the Canadian hospital, 62 shortages (median duration 9 days) in the French hospital, 46 shortages (median duration 37 days) in the Belgian hospital, 28 shortages (median duration 25 days) in the Spanish hospital, and 98 shortages (median duration 68 days) in the Swiss hospital. The number of manufacturers implicated in the shortages was 28 for the Canadian hospital, 30 for the French hospital, 19 for the Belgian hospital, 16 for the Spanish hospital, and 42 for the Swiss hospital. Most of the shortages involved parenteral drugs, with both innovative and generic manufacturers being affected. Most therapeutic classes were affected by shortages to some extent, with the top 3 classes being anti-infective agents (accounting for 21.1% of shortages overall), central nervous system drugs (11.3%), and cardiovascular drugs (8.2%). CONCLUSIONS Drug shortages occurred almost daily in all of the study hospitals. Across the 5 hospitals, the frequency of shortages varied by a factor of 3, which may imply similar variability at the national level. All stakeholders should work more diligently to prevent and manage drug shortages.
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Affiliation(s)
- Manon Videau
- is a PharmD candidate with the Faculty of Pharmacy (ISPB), Université Claude Bernard Lyon 1, Lyon, France, and a Research Assistant with the Pharmacy Practice Research Unit, Pharmacy Department, Centre hospitalier universitaire Sainte-Justine, Montréal, Quebec
| | - Lotfi Chemali
- is a PharmD candidate with the Faculty of Pharmacy, Université Paris Descartes, and is also a student intern with the Pharmacy Service, Hôpital Necker-Enfants malades, Paris, France
| | - Cyril Stucki
- , DPharm, is a Pharmacist with the Pharmacy Service, Hôpitaux universitaires de Genève, Geneva, Switzerland
| | - Mar Saavedra-Mitjans
- , DPharm, was, at the time of this study a Pharmacist with the Pharmacy Service, Hôpital de Santa Creu i Sant Pau, Barcelona, Spain
| | - Samuel Largana
- , DPharm, is a Pharmacist and specialist candidate in hospital pharmacy with the Pharmacy Service, Centre hospitalier régional de la Citadelle, Liège, Belgium
| | - Aurélie Guerin
- , DPharm, is a Pharmacist with the Pharmacy Service, Hôpital Necker-Enfants malades, Paris, France
| | - Pascal Bonnabry
- , DPharm, is Pharmacist and Head of the Pharmacy Service, Hôpitaux universitaires de Genève, Geneva, Switzerland
| | - Blaise Delhauteur
- , DPharm, is Pharmacist and Head of the Pharmacy Service, Centre hospitalier régional de la Citadelle, Liège, Belgium
| | - Thierry Van Hees
- , DPharm, is Pharmacist and Head of Clinical Pharmacy Services, Université de Liège, Liège, Belgium
| | - Denis Lebel
- , BPharm, MSc, FCSHP, is Assistant Director of Patient Care, Teaching and Research, Pharmacy Practice Research Unit, Pharmacy Department, Centre hospitalier universitaire Sainte-Justine, Montréal, Quebec
| | - Jean-François Bussières
- , BPharm, MSc, MBA, FCSHP, FOPQ, is Head, Pharmacy Practice Research Unit, Pharmacy Department, Centre hospitalier universitaire Sainte-Justine, and Clinical Professor, Faculty of Pharmacy, Université de Montréal, Montréal, Quebec
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24
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Rugo HS, Rifkin RM, Declerck P, Bair AH, Morgan G. Demystifying biosimilars: development, regulation and clinical use. Future Oncol 2018; 15:777-790. [PMID: 30500264 DOI: 10.2217/fon-2018-0680] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Biologics are an integral component in the treatment of various diseases. However, limited patient access to these medicines remains a significant global challenge, prompting development of safe and effective biosimilars. A biosimilar is 'highly similar to a reference (originator) product, for which there are no clinically meaningful differences between the two products in terms of safety, purity and potency'. Biosimilars have the potential to offer possible benefits, including lower treatment costs, thereby increasing patient access and clinical use, which may lead to better overall outcomes. Improved understanding of biosimilars may enhance confidence and trust in these agents. As increasing numbers of biosimilars achieve regulatory approval, this overview aims to address enduring knowledge gaps regarding the development and use of biosimilars.
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Affiliation(s)
- Hope S Rugo
- Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco, CA 94115, USA
| | | | - Paul Declerck
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, University of Leuven, Leuven, Belgium
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25
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Janvier S, De Spiegeleer B, Vanhee C, Deconinck E. Falsification of biotechnology drugs: current dangers and/or future disasters? J Pharm Biomed Anal 2018; 161:175-191. [DOI: 10.1016/j.jpba.2018.08.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/01/2018] [Accepted: 08/16/2018] [Indexed: 02/06/2023]
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26
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Alruthia YS, Alwhaibi M, Alotaibi MF, Asiri SA, Alghamdi BM, Almuaythir GS, Alsharif WR, Alrasheed HH, Alswayeh YA, Alotaibi AJ, Almeshal M, Aldekhail SN, Alhusaini A, Alrashed SA, Alrumaih AM, Dahhas MA, Alghamdi MA, Aleheidib MS, Alhaidari MH, Alharbi JA, Alshamsan A. Drug shortages in Saudi Arabia: Root causes and recommendations. Saudi Pharm J 2018; 26:947-951. [PMID: 30416350 PMCID: PMC6218331 DOI: 10.1016/j.jsps.2018.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/11/2018] [Indexed: 11/22/2022] Open
Abstract
Drug shortages are a multifaceted problem that has been recurring in Saudi Arabia over the past decade with its significant negative impact on patient care. However, there is a dearth of evidence about possible domestic reasons, if any, behind this recurring problem. Recently, the Pharmacy Education Unit at King Saud University College of Pharmacy has called for a meeting with multiple stakeholders from academia, pharmaceutical care, pharmaceutical industry, purchasing and planning, and regulatory bodies to unveil the root domestic causes of the drug shortages in the Kingdom. Four major topics were used to guide the discussion in this meeting, including: current situation of drug shortages in Saudi Arabia, major factors contributing to drug shortages, challenges and obstacles to improve drug supply, and stakeholders' recommendations to manage drug shortages. The meeting was audio-recorded and transcribed into verbatim by five authors. The text was then reviewed and analyzed to identify different themes by the first and third authors. Multiple causes were identified and several recommendations were proposed. The main domestic causes of drug shortages that were explored in this study included poor medication supply chain management, lack of government regulation that mandates early notification of drug shortages, a government procurement policy that does not keep pace with the changes in the pharmaceutical market, low profit margins of some essential drugs, weak and ineffective law-violation penalties against pharmaceutical companies and licensed drug importers and distributors, and overdependence on drug imports. The participants have also proposed multiple recommendations to address drug shortages. Policy makers should consider these factors that contribute to drug shortages in Saudi Arabia as well as the recommendations when designing future initiatives and interventions to prevent drug shortages.
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Affiliation(s)
- Yazed S. Alruthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacy Education Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mashal F. Alotaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Shatha A. Asiri
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Bushra M. Alghamdi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ghadah S. Almuaythir
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Wejdan R. Alsharif
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Hala H. Alrasheed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Yahya A. Alswayeh
- General Administration of Pharmaceutical Care, Ministry of Health, Riyadh, Saudi Arabia
| | - Abdulaziz J. Alotaibi
- Department of Medical Supply, General Directorate of Medical Services, Ministry of Interior, Riyadh, Saudi Arabia
| | - Mohammad Almeshal
- Former Chief Executive Officer of the Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Saleh N. Aldekhail
- Pharmaceutical Care Services, King Abdulaziz Medical City, National Guard-Health Affairs, Ministry of National Guard, Riyadh, Saudi Arabia
- Department of Pharmacy Practice, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulrahman Alhusaini
- Department of Supply Chain Management, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Sulaiman A. Alrashed
- Department of Medical Supply, Medical Services for Armed Forces, Ministry of Defense, Riyadh, Saudi Arabia
| | - Ali M. Alrumaih
- Department of Pharmaceutical Care, Medical Services for Armed Forces, Ministry of Defense, Riyadh, Saudi Arabia
| | - Mohammed A. Dahhas
- Department of Inspection and Law Enforcement, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Mohammed A. Alghamdi
- Department of Contracts and Purchasing, Prince Sultan Military Medical City, Ministry of Defense, Riyadh, Saudi Arabia
| | - Mohammad S. Aleheidib
- National Antivenom and Vaccines Production Center, Ministry of National Guard, Riyadh, Saudi Arabia
| | - Mohamed H. Alhaidari
- Former Head of Drug Central Registration Department and Executive Board, Health Ministers’ Council for Cooperation Council States, Riyadh, Saudi Arabia
| | - Jameel A. Alharbi
- Department of Pricing and Pharmacoeconomics, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Aws Alshamsan
- Nanomedicine Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Cazap E, Jacobs I, McBride A, Popovian R, Sikora K. Global Acceptance of Biosimilars: Importance of Regulatory Consistency, Education, and Trust. Oncologist 2018; 23:1188-1198. [PMID: 29769386 PMCID: PMC6263136 DOI: 10.1634/theoncologist.2017-0671] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/14/2018] [Indexed: 12/15/2022] Open
Abstract
Globally, biosimilars are expected to have a key role in improving patient access to biological therapies and addressing concerns regarding the escalating cost of health care. Indeed, in Europe, increased use of biologics and reduced drug prices have been observed after the introduction of biosimilars. Recently, several monoclonal antibody biosimilars of anticancer therapies have been approved, and numerous others are in various stages of clinical development. Biosimilars are authorized via a regulatory pathway separate from that used for generic drugs; they are also regulated separately from novel biologics. Biosimilar approval pathways in many major regulatory regions worldwide are, to a broad degree, scientifically aligned. However, owing to regional differences in health care priorities, policies, and resources, some important regulatory inconsistencies are evident. Acceptance of biosimilars by health care systems, health care professionals, and patients will be a key factor in the uptake of these therapies, and such regulatory variations could contribute to confusion and diminished confidence regarding the quality, efficacy, and reliability of these agents. Furthermore, the need for manufacturers to account for regulatory inconsistencies introduces inefficiencies and delays into biosimilar development programs. These issues should be addressed if biosimilars are to attain their maximal global potential. This review summarizes the evolution of the global biosimilar landscape and provides examples of inconsistencies between regulatory requirements in different regions. In addition, we review ongoing efforts to improve regulatory alignment and highlight the importance of education as a crucial factor in generating trust in, and acceptance of, biosimilars on a worldwide scale. IMPLICATIONS FOR PRACTICE Biosimilars of monoclonal antibody anticancer therapies are beginning to emerge, and more are likely to become available for clinical use in the near future. The extent to which biosimilars can contribute to cancer care will depend on their level of acceptance by health care systems, health care professionals, and patients. A better understanding of the regulatory basis for the approval of biosimilars may enhance confidence and trust in these agents. In order to have informed discussions about treatment choices with their patients, oncologists should familiarize themselves with the biosimilar paradigm.
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Affiliation(s)
- Eduardo Cazap
- Latin American & Caribbean Society of Medical Oncology, Buenos Aires, Argentina
| | | | - Ali McBride
- The University of Arizona Cancer Center, Department of Pharmacy, University of Arizona, Tucson, Arizona, USA
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28
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Husereau D, Feagan B, Selya-Hammer C. Policy Options for Infliximab Biosimilars in Inflammatory Bowel Disease Given Emerging Evidence for Switching. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:279-288. [PMID: 29411318 PMCID: PMC5940725 DOI: 10.1007/s40258-018-0371-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Biosimilars are becoming increasingly available internationally as patents expire on the originator biologic drugs they are intended to copy. Although substitution policies seen with generic drugs are being considered as a means to reduce expenditures on biologics, some biosimilars pose particular challenges in that the act of substitution may eventually lead to increased rates of therapeutic failure. As evidence requirements from regulators do not directly address this challenge, switch trials of biosimilars have emerged that may provide further answers. Using infliximab in inflammatory bowel disease as an example, we critically examine emerging evidence from two key switch trials (NOR-SWITCH and NCT020968610) and discuss the clinical and economic implications of these and what policy options may be most reasonable for payers. Options include reimbursing biosimilars for only newly diagnosed patients, using product-listing agreements to manage uncertainty, or using tiered co-payments or other incentives to promote biosimilar use.
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Affiliation(s)
- Don Husereau
- School of Epidemiology and Public Health, University of Ottawa, Room 101, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.
| | - Brian Feagan
- Robarts Clinical Trials, Robarts Research, University of Western Ontario, London, Canada
- Department of Medicine, University of Western Ontario, London, Canada
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada
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29
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Blandizzi C, Galeazzi M, Valesini G. Transitioning from first- to second-generation biosimilars: An appraisal of regulatory and post-marketing challenges. Pharmacol Res 2018; 128:306-314. [DOI: 10.1016/j.phrs.2017.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/31/2017] [Accepted: 10/31/2017] [Indexed: 12/28/2022]
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