1
|
Degli Esposti L. Author's Reply: "A retrospective analysis of treatment patterns, drug discontinuation and healthcare costs in Crohn's disease patients treated with biologics". Dig Liver Dis 2024; 56:216-217. [PMID: 38044227 DOI: 10.1016/j.dld.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Luca Degli Esposti
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy.
| |
Collapse
|
2
|
Maqsood Q, Sumrin A, Iqbal M, Younas S, Hussain N, Mahnoor M, Wajid A. Hepatitis C virus/Hepatitis B virus coinfection: Current prospectives. Antivir Ther 2023; 28:13596535231189643. [PMID: 37489502 DOI: 10.1177/13596535231189643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
In endemic areas, hepatitis C virus (HCV)/hepatitis B virus (HBV) coinfection is common, and patients with coinfection have a higher risk of developing liver disease such as hepatocellular carcinoma, liver fibrosis and cirrhosis. In such cases, HCV predominates, and HBV replication is suppressed by HCV. HCV core proteins and interferons that are activated by HCV are responsible for the suppression of HBV. Immunosuppression is also seen in patients with HCV and HBV coinfections. A decrease in HCV-neutralizing antibody response and circulation of Th1-like Tfh cells is observed in patients with HCV and HBV coinfection. Both viruses interacted in the liver, and treatment of HCV/HBV coinfection is genotype-based and complex due to the interaction of both viruses. In HCV-dominant cases, direct-acting antiviral drugs and peg interferon plus ribavirin are used for the treatment, with continuous monitoring of AST and ALT. HBV-dominant cases are less common and are treated with peg interferon and nucleoside nucleotide analogues with monitoring of AST and ALT. The SVR rate in HCV-HBV coinfection is higher than that in monoinfection when treated with direct-acting antiviral drugs. But there is a risk of reactivation of HBV during and after therapy. The rate of reactivation is lower in patients treated with direct-acting antiviral drugs as compared to those treated with peg interferon plus ribavirin. Biomarkers of HBV such as HBcrAg, HBV DNA and HBVpg RNA are not effective in the prediction of HBV reactivation; only the hepatitis B surface antigen titre can be used as a biomarker for HBV reactivation. HCV can also be reactive, but this is found in very rare cases in which HBV is present and is treated first.
Collapse
Affiliation(s)
- Quratulain Maqsood
- Centre for Applied Molecular Biology, University of the Punjab, Lahore, Pakistan
| | - Aleena Sumrin
- Centre for Applied Molecular Biology, University of the Punjab, Lahore, Pakistan
| | - Maryam Iqbal
- Centre for Applied Molecular Biology, University of the Punjab, Lahore, Pakistan
| | - Saima Younas
- Centre for Applied Molecular Biology, University of the Punjab, Lahore, Pakistan
| | - Nazim Hussain
- Centre for Applied Molecular Biology, University of the Punjab, Lahore, Pakistan
| | - Muhammada Mahnoor
- Department of Rehabilitation Science, The University of Lahore, Lahore, Pakistan
| | - Abdul Wajid
- Department of Biotechnology, Balochistan University of Information Technology, Engineering and Management Science, Quetta, Pakistan
| |
Collapse
|
3
|
Godman B, Fadare J, Kwon HY, Dias CZ, Kurdi A, Dias Godói IP, Kibuule D, Hoxha I, Opanga S, Saleem Z, Bochenek T, Marković-Peković V, Mardare I, Kalungia AC, Campbell S, Allocati E, Pisana A, Martin AP, Meyer JC. Evidence-based public policy making for medicines across countries: findings and implications for the future. J Comp Eff Res 2021; 10:1019-1052. [PMID: 34241546 DOI: 10.2217/cer-2020-0273] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: Global expenditure on medicines is rising up to 6% per year driven by increasing prevalence of non-communicable diseases (NCDs) and new premium priced medicines for cancer, orphan diseases and other complex areas. This is difficult to sustain without reforms. Methods: Extensive narrative review of published papers and contextualizing the findings to provide future guidance. Results: New models are being introduced to improve the managed entry of new medicines including managed entry agreements, fair pricing approaches and monitoring prescribing against agreed guidance. Multiple measures have also successfully been introduced to improve the prescribing of established medicines. This includes encouraging greater prescribing of generics and biosimilars versus originators and patented medicines in a class to conserve resources without compromising care. In addition, reducing inappropriate antibiotic utilization. Typically, multiple measures are the most effective. Conclusion: Multiple measures will be needed to attain and retain universal healthcare.
Collapse
Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Joseph Fadare
- Department of Pharmacology & Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Hye-Young Kwon
- Division of Biology and Public Health, Mokwon University, Daejeon, Korea
| | - Carolina Zampirolli Dias
- Graduate Program in Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Isabella Piassi Dias Godói
- Institute of Health & Biological Studies - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
- Researcher of the Group (CNPq) for Epidemiological, Economic and Pharmacological Studies of Arboviruses (EEPIFARBO) - Universidade Federal do Sul e Sudeste do Pará; Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
| | - Dan Kibuule
- Department of Pharmacy Practice & Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Albania
| | - Sylvia Opanga
- Department of Pharmaceutics & Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Zikria Saleem
- Faculty of Pharmacy, University of Lahore, Lahore, Pakistan
| | - Tomasz Bochenek
- Department of Nutrition & Drug Research, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Vanda Marković-Peković
- Department of Social Pharmacy, University of Banja Luka, Faculty of Medicine, Banja Luka, Republic of Srpska, Bosnia & Herzegovina
| | - Ileana Mardare
- "Carol Davila" University of Medicine & Pharmacy, Bucharest, Romania
| | | | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, UK
| | - Eleonora Allocati
- Istituto di Ricerche Farmacologiche 'Mario Negri' IRCCS, Milan, Italy
| | - Alice Pisana
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Antony P Martin
- Faculty of Health & Life Sciences, The University of Liverpool, Brownlow Hill, Liverpool, L69 3BX, UK
| | - Johanna C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| |
Collapse
|
4
|
Vogler S, Schneider P, Zuba M, Busse R, Panteli D. Policies to Encourage the Use of Biosimilars in European Countries and Their Potential Impact on Pharmaceutical Expenditure. Front Pharmacol 2021; 12:625296. [PMID: 34248615 PMCID: PMC8267415 DOI: 10.3389/fphar.2021.625296] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 05/31/2021] [Indexed: 01/15/2023] Open
Abstract
Introduction: Biosimilar medicines are considered promising alternatives to new biologicals with high price tags. The extent of savings resulting from biosimilar use depends on their price and uptake, which are largely shaped by pricing, reimbursement, and demand-side policies. This article informs about different policy measures employed by European countries to design the biologicals market and explores potential savings from the increased use of biosimilar medicines in Germany. Methods: Policy measures that target the price and uptake of biosimilar medicines were identified based on a prefilled questionnaire survey with public authorities in 16 European countries, who were the members of the Pharmaceutical Pricing and Reimbursement Information network (July 2020). Potential savings that could have been generated in Germany if different measures identified in the surveyed countries had been implemented were calculated for six publicly funded biological molecules. Price data of the Pharma Price Information service and German consumption data for 2018 were used for the calculation of five scenarios. Results: Several countries use a price link policy, setting the biosimilar price as a percentage of the price of the reference biological. Also lowering the price of the reference biological upon market entry of a biosimilar is less frequently used. While tendering of biosimilar medicines in the inpatient setting is the norm, it is rarely employed for biosimilars in outpatient use. Reference price systems and INN prescribing of medicines are the commonly used policy measures in the off-patent market, but some countries define exemptions for biologicals. Substituting biosimilars at the pharmacy level is rather an exception. Potential savings in Germany ranged from 5% (simple price link) to 55% (prices at the level of other countries) for the six studied molecules. Conclusion: Despite some differences, there are discernible tendencies across European countries with regard to their applications of certain policy measures targeting the price and uptake of biosimilar medicines. The potential for savings of some of these policies was clearly demonstrated. Monitoring and evaluation of these rather recent measures is key for obtaining a more comprehensive picture of their impact.
Collapse
Affiliation(s)
- Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Department of Pharmacoeconomics, Austrian National Public Health Institute (Gesundheit Österreich GmbH/GÖG), Vienna, Austria
| | - Peter Schneider
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Department of Pharmacoeconomics, Austrian National Public Health Institute (Gesundheit Österreich GmbH/GÖG), Vienna, Austria
| | - Martin Zuba
- Department of Health Economics and Health Systems Analysis, Austrian National Public Health Institute (Gesundheit Österreich GmbH/GÖG), Vienna, Austria
| | - Reinhard Busse
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Dimitra Panteli
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| |
Collapse
|
5
|
Gad M, Salem A, Oortwijn W, Hill R, Godman B. Mapping of Current Obstacles for Rationalizing Use of Medicines (CORUM) in Europe: Current Situation and Potential Solutions. Front Pharmacol 2020; 11:144. [PMID: 32194401 PMCID: PMC7063972 DOI: 10.3389/fphar.2020.00144] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/04/2020] [Indexed: 01/01/2023] Open
Abstract
Introduction There are increasing concerns regarding the inappropriate use of medicines with expenditure continuing to grow driven by increasing sales in oncology and orphan diseases, enhanced by their emotive nature. As a result, even high income countries are struggling to fund new premium priced medicines. These concerns have resulted in initiatives to better manage the entry of new medicines and enhance the rational use of medicines (RUM). However, there is a need to ascertain the current situation. We sought to address this by developing the Current Obstacles for Rationalizing Use of Medicines in Europe (CORUM) mapping tool to qualitatively investigate the current situation and provide analysis of current views on RUM and interventions among key European payers and their advisers. The findings will be used to provide future guidance. Methodology Descriptive study exploring and identifying perceived gaps to achieving optimal RUM. The CORUM tool was based on the WHO 12 key interventions to promote RUM. Results 62 participants took part with most respondents believing their country could improve RUM capacity. This included educational initiatives on the use of clinical guidelines (90%) and the inclusion of problem-based pharmacotherapy in undergraduate curricula and for Continued Professional Development. Key challenges included a lack of regular updates of guidelines, exacerbated by limited funding and a lack of follow-up to monitor adherence to agreed guidelines. RUM could also be enhanced by the development of regional formularies as well as implementing Drug and Therapeutic Committees where these are currently limited. There also needs to be greater co-ordination between RUM and Health Technology Assessment activities, with countries learning from each other. Conclusion There is an urgent need to improve RUM through improved educational and other activities among European countries, with countries learning from each other. This will involve addressing current challenges and we will be following this up.
Collapse
Affiliation(s)
- Mohamed Gad
- Global Health and Development Group, Imperial College London, London, United Kingdom
| | - Ahmed Salem
- Real World Evidence Solutions, IQVIA, Zaventem, Belgium
| | - Wija Oortwijn
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, United Kingdom
| | - Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Health Economics Centre, University of Liverpool Management School, Liverpool, United Kingdom.,Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| |
Collapse
|
6
|
Mardetko N, Kos M, Vogler S. Review of studies reporting actual prices for medicines. Expert Rev Pharmacoecon Outcomes Res 2018; 19:159-179. [DOI: 10.1080/14737167.2019.1552137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Nika Mardetko
- Faculty of pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Mitja Kos
- Faculty of pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (Austrian Public Health Institute), Vienna, Austria
| |
Collapse
|
7
|
Godman B, Bucsics A, Vella Bonanno P, Oortwijn W, Rothe CC, Ferrario A, Bosselli S, Hill A, Martin AP, Simoens S, Kurdi A, Gad M, Gulbinovič J, Timoney A, Bochenek T, Salem A, Hoxha I, Sauermann R, Massele A, Guerra AA, Petrova G, Mitkova Z, Achniotou G, Laius O, Sermet C, Selke G, Kourafalos V, Yfantopoulos J, Magnusson E, Joppi R, Oluka M, Kwon HY, Jakupi A, Kalemeera F, Fadare JO, Melien O, Pomorski M, Wladysiuk M, Marković-Peković V, Mardare I, Meshkov D, Novakovic T, Fürst J, Tomek D, Zara C, Diogene E, Meyer JC, Malmström R, Wettermark B, Matsebula Z, Campbell S, Haycox A. Barriers for Access to New Medicines: Searching for the Balance Between Rising Costs and Limited Budgets. Front Public Health 2018; 6:328. [PMID: 30568938 PMCID: PMC6290038 DOI: 10.3389/fpubh.2018.00328] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/26/2018] [Indexed: 01/26/2023] Open
Abstract
Introduction: There is continued unmet medical need for new medicines across countries especially for cancer, immunological diseases, and orphan diseases. However, there are growing challenges with funding new medicines at ever increasing prices along with funding increased medicine volumes with the growth in both infectious diseases and non-communicable diseases across countries. This has resulted in the development of new models to better manage the entry of new medicines, new financial models being postulated to finance new medicines as well as strategies to improve prescribing efficiency. However, more needs to be done. Consequently, the primary aim of this paper is to consider potential ways to optimize the use of new medicines balancing rising costs with increasing budgetary pressures to stimulate debate especially from a payer perspective. Methods: A narrative review of pharmaceutical policies and implications, as well as possible developments, based on key publications and initiatives known to the co-authors principally from a health authority perspective. Results: A number of initiatives and approaches have been identified including new models to better manage the entry of new medicines based on three pillars (pre-, peri-, and post-launch activities). Within this, we see the growing role of horizon scanning activities starting up to 36 months before launch, managed entry agreements and post launch follow-up. It is also likely there will be greater scrutiny over the effectiveness and value of new cancer medicines given ever increasing prices. This could include establishing minimum effectiveness targets for premium pricing along with re-evaluating prices as more medicines for cancer lose their patent. There will also be a greater involvement of patients especially with orphan diseases. New initiatives could include a greater role of multicriteria decision analysis, as well as looking at the potential for de-linking research and development from commercial activities to enhance affordability. Conclusion: There are a number of ongoing activities across countries to try and fund new valued medicines whilst attaining or maintaining universal healthcare. Such activities will grow with increasing resource pressures and continued unmet need.
Collapse
Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Health Economics Centre, University of Liverpool Management School, Liverpool, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Anna Bucsics
- Mechanism of Coordinated Access to Orphan Medicinal Products (MoCA), Brussels, Belgium
| | - Patricia Vella Bonanno
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Wija Oortwijn
- Ecorys, Rotterdam, Netherlands
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Celia C. Rothe
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Alessandra Ferrario
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | | | - Andrew Hill
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Antony P. Martin
- Health Economics Centre, University of Liverpool Management School, Liverpool, United Kingdom
- HCD Economics, The Innovation Centre, Daresbury, United Kingdom
| | - Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Mohamed Gad
- Global Health and Development Group, Imperial College, London, United Kingdom
| | - Jolanta Gulbinovič
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, Vilnius, Lithuania
| | - Angela Timoney
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- NHS Lothian, Edinburgh, United Kingdom
| | - Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | | | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Robert Sauermann
- Hauptverband der Österreichischen Sozialversicherungsträger, Vienna, Austria
| | - Amos Massele
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Augusto Alfonso Guerra
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Av. Presidente Antônio Carlos, Belo Horizonte, Brazil
- SUS Collaborating Centre – Technology Assessment & Excellence in Health (CCATES/UFMG), College of Pharmacy, Federal University of Minas Gerais. Av. Presidente Antônio Carlos, Belo Horizonte, Brazil
| | - Guenka Petrova
- Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Zornitsa Mitkova
- Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | | | - Ott Laius
- State Agency of Medicines, Tartu, Estonia
| | | | - Gisbert Selke
- Wissenschaftliches Institut der AOK (WIdO), Berlin, Germany
| | - Vasileios Kourafalos
- EOPYY-National Organization for the Provision of Healthcare Services, Athens, Greece
| | - John Yfantopoulos
- School of Economics and Political Science, University of Athens, Athens, Greece
| | - Einar Magnusson
- Department of Health Services, Ministry of Health, Reykjavík, Iceland
| | - Roberta Joppi
- Pharmaceutical Drug Department, Azienda Sanitaria Locale of Verona, Verona, Italy
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Hye-Young Kwon
- Division of Biology and Public Health, Mokwon University, Daejeon, South Korea
| | | | - Francis Kalemeera
- Department of Pharmacology and Therapeutics, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph O. Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
| | | | - Maciej Pomorski
- Agency for Health Technology Assessment and Tariff System (AOTMiT), Warsaw, Poland
| | | | - Vanda Marković-Peković
- Ministry of Health and Social Welfare, Banja Luka, Bosnia and Herzegovina
- Department of Social Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Ileana Mardare
- Public Health and Management Department, Faculty of Medicine, “Carol Davila”, University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Dmitry Meshkov
- National Research Institution for Public Health, Moscow, Russia
| | | | - Jurij Fürst
- Health Insurance Institute, Ljubljana, Slovenia
| | - Dominik Tomek
- Faculty of Medicine, Slovak Medical University in Bratislava, Bratislava, Slovakia
| | - Corrine Zara
- Drug Territorial Action Unit, Catalan Health Service, Barcelona, Spain
| | - Eduardo Diogene
- Vall d'Hebron University Hospital, Fundació Institut Català de Farmacologia, Barcelona, Spain
| | - Johanna C. Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Rickard Malmström
- Department of Medicine Solna, Karolinska Institutet and Clinical Pharmacology Karolinska University Hospital, Stockholm, Sweden
| | - Björn Wettermark
- Department of Medicine Solna, Karolinska Institutet and Clinical Pharmacology Karolinska University Hospital, Stockholm, Sweden
- Department of Healthcare Development, Stockholm County Council, Stockholm, Sweden
| | | | - Stephen Campbell
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Alan Haycox
- Health Economics Centre, University of Liverpool Management School, Liverpool, United Kingdom
| |
Collapse
|
8
|
Espin J, Schlander M, Godman B, Anderson P, Mestre-Ferrandiz J, Borget I, Hutchings A, Flostrand S, Parnaby A, Jommi C. Projecting Pharmaceutical Expenditure in EU5 to 2021: Adjusting for the Impact of Discounts and Rebates. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:803-817. [PMID: 30088251 PMCID: PMC6244625 DOI: 10.1007/s40258-018-0419-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Within (European) healthcare systems, the predominant goal for pharmaceutical expenditure is cost containment. This is due to a general belief among healthcare policy makers that pharmaceutical expenditure-driven by high prices-will be unsustainable unless further reforms are enacted. OBJECTIVE The aim of this paper is to provide more realistic expectations of pharmaceutical expenditure for all key stakeholder groups by estimating pharmaceutical expenditure at 'net' prices. We also aim to estimate any gaps developing between list and net pharmaceutical expenditure for the EU5 countries (i.e. France, Germany, Italy, Spain, and the UK). METHODS We adjusted an established forecast of pharmaceutical expenditure for the EU5 countries, from 2017 to 2021, by reflecting discounts and rebates not previously considered, i.e. we moved from 'list' to 'net' prices, as far as data were available. RESULTS We found an increasing divergence between expenditure measured at list and net prices. When the forecasts for the five countries were aggregated, the EU5 (unweighted) average historical growth (2010-2016) rate fell from 3.4% compound annual growth rate at list to 2.5% at net. For the forecast, the net growth rate was estimated at 1.5 versus 2.9% at list. CONCLUSIONS Our results suggest that future growth in pharmaceutical expenditure in Europe is likely to be (1) lower than previously understood from forecasts based on list prices and (2) below predicted healthcare expenditure growth in Europe and in line with long-term economic growth rates. For policy makers concerned about the sustainability of pharmaceutical expenditure, this study may provide some comfort, in that the perceived problem is not as large as expected.
Collapse
Affiliation(s)
- Jaime Espin
- Andalusian School of Public Health, Granada, Spain
| | - Michael Schlander
- Division of Health Economics, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
- Institute for Innovation & Valuation in Health Care (InnoVal-HC), Wiesbaden, Germany
| | - Brian Godman
- Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
| | | | | | - Isabelle Borget
- Gustave Roussy, Service de Biostatistique et d'Epidémiologie, Villejuif, France
- University Paris-Saclay, University Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
- GRADES, University Paris-Sud, Chatenay-Malabry, France
| | | | | | | | - Claudio Jommi
- Università del Piemonte Orientale, Novara, Italy
- Cergas (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management, Milan, Italy
| |
Collapse
|
9
|
Cipriano LE, Liu S, Shahzada KS, Holodniy M, Goldhaber-Fiebert JD. Economically Efficient Hepatitis C Virus Treatment Prioritization Improves Health Outcomes. Med Decis Making 2018; 38:849-865. [PMID: 30132410 PMCID: PMC8826843 DOI: 10.1177/0272989x18792284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The total cost of treating the 3 million Americans chronically infected with hepatitis C virus (HCV) represents a substantial affordability challenge requiring treatment prioritization. This study compares the health and economic outcomes of alternative treatment prioritization schedules. METHODS We developed a multiyear HCV treatment budget allocation model to evaluate the tradeoffs of 7 prioritization strategies. We used optimization to identify the priority schedule that maximizes population net monetary benefit (NMB). We compared prioritization schedules in terms of the number of individuals treated, the number of individuals who progress to end-stage liver disease (ESLD), and population total quality-adjusted life years (QALYs). We applied the model to the population of treatment-naive patients with a total annual HCV treatment budget of US$8.6 billion. RESULTS First-come, first-served (FCFS) treats the fewest people with advanced fibrosis, prevents the fewest cases of ESLD, and gains the fewest QALYs. A schedule developed from optimizing population NMB prioritizes treatment in the first year to patients with moderate to severe fibrosis who are younger than 65 years, followed by older individuals with moderate to severe fibrosis. While this strategy yields the greatest population QALYs, prioritization by disease severity alone prevents more cases of ESLD. Sensitivity analysis indicated that the differences between prioritization schedules are greater when the budget is smaller. A 10% annual treatment price reduction enabled treatment 1 year sooner to several patient subgroups, specifically older patients and those with less severe liver fibrosis. CONCLUSION In the absence of a sufficient budget to treat all patients, explicit prioritization targeting younger people with more severe disease first provides the greatest health benefits. We provide our spreadsheet model so that decision makers can compare health tradeoffs of different budget levels and various prioritization strategies with inputs tailored to their population.
Collapse
Affiliation(s)
| | - Shan Liu
- Industrial and Systems Engineering, University of Washington, Seattle, WA, U.S.A
| | | | - Mark Holodniy
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, U.S.A
- Department of Medicine, Stanford University, Stanford, Stanford, CA, U.S.A
- Division of Infectious Diseases & Geographic Medicine, Stanford University, Stanford, CA, U.S.A
| | - Jeremy D. Goldhaber-Fiebert
- Stanford Health Policy, Center for Health Policy and Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University, Stanford, CA, U.S.A
| |
Collapse
|
10
|
The Role of European Healthcare Databases for Post-Marketing Drug Effectiveness, Safety and Value Evaluation: Where Does Italy Stand? Drug Saf 2018; 42:347-363. [DOI: 10.1007/s40264-018-0732-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
11
|
Irino S, Kurihara Y. A Method for Deriving Quasi-healthy Cohorts From Clinical Data. BIOMEDICAL INFORMATICS INSIGHTS 2018; 10:1178222618777758. [PMID: 29872307 PMCID: PMC5977427 DOI: 10.1177/1178222618777758] [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: 09/15/2017] [Accepted: 04/25/2018] [Indexed: 12/01/2022]
Abstract
We evaluated quasi-healthy cohorts (model cohorts), derived from clinical data, to determine how well they simulated control cohorts. Control cohorts comprised individuals extracted from a public checkup database in Japan, under the condition that their values for 3 basic laboratory tests fall within specific reference ranges (3Ts condition). Model cohorts comprised outpatients, extracted from a clinical database at a hospital, under the 3Ts condition or under the condition that their values for 4 laboratory tests fall within specific reference ranges (4Ts condition). Because even a patient with a serious illness, such as cancer, may present with normal values on basic laboratory tests, one additional condition was added: the duration (1 or 3 months; 1M or 3M) during which patients were not hospitalized after their first laboratory test. For evaluations, cohorts were specified by age and sex. The 4Ts + 3M condition was the most effective condition, under which model cohorts were used to successfully simulate age-dependent changes and sex differences in laboratory test values for control cohorts. Therefore, by properly setting the conditions for extracting quasi-healthy individuals, we can derive cohorts from clinical data to simulate various types of cohorts. Although some issues with the proposed method remain to be solved, this approach presents new possibilities for using clinical data for cohort studies.
Collapse
Affiliation(s)
- Satoshi Irino
- Department of Nursing, Ehime Prefectural University of Health Sciences, Tobe-cho, Japan
| | | |
Collapse
|
12
|
Osorio-de-Castro CGS, Azeredo TB, Pepe VLE, Lopes LC, Yamauti S, Godman B, Gustafsson LL. Policy Change and the National Essential Medicines List Development Process in Brazil between 2000 and 2014: Has the Essential Medicine Concept been Abandoned? Basic Clin Pharmacol Toxicol 2017; 122:402-412. [DOI: 10.1111/bcpt.12932] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/27/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Claudia G. S. Osorio-de-Castro
- Department of Pharmaceutical Policy and Pharmaceutical Services; Sergio Arouca National School of Public Health; Oswaldo Cruz Foundation; Rio de Janeiro Brazil
| | - Thiago B. Azeredo
- Medicines Use and Surveillance Observatory; School of Pharmacy; Federal University of Rio de Janeiro; Rio de Janeiro Brazil
| | - Vera L. E. Pepe
- Department of Health Administration and Planning; Sergio Arouca National School of Public Health; Oswaldo Cruz Foundation; Rio de Janeiro Brazil
| | - Luciane C. Lopes
- Pharmaceutical Science Graduate Course; University of Sorocaba; Sorocaba Brazil
| | - Sueli Yamauti
- Pharmaceutical Science Graduate Course; University of Sorocaba; Sorocaba Brazil
| | - Brian Godman
- Division of Clinical Pharmacology; Karolinska Institutet; Karolinska University Hospital Huddinge; Stockholm Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences; University of Strathclyde; Glasgow UK
| | - Lars L. Gustafsson
- Division of Clinical Pharmacology; Karolinska Institutet; Karolinska University Hospital Huddinge; Stockholm Sweden
| |
Collapse
|
13
|
Duffy D, Mottez E, Ainsworth S, Buivan TP, Baudin A, Vray M, Reed B, Fontanet A, Rohel A, Petrov-Sanchez V, Abel L, Theodorou I, Miele G, Pol S, Albert ML. An in vitro diagnostic certified point of care single nucleotide test for IL28B polymorphisms. PLoS One 2017; 12:e0183084. [PMID: 28877177 PMCID: PMC5587232 DOI: 10.1371/journal.pone.0183084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 07/29/2017] [Indexed: 01/26/2023] Open
Abstract
Numerous genetic polymorphisms have been identified as associated with disease or treatment outcome, but the routine implementation of genotyping into actionable medical care remains limited. Point-of-care (PoC) technologies enable rapid and real-time treatment decisions, with great potential for extending molecular diagnostic approaches to settings with limited medical infrastructure (e.g., CLIA certified diagnostic laboratories). With respect to resource-limited settings, there is a need for simple devices to implement biomarker guided treatment strategies. One relevant example is chronic hepatitis C infection, for which several treatment options are now approved. Single nucleotide polymorphisms (SNPs) in the IL-28B / IFNL3 locus have been well described to predict both spontaneous clearance and response to interferon based therapies. We utilized the Genedrive® platform to develop an assay for the SNP rs12979860 variants (CC, CT and TT). The assay utilizes a hybrid thermal engine, permitting rapid heating and cooling, enabling an amplification based assay with genetic variants reported using endpoint differential melting cure analysis in less than 60 minutes. We validated this assay using non-invasive buccal swab sampling in a prospective study of 246 chronic HCV patients, achieving 100% sensitivity and 100% specificity (95% exact CI: 98.8-100%)) in 50 minutes as compared to conventional lab based PCR testing. Our results provide proof of concept that precision medicine is feasible in resource-limited settings, offering the first CE-IVD (in vitro diagnostics) validated PoC SNP test. We propose that IL-28B genotyping may be useful for directing patients towards lower cost therapies, and rationing use of costly direct antivirals for use in those individuals showing genetic risk.
Collapse
Affiliation(s)
- Darragh Duffy
- Immunobiology of Dendritic Cells, Institut Pasteur, Paris, France
- Inserm U1223, Institut Pasteur, Paris, France
- Centre for Translational Research, Institut Pasteur, Paris, France
| | - Estelle Mottez
- Centre for Translational Research, Institut Pasteur, Paris, France
- Inserm UMS20, Institut Pasteur Paris, France
| | | | - Tan-Phuc Buivan
- Centre for Translational Research, Institut Pasteur, Paris, France
- Inserm UMS20, Institut Pasteur Paris, France
- Université Paris Descartes et Département d'hépatologie, Groupe Hospitalier Cochin Hôtel- Dieu, Paris, France
| | - Aurelie Baudin
- Université Paris Descartes et Département d'hépatologie, Groupe Hospitalier Cochin Hôtel- Dieu, Paris, France
| | - Muriel Vray
- Emerging Disease Epidemiology Unit, Institut Pasteur, Paris, France
- PARCI Unit, Conservatoire National des Arts et Métiers, Paris, France
- Unit of epidemiology of infectious diseases, Institut Pasteur, Dakar, Senegal
| | - Ben Reed
- Genedrive plc, Manchester, United Kingdom
| | - Arnaud Fontanet
- Emerging Disease Epidemiology Unit, Institut Pasteur, Paris, France
- PARCI Unit, Conservatoire National des Arts et Métiers, Paris, France
| | - Alexandra Rohel
- ANRS (France REcherche Nord&Sud Sida-hiv Hépatites), Paris, France
| | | | - Laurent Abel
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Inserm U1163, Paris, France
- Paris Descartes University, Imagine Institute, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, New York, United States of America
| | - Ioannis Theodorou
- Department of Immunology, AP-HP, La Pitie Salpetriere, Paris, France
| | - Gino Miele
- Genedrive plc, Manchester, United Kingdom
| | - Stanislas Pol
- Immunobiology of Dendritic Cells, Institut Pasteur, Paris, France
- Inserm U1223, Institut Pasteur, Paris, France
- Centre for Translational Research, Institut Pasteur, Paris, France
- Inserm UMS20, Institut Pasteur Paris, France
- Université Paris Descartes et Département d'hépatologie, Groupe Hospitalier Cochin Hôtel- Dieu, Paris, France
| | - Matthew L. Albert
- Immunobiology of Dendritic Cells, Institut Pasteur, Paris, France
- Inserm U1223, Institut Pasteur, Paris, France
- Centre for Translational Research, Institut Pasteur, Paris, France
- Inserm UMS20, Institut Pasteur Paris, France
| |
Collapse
|
14
|
Vella Bonanno P, Ermisch M, Godman B, Martin AP, Van Den Bergh J, Bezmelnitsyna L, Bucsics A, Arickx F, Bybau A, Bochenek T, van de Casteele M, Diogene E, Eriksson I, Fürst J, Gad M, Greičiūtė-Kuprijanov I, van der Graaff M, Gulbinovic J, Jones J, Joppi R, Kalaba M, Laius O, Langner I, Mardare I, Markovic-Pekovic V, Magnusson E, Melien O, Meshkov DO, Petrova GI, Selke G, Sermet C, Simoens S, Schuurman A, Ramos R, Rodrigues J, Zara C, Zebedin-Brandl E, Haycox A. Adaptive Pathways: Possible Next Steps for Payers in Preparation for Their Potential Implementation. Front Pharmacol 2017; 8:497. [PMID: 28878667 PMCID: PMC5572364 DOI: 10.3389/fphar.2017.00497] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/12/2017] [Indexed: 01/11/2023] Open
Abstract
Medicines receiving a conditional marketing authorization through Medicines Adaptive Pathways to Patients (MAPPs) will be a challenge for payers. The "introduction" of MAPPs is already seen by the European Medicines Agency (EMA) as a fait accompli, with payers not consulted or involved. However, once medicines are approved through MAPPs, they will be evaluated for funding by payers through different activities. These include Health Technology Assessment (HTA) with often immature clinical data and high uncertainty, financial considerations, and negotiations through different types of agreements, which can require monitoring post launch. Payers have experience with new medicines approved through conditional approval, and the fact that MAPPs present additional challenges is a concern from their perspective. There may be some activities where payers can collaborate. The final decisions on whether to reimburse a new medicine via MAPPs will have more variation than for medicines licensed via conventional processes. This is due not only to increasing uncertainty associated with medicines authorized through MAPPs but also differences in legal frameworks between member states. Moreover, if the financial and side-effect burden from the period of conditional approval until granting full marketing authorization is shifted to the post-authorization phase, payers may have to bear such burdens. Collection of robust data during routine clinical use is challenging along with high prices for new medicines during data collection. This paper presents the concept of MAPPs and possible challenges. Concerns and potential ways forward are discussed and a number of recommendations are presented from the perspective of payers.
Collapse
Affiliation(s)
- Patricia Vella Bonanno
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of StrathclydeGlasgow, United Kingdom
| | - Michael Ermisch
- Pharmaceutical Department, National Association of Statutory Health Insurance FundsBerlin, Germany
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of StrathclydeGlasgow, United Kingdom.,Health Economics Centre, University of Liverpool Management SchoolLiverpool, United Kingdom.,Division of Clinical Pharmacology, Karolinska InstitutetStockholm, Sweden
| | - Antony P Martin
- Health Economics Centre, University of Liverpool Management SchoolLiverpool, United Kingdom
| | | | | | - Anna Bucsics
- Mechanism of Coordinated Access to Orphan Medicinal Products (MoCA)Brussels, Belgium
| | - Francis Arickx
- Department of Pharmaceutical Policy, National Institute for Health and Disability InsuranceBruxelles, Belgium
| | | | - Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical CollegeKraków, Poland
| | - Marc van de Casteele
- Department of Pharmaceutical Policy, National Institute for Health and Disability InsuranceBruxelles, Belgium
| | - Eduardo Diogene
- Clinical Pharmacology Service, University Hospital Vall d'Hebron, Universitat Autonoma de BarcelonaBarcelona, Spain
| | - Irene Eriksson
- Department of Healthcare Development, Stockholm County CouncilStockholm, Sweden.,Department of Medicine Solna, Karolinska InstitutetStockholm, Sweden
| | - Jurij Fürst
- Medicinal Products Department, Health Insurance Institute of SloveniaLjubljana, Slovenia
| | - Mohamed Gad
- Global Health and Development Group, Imperial CollegeLondon, United Kingdom
| | | | | | - Jolanta Gulbinovic
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius UniversityVilnius, Lithuania.,State Medicines Control AgencyVilnius, Lithuania
| | - Jan Jones
- Scottish Medicines ConsortiumGlasgow, United Kingdom
| | - Roberta Joppi
- Clinical Research and Drug Assessment UnitVerona, Italy
| | - Marija Kalaba
- Pediatric Cardiology, Primary Healthcare Centre "Zemun"Belgrade, Serbia
| | - Ott Laius
- Department of Post-authorisation Safety, State Agency of MedicinesTartu, Estonia
| | | | - Ileana Mardare
- Faculty of Medicine, Public Health and Management Department, "Carol Davila" University of Medicine and Pharmacy BucharestBucharest, Romania
| | - Vanda Markovic-Pekovic
- Ministry of Health and Social WelfareBanja Luka, Bosnia and Herzegovina.,Department of Social Pharmacy, Medical Faculty, University of Banja LukaBanja Luka, Bosnia and Herzegovina
| | - Einar Magnusson
- Department of Health Services, Ministry of HealthReykjavík, Iceland
| | | | | | - Guenka I Petrova
- Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University of SofiaSofia, Bulgaria
| | | | - Catherine Sermet
- Institut de Recherche et Documentation en Economie de la Santé (IRDES)Paris, France
| | - Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological SciencesLeuven, Belgium
| | - Ad Schuurman
- National Health Care Institute (ZIN)Diemen, Netherlands
| | - Ricardo Ramos
- Health Technology Assessment, Pricing and Reimbursement Department, Central Administration of the Health System, National Authority of Medicines and Health Products (I.P., INFARMED)Lisboa, Portugal
| | - Jorge Rodrigues
- Health Technology Assessment, Pricing and Reimbursement Department, Central Administration of the Health System, National Authority of Medicines and Health Products (I.P., INFARMED)Lisboa, Portugal
| | - Corinne Zara
- Barcelona Health Region, Catalan Health ServiceBarcelona, Spain
| | - Eva Zebedin-Brandl
- Department of Pharmaceutical Affairs, Main Association of Austrian Social Insurance InstitutionsVienna, Austria
| | - Alan Haycox
- Health Economics Centre, University of Liverpool Management SchoolLiverpool, United Kingdom
| |
Collapse
|
15
|
Brawley OW. The role of government and regulation in cancer prevention. Lancet Oncol 2017; 18:e483-e493. [DOI: 10.1016/s1470-2045(17)30374-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/03/2017] [Accepted: 03/07/2017] [Indexed: 12/17/2022]
|
16
|
Abstract
Between 2000 and 2013, spending on medicines in Korea increased by 275.3%. In order to curb this trend, several pricing policies and measures were introduced. This study reviews these policies and their implications based on pricing regulations as well as a literature review. New medicines now undergo both a reimbursement assessment and price negotiations. The reimbursement of new medicines is based on their cost effectiveness. The prices of new medicines are subsequently fixed through negotiations between the payer, the National Health Insurance Service, and the relevant manufacturer. Generic drugs are automatically priced via a new standard methodology. Repricing mechanisms were complicated and now redundant. Simple and efficient measures rather than complex and inefficient measures are needed to maintain the value-for-money principle for new medicines as well as achieve financial efficiency through price competition among generic drugs.
Collapse
Affiliation(s)
- Hye-Young Kwon
- Mokwon University, 88 Doan-bukro, Seo-gu, Daejeon, Republic of Korea.
| | - Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK
| |
Collapse
|
17
|
Gray E, O'Leary A, Bergin C, Cannon M, Courtney G, Crosbie O, De Gascun CF, Fanning LJ, Feeney E, Houlihan DD, Kelleher B, Lambert JS, Lee J, Mallon P, McConkey S, McCormick A, McKiernan S, McNally C, Murray F, Sheehan G, Stewart S, Walsh C, Norris S. Effectiveness of interferon-free therapy for the treatment of HCV-patients with compensated cirrhosis treated through the Irish early access program. Expert Rev Gastroenterol Hepatol 2017; 11:593-601. [PMID: 28276815 DOI: 10.1080/17474124.2017.1292850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND We investigated the real-world effectiveness of interferon-free regimens for the treatment of patients with compensated cirrhosis infected with hepatitis C virus (HCV). METHOD Using the Irish national HCV treatment registry, the effectiveness and safety of interferon-free regimens for HCV-infected patients treated between April 2015 and August 2016, was determined. RESULTS A SVR12 was achieved in 86% of subjects treated with sofosbuvir/ledipasvir ± ribavirin (SOF/LDV±RBV), 93% treated with paritaprevir, ombitasvir and ritonavir combined with dasabuvir ± ribavirin (3D±RBV) and 89% treated with sofosbuvir/daclatasvir ± ribavirin (SOF/DCV±RBV). The discontinuation rate was 5% and the on-treatment mortality rate was 1%. CONCLUSION The availability of interferon-free regimens represents a significant breakthrough for the treatment of HCV infection. Treatments options, with high SVR12 rates, are now available for patients with compensated cirrhosis who were unsuitable for treatment with interferon-based regimens. Data obtained from studies conducted in real world practice provide robust information fundamental for input into future economic evaluations for agents used for the treatment of HCV infection.
Collapse
Affiliation(s)
- E Gray
- a School of Medicine, Trinity College Dublin , Dublin , Ireland
| | - A O'Leary
- b National Centre for Pharmacoeconomics, St. James' Hospital , Dublin , Ireland.,c School of Pharmacy, Royal College of Surgeons of Ireland , Dublin , Ireland
| | - C Bergin
- a School of Medicine, Trinity College Dublin , Dublin , Ireland.,e St James' Hospital , Dublin , Ireland
| | - M Cannon
- f Beaumont Hospital , Dublin , Ireland
| | - G Courtney
- g St. Luke's Hospital , Kilkenny , Ireland
| | - O Crosbie
- h Cork University Hospital , Cork , Ireland
| | - C F De Gascun
- i National Virus Reference Laboratory , University College Dublin , Dublin , Ireland
| | - L J Fanning
- j Molecular Virology Diagnostic & Research Laboratory, Department of Medicine , University College Cork , Cork , Ireland
| | - E Feeney
- k St. Vincent's University Hospital , Dublin , Ireland
| | - D D Houlihan
- k St. Vincent's University Hospital , Dublin , Ireland
| | - B Kelleher
- d Mater Misericordiae University Hospital , Dublin , Ireland
| | - J S Lambert
- d Mater Misericordiae University Hospital , Dublin , Ireland.,n School of Medicine , University College Dublin , Dublin , Ireland
| | - J Lee
- l University College Hospital , Galway , Ireland
| | - Pwg Mallon
- d Mater Misericordiae University Hospital , Dublin , Ireland.,n School of Medicine , University College Dublin , Dublin , Ireland
| | | | - A McCormick
- k St. Vincent's University Hospital , Dublin , Ireland
| | | | - C McNally
- f Beaumont Hospital , Dublin , Ireland
| | - F Murray
- f Beaumont Hospital , Dublin , Ireland
| | - G Sheehan
- d Mater Misericordiae University Hospital , Dublin , Ireland
| | - S Stewart
- d Mater Misericordiae University Hospital , Dublin , Ireland
| | - C Walsh
- m University of Limerick , Limerick , Ireland
| | - S Norris
- a School of Medicine, Trinity College Dublin , Dublin , Ireland.,e St James' Hospital , Dublin , Ireland
| | | |
Collapse
|
18
|
Magarinos-Torres R, Lynd LD, Luz TCB, Marques PEPC, Osorio-de-Castro CGS. Essential Medicines List Implementation Dynamics: A Case Study Using Brazilian Federal Medicines Expenditures. Basic Clin Pharmacol Toxicol 2017; 121:181-188. [PMID: 28371342 DOI: 10.1111/bcpt.12783] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/20/2017] [Indexed: 11/29/2022]
Abstract
The aim was to analyse the implementation dynamics of the essential medicines list (EML). We used the government expenditures on medicines and Brazil as a case study. Drug purchases were considered as a proxy for utilization. The essential medicines (EMs) expenditures were followed over time by Brazilian National EMLs life-time and defined by broad therapeutic categories and by specific medicines. Brazil increased the number of the medicines during the last four editions of Brazilian National EMLs and the federal government expenditures on them. The EML implementation dynamics changed the distribution of expenditures on EMs. We identified a common set of 404 EMs present in all four editions of the Brazilian National EMLs. There was a proportional decrease in expenditures on anti-infectives for systemic use, blood and blood-forming organs and alimentary tract and metabolism, and increase in expenditures on antineoplastic and immunomodulating agents. The expenditures distribution per specific medicines revealed that a small set of EMs was responsible for 50% or more of expenditures considering Brazilian National EML life-time for all four periods. The increase in expenditures on EMs in Brazil was a consequence of the newer medicines incorporated over time in the Brazilian National EMLs. The use of the medicines expenditures as a source of data and the definition of an EML life-time permitted follow-up of the implementation dynamics of different versions of the Brazilian National EMLs. Our results have implications for policymakers and stakeholders to gain a better understanding of the role EMLs play in health system sustainability and in the provision of the most beneficial heath care.
Collapse
Affiliation(s)
- Rachel Magarinos-Torres
- Faculty of Pharmacy, Federal University of the State of Rio de Janeiro (UFF), Niteroi, Rio de Janeiro, Brazil.,Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Larry David Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada
| | - Tatiana Chama Borges Luz
- René Rachou Research Center, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil.,Department of Medicine, Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | | | | |
Collapse
|
19
|
Godói IP, Santos AS, Reis EA, Lemos LLP, Brandão CMR, Alvares J, Acurcio FA, Godman B, Guerra Júnior AA. Consumer Willingness to Pay for Dengue Vaccine (CYD-TDV, Dengvaxia ®) in Brazil; Implications for Future Pricing Considerations. Front Pharmacol 2017; 8:41. [PMID: 28210223 PMCID: PMC5288336 DOI: 10.3389/fphar.2017.00041] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/19/2017] [Indexed: 01/24/2023] Open
Abstract
Introduction and Objective: Dengue virus is a serious global health problem with an estimated 3.97 billion people at risk for infection worldwide. In December 2015, the first vaccine (CYD-TDV) for dengue prevention was approved in Brazil, developed by Sanofi Pasteur. However, given that the vaccine will potentially be paid via the public health system, information is need regarding consumers' willingness to pay for the dengue vaccine in the country as well as discussions related to the possible inclusion of this vaccine into the public health system. This was the objective of this research. Methods: We conducted a cross-sectional study with residents of Greater Belo Horizonte, Minas Gerais, about their willingness to pay for the CYD-TDV vaccine. Results: 507 individuals were interviewed. These were mostly female (62.4%) had completed high school (62.17%), were working (74.4%), had private health insurance (64.5%) and did not have dengue (67.4%). The maximum median value of consumers' willingness to pay for CYD-TDV vaccine is US$33.61 (120.00BRL) for the complete schedule and US$11.20 (40.00BRL) per dose. At the price determined by the Brazil's regulatory chamber of pharmaceutical products market for the commercialization of Dengvaxia® for three doses, only 17% of the population expressed willingness to pay for this vaccine. Conclusion: Brazil is currently one of the largest markets for dengue vaccine and the price established is a key issue. We believe the manufacturer should asses the possibility of lower prices to reach a larger audience among the Brazilian population.
Collapse
Affiliation(s)
- Isabella P. Godói
- Programa de Pós-graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas GeraisBelo Horizonte, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Faculdade de Farmácia, Universidade Federal de Minas GeraisBelo Horizonte, Brazil
| | - André S. Santos
- Programa de Pós-graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas GeraisBelo Horizonte, Brazil
| | - Edna A. Reis
- Department of Statistics, Exact Sciences Institute, Universidade Federal de Minas GeraisBelo Horizonte, Brazil
| | - Livia L. P. Lemos
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Faculdade de Farmácia, Universidade Federal de Minas GeraisBelo Horizonte, Brazil
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas GeraisBelo Horizonte, Brazil
| | - Cristina M. R. Brandão
- Programa de Pós-graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas GeraisBelo Horizonte, Brazil
| | - Juliana Alvares
- Programa de Pós-graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas GeraisBelo Horizonte, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Faculdade de Farmácia, Universidade Federal de Minas GeraisBelo Horizonte, Brazil
| | - Francisco A. Acurcio
- Programa de Pós-graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas GeraisBelo Horizonte, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Faculdade de Farmácia, Universidade Federal de Minas GeraisBelo Horizonte, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde UniversityGlasgow, UK
- Division of Clinical Pharmaclogy, Karolinska Institutet, Karolinska University HospitalStockholm, Sweden
| | - Augusto A. Guerra Júnior
- Programa de Pós-graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas GeraisBelo Horizonte, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Faculdade de Farmácia, Universidade Federal de Minas GeraisBelo Horizonte, Brazil
| |
Collapse
|
20
|
Younossi Z, Stepanova M, Omata M, Mizokami M, Walters M, Hunt S. Health utilities using SF-6D scores in Japanese patients with chronic hepatitis C treated with sofosbuvir-based regimens in clinical trials. Health Qual Life Outcomes 2017; 15:25. [PMID: 28143559 PMCID: PMC5282717 DOI: 10.1186/s12955-017-0598-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 01/18/2017] [Indexed: 12/15/2022] Open
Abstract
Background Health utilities are preference-based measures for health states which are typically used in economic analyses to estimate quality-adjusted life years. Our aim is to report the standard SF-6D health utility scores in Japanese patients with hepatitis C virus (HCV) during treatment with different regimens. Methods Japanese patients were enrolled in clinical trials of sofosbuvir (SOF) used in combination with or without ledipasvir (LDV) and/or ribavirin (RBV). The SF-6D health utility scores were calculated at multiple time points from the SF-36 instrument. Results Four hundred ninety-four patients with HCV (genotype 1 and 2) were enrolled: 19% with cirrhosis, 48% with a prior history of anti-HCV treatment. Of those, 153 received SOF + RBV, 170 received LDV/SOF + RBV, 171 received LDV/SOF for 12 weeks; the SVR rates were: 97, 98 and 100%, respectively. Patients treated with the three regimens had similar SF-6D scores before treatment (p = 0.87): 76.1 ± 11.5. During treatment with RBV containing regimen, patients experienced a decrement in their health utility scores to 74.3 ± 12.5 by the end of treatment (p = 0.03), while patients treated with RBV-free LDV/SOF had their SF-6D scores improved to 79.2 ± 12.8 after 12 weeks of treatment (p = 0.0004). At post-treatment week 12, in patients who achieved SVR-12, the SF-6D scores were similar between the treatment regimens (p = 0.36), and an average improvement of +1.4 points from baseline (p = 0.01) was noted. In multivariate analysis, the use of RBV was independently associated with lower utility score during treatment (beta = 4.7 ± 1.6, p < 0.0001). Conclusion Health utilities are lower in Japanese HCV patients and tend to improve after clearance of infection.
Collapse
Affiliation(s)
- Zobair Younossi
- Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA. .,Department of Medicine, Beatty Liver and Obesity Research Program, Inova Fairfax Hospital, Falls Church, VA, USA. .,Betty and Guy Beatty Center for Integrated Research, Claude Moore Health Education and Research Building, 3300 Gallows Road, Falls Church, VA, 22042, USA.
| | - Maria Stepanova
- Center for Outcomes Research in Liver Diseases, Washington, DC, USA
| | - Masao Omata
- Yamanashi Prefectural Hospital Organization, Yamanashi, Japan
| | - Masashi Mizokami
- Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Mercedes Walters
- Center for Outcomes Research in Liver Diseases, Washington, DC, USA
| | - Sharon Hunt
- Center for Outcomes Research in Liver Diseases, Washington, DC, USA
| |
Collapse
|
21
|
Borba HH, Wiens A, Steimbach LM, Tonin FS, Pedroso MLA, Ivantes CA, Fernandez-Llimos F, Pontarolo R. Rapid virological response of telaprevir and boceprevir in a Brazilian cohort of HCV genotype 1 patients: a multicenter longitudinal study. Ther Clin Risk Manag 2017; 13:59-64. [PMID: 28138248 PMCID: PMC5237588 DOI: 10.2147/tcrm.s124663] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Chronic hepatitis C is a major public health issue, but there is a gap in the literature regarding the effectiveness and safety of direct-acting antiviral agents in the Brazilian population. The main aim of this study was to describe the effectiveness of boceprevir and telaprevir in patients treated at public health care institutions in Brazil. Materials and methods A prospective longitudinal and multicenter study was conducted in five centers in the State of Paraná between September 2014 and June 2016. Data regarding effectiveness and safety were collected from medical records of patients treated with boceprevir or telaprevir. The effectiveness outcome comprised the rapid virological response (RVR). Multivariate analysis was performed to verify the influence of independent variables (ie, age, gender, baseline viral load) on RVR achievement. Results Data were collected from 117 patients with chronic hepatitis C virus (HCV) genotype 1 infection. Fifteen patients received treatment with boceprevir and 102 received telaprevir. The mean age was 51.6 years, 64.1% were male, 44.4% were infected with HCV subtype 1a, 62.4% had a high baseline viral load (≥800,000 IU/mL) and 33% were cirrhotic. Furthermore, 79.5% of patients achieved RVR (26.7% in the boceprevir group and 87.3% in the telaprevir group). Multivariate analysis demonstrated that the type of protease inhibitor (boceprevir or telaprevir) and the baseline viral load had an influence on the RVR rate (odds ratio [OR] =0.011; 95% confidence interval [CI]: 0.001–0.119; P<0.001/OR =13.004; 95% CI: 1.522–111.115; P=0.019, respectively). Conclusion In this longitudinal multicenter cohort study conducted from the Brazilian perspective, differences were found in the RVR rates, favoring telaprevir over boceprevir for genotype 1 HCV-infected patients. In addition, the baseline viral load was associated with RVR achievement in both evaluated groups. As RVR is also reported in the literature as a predictor of the sustained virological response (SVR), further analyses of RVR as predictor of SVR outcomes should be further evaluated in Brazil.
Collapse
Affiliation(s)
- Helena Hl Borba
- Pharmaceutical Sciences Postgraduate Research Program, Department of Pharmacy
| | - Astrid Wiens
- Pharmaceutical Sciences Postgraduate Research Program, Department of Pharmacy
| | - Laiza M Steimbach
- Pharmaceutical Sciences Postgraduate Research Program, Department of Pharmacy
| | - Fernanda S Tonin
- Pharmaceutical Sciences Postgraduate Research Program, Department of Pharmacy
| | - Maria LA Pedroso
- Gastroenterology Service, Hospital de Clínicas, Federal University of Paraná
| | - Cláudia Ap Ivantes
- Guidance and Counseling Center, Curitiba City Hall, Curitiba, Paraná, Brazil
| | - Fernando Fernandez-Llimos
- Department of Social Pharmacy, Faculty of Pharmacy, Research Institute for Medicines, University of Lisboa, Lisbon, Portugal
| | - Roberto Pontarolo
- Pharmaceutical Sciences Postgraduate Research Program, Department of Pharmacy
| |
Collapse
|
22
|
Perlman DC, Jordan AE, Nash D. Conceptualizing Care Continua: Lessons from HIV, Hepatitis C Virus, Tuberculosis and Implications for the Development of Improved Care and Prevention Continua. Front Public Health 2017; 4:296. [PMID: 28119910 PMCID: PMC5222805 DOI: 10.3389/fpubh.2016.00296] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/23/2016] [Indexed: 01/04/2023] Open
Abstract
Background To examine the application of continuum models to tuberculosis, HIV, and other conditions; to theorize the concept of continua; and to learn lessons that could inform the development of improved care and prevention continua as public health metrics. Methods An analytic review of literature drawn from several fields of health care. Results The continuum construct is now part of public health evaluation systems for HIV, and is increasingly used in public health and the medical literature. Issues with the comparability and optimal design of care continuum models have been raised, and their methodologic and theoretic underpinnings and scope of focus have been under-addressed. Review of relevant publications suggests that a key limitation of current models is their lack of measures reflecting incidence and mortality. Issues relating to continua data being longitudinal or cross-sectional, definition of numerators and denominators for each step, data sources, measures of timeliness of step completion, theoretic models to facilitate inferences of causes of care continuum gaps, how measures of prevention efforts, reinfection/relapses, and interactions of continua for co-occurring comorbidities should be reflected, and how analyses of differences in retention over time, across geographic regions, and in response to interventions should be conducted are critical to the development of sound care and prevention continuum models. Conclusion Lessons learned from the application of continuum models to HIV and other conditions suggest that the application of well-formulated constructs of care and prevention continua, that depict, in well defined, standardized steps, incidence and mortality, along with degrees of and time to screening, engagement in care and prevention, treatment and treatment outcomes, including relapse or reinfection, may be vital tools in evaluating intervention and program outcomes, and in improving population health and population health metrics for a wide range conditions.
Collapse
Affiliation(s)
- David C Perlman
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA; Center for Drug Use and HIV Research, New York, NY, USA
| | - Ashly E Jordan
- Department of Epidemiology, School of Public Health, City University of New York, New York, NY, USA; Center for Drug Use and HIV Research, New York, NY, USA
| | - Denis Nash
- Department of Epidemiology, School of Public Health, City University of New York , New York, NY , USA
| |
Collapse
|
23
|
Ermisch M, Bucsics A, Vella Bonanno P, Arickx F, Bybau A, Bochenek T, van de Casteele M, Diogene E, Fürst J, Garuolienė K, van der Graaff M, Gulbinovič J, Haycox A, Jones J, Joppi R, Laius O, Langner I, Martin AP, Markovic-Pekovic V, McCullagh L, Magnusson E, Nilsen E, Selke G, Sermet C, Simoens S, Sauermann R, Schuurman A, Ramos R, Vlahovic-Palcevski V, Zara C, Godman B. Payers' Views of the Changes Arising through the Possible Adoption of Adaptive Pathways. Front Pharmacol 2016; 7:305. [PMID: 27733828 PMCID: PMC5039228 DOI: 10.3389/fphar.2016.00305] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/26/2016] [Indexed: 12/29/2022] Open
Abstract
Payers are a major stakeholder in any considerations and initiatives concerning adaptive licensing of new medicinal products, also referred to as Medicines Adaptive Pathways to patients (MAPPs). Firstly, the scope and necessity of MAPPs need further scrutiny, especially with regard to the definition of unmet need. Conditional approval pathways already exist for new medicines for seriously debilitating or life-threatening diseases and only a limited number of new medicines are innovative. Secondly, MAPPs will result in new medicines on the market with limited evidence about their effectiveness and safety. Additional data are to be collected after approval. Consequently, adaptive pathways may increase the risk of exposing patients to ineffective or unsafe medicines. We have already seen medicines approved conventionally that subsequently proved ineffective or unsafe amongst a wider, more co-morbid population as well as medicines that could have been considered for approval under MAPPs but subsequently proved ineffective or unsafe in Phase III trials and were never licensed. Thirdly, MAPPs also put high demands on payers. Routine collection of patient level data is difficult with high transaction costs. It is not clear who will fund these. Other challenges for payers include shifts in the risk governance framework, implications for evaluation and HTA, increased complexity of setting prices, difficulty with ensuring equity in the allocation of resources, definition of responsibility and liability and implementation of stratified use. Exit strategies also need to be agreed in advance, including price reductions, rebates, or reimbursement withdrawals when price premiums are not justified. These issues and concerns will be discussed in detail including potential ways forward.
Collapse
Affiliation(s)
- Michael Ermisch
- Pharmaceuticals Department, National Association of Statutory Health Insurance Funds Berlin, Germany
| | - Anna Bucsics
- Department of Finance, University of Vienna Vienna, Austria
| | | | - Francis Arickx
- National Institute for Health and Disability Insurance Bruxelles, Belgium
| | | | - Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College Krakow, Poland
| | | | - Eduardo Diogene
- Clinical Pharmacology Service, Vall d'Hebron University Hospital, Fundació Institut Català de Farmacologia Barcelona, Spain
| | - Jurij Fürst
- Medicinal Products Department, Health Insurance Institute of Slovenia Ljubljana, Slovenia
| | - Kristina Garuolienė
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius UniversityVilnius, Lithuania; Medicines Reimbursement Department, National Health Insurance FundVilnius, Lithuania
| | | | - Jolanta Gulbinovič
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius UniversityVilnius, Lithuania; State Medicines Control AgencyVilnius, Lithuania
| | - Alan Haycox
- Health Economics Centre, University of Liverpool Management School Liverpool, UK
| | - Jan Jones
- Scottish Medicines Consortium Glasgow, UK
| | - Roberta Joppi
- Pharmaceutical Drug Department, Azienda Sanitaria Locale of Verona Verona, Italy
| | - Ott Laius
- State Agency of Medicines Tartu, Estonia
| | - Irene Langner
- Wissenschaftliches Institut der AOK (WIdO) Berlin, Germany
| | - Antony P Martin
- Health Economics Centre, University of Liverpool Management School Liverpool, UK
| | - Vanda Markovic-Pekovic
- Ministry of Health and Social WelfareBanja Luka, Bosnia and Herzegovina; Department of Social Pharmacy, Medical Faculty, University Banja LukaBanja Luka, Bosnia and Herzegovina
| | - Laura McCullagh
- Pharmacoeconomics and Health Technology Assessment, Department of Pharmacology and Therapeutics, Trinity College Dublin, Ireland
| | - Einar Magnusson
- Department of Health Services, Ministry of Health Reykjavík, Iceland
| | | | - Gisbert Selke
- Wissenschaftliches Institut der AOK (WIdO) Berlin, Germany
| | - Catherine Sermet
- Institut de Recherche et Documentation en Economie de la Santé (IRDES) Paris, France
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven Leuven, Belgium
| | - Robert Sauermann
- Department of Pharmaceutical Affairs, Main Association of Austrian Social Insurance Institutions Vienna, Austria
| | - Ad Schuurman
- National Health Care Institute Diemen, Netherlands
| | - Ricardo Ramos
- Health Technology Assessment, Prices and Reimbursement Department, INFARMED - National Authority of Medicines and Health Products, I. P., Parque de Saúde de Lisboa Lisbon, Portugal
| | | | - Corinne Zara
- Barcelona Health Region, Catalan Health Service Barcelona, Spain
| | - Brian Godman
- Health Economics Centre, University of Liverpool Management SchoolLiverpool, UK; Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of StrathclydeGlasgow, UK; Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital HuddingeStockholm, Sweden
| |
Collapse
|