1
|
Garattini L, Finazzi B, Mazzone A. Antibiotic shortages in Europe: Another question of prices? Eur J Intern Med 2024:S0953-6205(24)00125-0. [PMID: 38494376 DOI: 10.1016/j.ejim.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/13/2024] [Indexed: 03/19/2024]
Affiliation(s)
- L Garattini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - B Finazzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - A Mazzone
- Department of Internal Medicine, Legnano and Magenta Hospitals, ASST Ovest Milanese, Legnano, MI, Italy
| |
Collapse
|
2
|
Garattini L, Badinella Martini M. Modeling European health systems: an ideal chain of services. Eur J Health Econ 2024; 25:189-192. [PMID: 38095820 DOI: 10.1007/s10198-023-01651-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Livio Garattini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy.
| | - Marco Badinella Martini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| |
Collapse
|
3
|
Garattini L, Nobili A, Remuzzi G. The Italian health-care crisis-only a matter of funding? Lancet 2024; 403:727-728. [PMID: 38401960 DOI: 10.1016/s0140-6736(23)02224-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/02/2023] [Indexed: 02/26/2024]
Affiliation(s)
- Livio Garattini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan 20156, Italy
| | - Alessandro Nobili
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan 20156, Italy
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan 20156, Italy.
| |
Collapse
|
4
|
Garattini L, Badinella Martini M, Nobili A. Urgent and emergency care in europe: Time for a rational network? Eur J Intern Med 2024; 120:1-2. [PMID: 38030464 DOI: 10.1016/j.ejim.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Livio Garattini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | | | | |
Collapse
|
5
|
Garattini L, Nobili A, Mannucci PM. A European National Health and Social Service model: the S of social. Intern Emerg Med 2024; 19:233-235. [PMID: 38091229 DOI: 10.1007/s11739-023-03483-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/07/2023] [Indexed: 01/31/2024]
Affiliation(s)
- Livio Garattini
- Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and University of Milan, Milan, Italy.
| |
Collapse
|
6
|
Garattini L, Badinella Martini M, Schumacher F, Nobili A. Medical specialties in Europe: The less the better? Eur J Intern Med 2024; 119:141-143. [PMID: 37777424 DOI: 10.1016/j.ejim.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Livio Garattini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | | | | | | |
Collapse
|
7
|
Garattini L, Badinella Martini M. Modeling European health systems: a theoretical exercise. Eur J Health Econ 2023; 24:1249-1252. [PMID: 37665522 DOI: 10.1007/s10198-023-01628-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/05/2023]
Affiliation(s)
- L Garattini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy.
| | - Marco Badinella Martini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| |
Collapse
|
8
|
Garattini L, Badinella Martini M, Freemantle N, Nobili A, Mannucci PM. A European national health and social service model: imagining a rational philosophy for health care organizations. Intern Emerg Med 2023; 18:2435-2437. [PMID: 37656408 DOI: 10.1007/s11739-023-03409-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023]
Affiliation(s)
- Livio Garattini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | | | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, University of Milan, Milan, Italy.
| |
Collapse
|
9
|
Garattini L, Badinella Martini M, Freemantle N, Nobili A, Mannucci PM. A European national health and social service model: a rational network of health care facilities. Intern Emerg Med 2023; 18:1855-1857. [PMID: 37329430 DOI: 10.1007/s11739-023-03342-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/08/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Livio Garattini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - Marco Badinella Martini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - Nicholas Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Alessandro Nobili
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - Pier Mannuccio Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| |
Collapse
|
10
|
Garattini L, Freemantle N, Nobili A, Mannucci PM. A European national health and social service model: a few rules of the game. Intern Emerg Med 2023; 18:1583-1585. [PMID: 37171651 DOI: 10.1007/s11739-023-03301-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/05/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Livio Garattini
- Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | | | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and University of Milan, Milan, Italy.
| |
Collapse
|
11
|
Garattini L, Freemantle N, Nobili A, Mannucci PM. Conceptualizing a model for European health systems: the institutional framework. Intern Emerg Med 2023; 18:1213-1215. [PMID: 37014494 DOI: 10.1007/s11739-023-03261-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023]
Affiliation(s)
- L Garattini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - N Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - A Nobili
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - P M Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| |
Collapse
|
12
|
Garattini L, Nobili A, Badinella Martini M, Mannucci PM. The role of general practitioners in the EU: time to draw lessons from a too wide range? Intern Emerg Med 2023; 18:343-346. [PMID: 36680736 DOI: 10.1007/s11739-023-03205-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
Although the role played by general practitioners (GPs) is historically consolidated, continuous changes have been recently introduced in Europe because of the increasing multimorbidity and complexity of patients. Here we try to compare the roles played by GPs in the four major countries of Europe. In France GPs are self-employed medical doctors, and their remuneration consists of a payment scheme for the services provided. The weekly opening hours of French GPs are on average approximately 48. In Germany primary care is mainly provided by GPs and outpatient internists, and patients are free to choose the facility and the professional. German GPs are self-employed professionals mainly remunerated for each consultation, who work for an average of 50 opening hours per week. In Italy GPs are self-employed professionals mainly paid on per capita basis, who have their own list of patients and must guarantee a minimum number of clinical opening hours per week, which has often become the average number in practice. Accordingly, the patients' weekly access to Italian GPs' clinics is very limited. In Spain GPs are civil servants who work in multifunctional facilities with multi-professional teams. The weekly hours worked by Spanish GPs are 38 hours, as for any other civil servant. Trying to draw positive lessons from the comparison, the Spanish facilities seem to be the most advanced examples of horizontal-integrated organizations able to fulfil the expectations of a growing population of ageing people. The range of generalist professionals could be enlarged beyond GPs, as the German example shows.
Collapse
Affiliation(s)
- Livio Garattini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - Alessandro Nobili
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - Marco Badinella Martini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - Pier Mannuccio Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| |
Collapse
|
13
|
Garattini L, Badinella Martini M, Nobili A. General practice in the EU: countries you see, customs you find. Eur J Health Econ 2023; 24:153-156. [PMID: 36399195 DOI: 10.1007/s10198-022-01549-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy.
| | | | - Alessandro Nobili
- Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| |
Collapse
|
14
|
Garattini L, Badinella Martini M, Freemantle N, Nobili A. Integrated care in a National Health Service: better horizontal than vertical for general practice? Fam Pract 2022; 39:1194-1195. [PMID: 35595259 DOI: 10.1093/fampra/cmac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Livio Garattini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - Marco Badinella Martini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Alessandro Nobili
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| |
Collapse
|
15
|
Badinella Martini M, Garattini L, Nobili A, Mannucci PM. Why so many different specialty training programmes in general practice in Europe? Intern Emerg Med 2022; 17:1851-1854. [PMID: 35962271 DOI: 10.1007/s11739-022-03066-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/24/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Marco Badinella Martini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - Livio Garattini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - Alessandro Nobili
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy.
| |
Collapse
|
16
|
Badinella Martini M, Nobili A, Garattini L. [The European mosaic of specialty training programmes in general practice.]. Recenti Prog Med 2022; 113:583-586. [PMID: 36173269 DOI: 10.1701/3888.38703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
During last decades, general practice has been internationally recognized as an independent and essential medical specialization, with specific skills and tasks. This inevitably created the need to widely implement an organized specialty training programmes to allow future general practitioners to acquire all the skills and knowledge necessary to work within the world of primary care. However, this process has not led to homogeneous applications in European countries, mainly due to the profound and structural differences of each national health system. In our contribution we have tried to make a synoptic comparison of specialty training programmes in general practice in the main European countries (England, Italy, Spain, France and Germany).
Collapse
Affiliation(s)
| | | | - Livio Garattini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano
| |
Collapse
|
17
|
Affiliation(s)
- Livio Garattini
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Michela Bozzetto
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Giuseppe Remuzzi
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Nick Freemantle
- Institute for Clinical Trials and Methodology, University College of London, London, United Kingdom
| | - Alessandro Nobili
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| |
Collapse
|
18
|
Garattini L, Bozzetto M, Nobili A, Mannucci PM. Health technology assessment for pharmaceuticals in the European Union: what lessons after two decades? Intern Emerg Med 2022; 17:1251-1253. [PMID: 35674925 DOI: 10.1007/s11739-022-03008-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/16/2022] [Indexed: 11/05/2022]
Affiliation(s)
- L Garattini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - M Bozzetto
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - A Nobili
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - P M Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| |
Collapse
|
19
|
Garattini L, Finazzi B. Pharmaceutical Patents in Europe: Radical Reforms Rather Than Getting Rid? Appl Health Econ Health Policy 2022; 20:453-455. [PMID: 34841473 PMCID: PMC8627787 DOI: 10.1007/s40258-021-00697-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy.
| | - Bruno Finazzi
- Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| |
Collapse
|
20
|
Garattini L, Badinella Martini M, Nobili A. Community care reform in Italy: Get a move on! Eur J Intern Med 2022; 101:130-131. [PMID: 35314120 DOI: 10.1016/j.ejim.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/14/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research "Mario Negri" IRCCS, Via Gian Battista Camozzi 3, Ranica 24020, Italy
| | - Marco Badinella Martini
- Institute for Pharmacological Research "Mario Negri" IRCCS, Via Gian Battista Camozzi 3, Ranica 24020, Italy.
| | - Alessandro Nobili
- Institute for Pharmacological Research "Mario Negri" IRCCS, Via Gian Battista Camozzi 3, Ranica 24020, Italy
| |
Collapse
|
21
|
Abstract
A price stems from the intersection between supply and demand curves in any common market. However, there are special markets where consumers do not pay for goods directly, and prescription drugs are a well-known example in healthcare. Drugs are mainly funded by public expenditure in well-established welfare systems like those of the Western European countries. However, the present era of austerity in public funding has made financial resources scarce in most European nations. Currently, the leading tendency for pharmaceutical pricing in Europe is direct negotiation with pharma companies. However, these negotiations are administratively burdensome, with costs not necessarily offsetting savings. Moreover, since any trade negotiation implies some degree of confidentiality to be effective these strategies are scantily transparent. When prices are set for many products through unavoidably arbitrary decisions, the final consequence is an irrational allocation of financial resources. Here, we raise a proposal to restore a reasonable balance between public equity objectives of health authorities and private profit incentives of the pharma industry in Europe, switching from pricing to budgeting. The underlying rationale of our proposal is to stop setting arbitrary prices in a context of market failure.
Collapse
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy
| | - Bruno Finazzi
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy
| | - Pier Mannuccio Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| |
Collapse
|
22
|
Badinella Martini M, Finazzi B, Garattini L. [The European enigma of pharmaceutical pricing: still solvable?]. Recenti Prog Med 2022; 113:355-358. [PMID: 35758112 DOI: 10.1701/3827.38107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The attempt to regulate pharmaceutical pricing has a long tradition in Western European countries and various solutions have been experienced in recent decades to try to control public pharmaceutical spending. Nonetheless, drug prices have become increasingly out of control and unsustainable even in the richest European countries. In a situation of "market failure" such as the pharmaceutical one, in fact, two totally opposite needs collide: the main objective of the health authorities of universal access to essential drugs, versus the aim of the pharmaceutical industry to maximize turnover in order to guarantee high returns on investments. We are therefore convinced that the growing threat of drug prices that are too high must be solved with drastic solutions. The goal of this contribution is therefore to first summarize the current situation of pharmaceutical pricing in Western European countries, then debate the main issues currently discussed and finally propose a radically alternative scenario that moves from prices to the budget.
Collapse
Affiliation(s)
| | - Bruno Finazzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano
| | - Livio Garattini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano
| |
Collapse
|
23
|
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy.
| | | | | |
Collapse
|
24
|
Garattini L, Badinella Martini M, Nobili A. Integrated care in Western Europe: a wise solution for the future? Expert Rev Pharmacoecon Outcomes Res 2022; 22:717-721. [PMID: 35196951 DOI: 10.1080/14737167.2022.2046465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION IC is a term commonly adopted across the world underpinning a positive attitude against fragmentation of healthcare service provision. While the principles supporting IC are simple, their implementation is more controversial. AREAS COVERED The growing number of IC definitions is related to the increasing domains of applications, which reflect the increasing demand induced by aging multi-morbid patients. A comprehensive definition of IC should now include the coordination of health and social services useful to deliver continuous care across organizational boundaries. The recent debate on IC is largely influenced by the mismatch between the increasing burden of health and social needs for chronic conditions from the demand side, and the design of health-care systems still focused on acute care from the supply side. EXPERT OPINION The major reasons of persisting IC weakness in European countries stem from arguable choices of health policy taken in the recent past. The political creed in 'market competition' is probably the most emblematic. All initiatives encouraging health-care providers to compete with each other are likely to discourage IC. Since most European GPs are still self-employed professionals working in their own cabinets, the anachronistic professional status of GPs is another historically rooted reason of IC weakness.
Collapse
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | | | - Alessandro Nobili
- Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| |
Collapse
|
25
|
Garattini L, Badinella Martini M, Nobili A. Integrated Care in Europe: Time to Get it Together? Appl Health Econ Health Policy 2022; 20:145-147. [PMID: 34458969 DOI: 10.1007/s40258-021-00680-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy.
| | | | - Alessandro Nobili
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy
| |
Collapse
|
26
|
Badinella Martini M, Nobili A, Garattini L. [What future for the pharmaceutical patenting in europe: reforming or getting rid of it?]. Recenti Prog Med 2022; 113:157-160. [PMID: 35315444 DOI: 10.1701/3761.37479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The covid-19 pandemic and the anti-SARS-CoV-2 vaccines have once again brought to the fore the issue of patents in the health sector. The current European panorama on the patenting of pharmaceuticals is rather confused and difficult to understand, characterized by a precarious (dis)balance between the commercial incentives guaranteed to the industry by supply-side patents and the regulatory framework in support of public interests on the demand side. Here, we first focus on a regulatory analysis of pharmaceutical patenting and more in general on market exclusivity within the European Union, and then set out some proposals for a radical reform of European legislation. In particular, we believe that there are three major critical issues on the subject that must be addressed and reformed as soon as possible: 1. the management of pharmaceutical patents through the European Patent Office and the parallel network of national offices, 2. the excess of discretion of pharmaceutical companies in the filing of patents and 3. the short duration of market exclusivity on drugs. In fact, the right moment has come to definitively reform the European legislation on pharmaceutical patents in line with the tradition of continental welfare.
Collapse
Affiliation(s)
| | - Alessandro Nobili
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (Bergamo)
| | - Livio Garattini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (Bergamo)
| |
Collapse
|
27
|
Garattini L, Badinella Martini M, Zanetti M. The Italian NHS at regional level: same in theory, different in practice. Eur J Health Econ 2022; 23:1-5. [PMID: 34009494 PMCID: PMC8131486 DOI: 10.1007/s10198-021-01322-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 05/09/2023]
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy.
| | | | - Michele Zanetti
- Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| |
Collapse
|
28
|
Abstract
Integrated care (IC) is a term now commonly adopted across the world, which implies a positive attitude towards addressing fragmentation of service provision inside health systems. While the principles of IC are simple, their implementation is more controversial. The ever growing number of IC definitions is related to the increasing domains of applications, which reflect the increasing demand induced by ageing multi-morbid patients. An exhaustive definition of IC should now enclose the coordination of health and social services useful to deliver seamless care across organizational boundaries. The current debate on IC is largely fueled by the modern mismatch between the growing burden of health needs for chronic conditions from the demand side and the design of health systems still largely centered on acute care from the supply side. The major reasons of persisting IC weakness in Western European nations stem from arguable choices of health policy taken in a quite recent past. The political creed in 'market competition' is likely to be the most emblematic. All initiatives encouraging healthcare providers to compete with each other are likely to discourage IC. Another historically rooted reason of IC weakness is the occupational status of European general practitioners (GPs). While single large-scale organizations have become a pressing priority for a modern primary care, most GPs are still selfemployed professionals working in their own cabinets. It is time to reconsider the anachronistic status of GPs so as to enhance IC in the future.
Collapse
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy.
| | | | | |
Collapse
|
29
|
Garattini L, Padula A, Freemantle N. Pricing vaccines and drugs in Europe: worth differentiating? Eur J Health Econ 2021; 22:1345-1348. [PMID: 32577858 PMCID: PMC7308223 DOI: 10.1007/s10198-020-01211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Livio Garattini
- Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, Ranica, Italy.
| | - Anna Padula
- Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, Ranica, Italy
| | - Nicholas Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| |
Collapse
|
30
|
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy.
| | | | - Alessandro Nobili
- Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| |
Collapse
|
31
|
Garattini L, Badinella Martini M, Nobili A. [Integrated care: the right way for the future?]. Recenti Prog Med 2021; 112:615-618. [PMID: 34647529 DOI: 10.1701/3679.36649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Integrated Care (IC) is an "umbrella" term, under which numerous definitions are collected, which implies an attempt to coordinate and integrate fragmented and piecemeal health systems with new organizational arrangements. In fact, poor coordination of care is often a major obstacle for patients who access to health services. This adds on concern to the increasing demand for health and the greater proportion of healthcare expenditure induced by aging and chronic multiple comorbidity of patients. IC therefore sets itself the ambitious goal of harmonizing and optimizing patient care, both physical-mental and social, in order to obtain a continuous multi-organizational assistance. Although the principles on which IC is based are intuitive and simple, its extensive application is complicated and difficult to achieve. Within this article, we first try to define the concept of IC through a general review of the scientific literature on the subject. Then, we analyze the main economic and political criticalities of IC. Finally, we try to suggest recommendations about IC that can be extended to the health services of the member countries of the European Union.
Collapse
|
32
|
Vrdoljak E, Sekerija M, Plestina S, Belac Lovasic I, Katalinic Jankovic V, Garattini L, Bobinac A, Voncina L. Is it too expensive to fight cancer? Analysis of incremental costs and benefits of the Croatian National Plan Against Cancer. Eur J Health Econ 2021; 22:393-403. [PMID: 33438133 DOI: 10.1007/s10198-020-01262-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
This cost-effectiveness study analyses the expected impacts of activities proposed by the Croatian National Plan Against Cancer (NPAC) on cancer incidence and survival rates, as related to their respective costs. We evaluated the impact of the NPAC on two main outcomes, namely, reduced incidence and the improved survival of cancer patients, expressed as life years gained (LYGs), which enabled the calculation of incremental cost-effectiveness ratios (ICERs) in the form of cost per LYG. In the analysis of costs, we considered both the direct costs of NPAC activities as well as the wider indirect societal costs of cancer, thus permitting the calculation of the ICER both from the narrower national health insurer's perspective (accounting only for the direct costs) and the wider societal perspective (accounting both for the direct and indirect costs). We estimated that on average, for all patients benefiting from the implementation of the NPAC in Croatia, an additional LYG would be yielded at the additional cost of €1.021 (societal perspective). The NPAC can, for some sites, even be considered a dominant intervention due to the negative cost/LYG ratio, meaning that it generates additional LYGs while at the same time, reducing total societal costs. Taking a narrower health insurer's perspective (i.e., accounting only for the direct costs), the NPAC produces an additional LYG at an additional cost of €1.408. Both cost per LYG estimates can be considered cost-effective investment options.
Collapse
Affiliation(s)
- Eduard Vrdoljak
- Department of Oncology and Radiotherapy, University Hospital of Split, Split, Croatia
| | - Mario Sekerija
- Croatian National Cancer Registry, Croatian Institute of Public Health, Zagreb, Croatia
- School of Public Health Dr Andrija Štampar, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Stjepko Plestina
- Clinical Hospital Centre Zagreb, Zagreb Medical School, University of Zagreb, Zagreb, Croatia
| | - Ingrid Belac Lovasic
- Clinical Hospital Centre Rijeka, Department for Radiotherapy and Oncology, Faculty of Medicine Rijeka, University of Rijeka, Rijeka, Croatia
| | | | - Livio Garattini
- Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, Ranica, Italy
| | - Ana Bobinac
- Centre for Health Economics and Pharmacoeconomics, Faculty of Economics and Business, University of Rijeka, Rijeka, Croatia.
| | - Luka Voncina
- Faculty of Health Studies, University of Rijeka, Rijeka, Croatia
| |
Collapse
|
33
|
Badinella Martini M, Garattini L, Mannucci PM. [An instruction manual for reforming Italian general practice.]. Recenti Prog Med 2021; 112:182-185. [PMID: 33687355 DOI: 10.1701/3565.35455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
General practice occupies a fundamental and irreplaceable role within the Italian National Health System. Despite this, its structural conditions are currently precarious and not up to date. In order to safeguard its existence, a radical reform is therefore necessary distancing itself from the old and obsolete Italian concept of primary care. First of all, it is now mandatory to establish a university specialization in general practice to improve the medical training of future general practitioners. At the same time, the growth of an organized clinical research system in the primary care setting must be encouraged. Together with these measures, an extensive modernization of the organizational system of general practice must be implemented with the overcoming of the current obstacles that largely limit its clinical-assistance possibilities. The creation of primary care centers and the strengthening of the telemedicine system are two essential points of this reform. We deeply trust that future generations of general practitioners will be the promoters of these necessary changes.
Collapse
Affiliation(s)
| | - Livio Garattini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG)
| | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano. Pervenuto il 18 ottobre 2020. Accettato il 27 ottobre 2020
| |
Collapse
|
34
|
Garattini L, Badinella Martini M, Mannucci PM. Improving primary care in Europe beyond COVID-19: from telemedicine to organizational reforms. Intern Emerg Med 2021; 16:255-258. [PMID: 33196973 PMCID: PMC7668282 DOI: 10.1007/s11739-020-02559-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/30/2020] [Indexed: 12/04/2022]
Abstract
The COVID-19 pandemic has put under pressure all the health national systems in Europe and telemedicine (TM) has been an almost unavoidable answer for primary care (PC) services to constrain the contagion. PC includes all the healthcare services that are the first level of contact for individuals. General practitioners (GPs) are the pivotal providers of PC throughout Europe. Although GP costs are mainly covered by public services or social insurances in Europe, they are still self-employed physicians everywhere, differently from their colleagues in hospitals who are traditionally employees. TM is a very general term open to various interpretations and definitions. TM can now be practiced by means of modern audio-visual devices and is an alternative to the traditional face-to-face consultation in general practice. Although the adoption of TM seems to be compelling in our era, its practical dissemination in PC has been quite slow so far, and many different concerns have been raised on it. On the whole, TM widespread adoption in PC seems to be more a matter of labor organization and health care funding than of technology and ethics. Larger-scale organizations comprising a wide range of health professionals have become a pressing priority for a modern PC, because working together is crucial to provide high-quality care to patients, and co-location should boost teamwork and facilitate the management of information technology. A national network of large organizations in PC could be rationally managed through local budgets and should increase efficiency by adopting tools such as TM.
Collapse
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy.
| | | | | |
Collapse
|
35
|
Garattini L, Badinella Martini M, Zanetti M. More room for telemedicine after COVID-19: lessons for primary care? Eur J Health Econ 2021; 22:183-186. [PMID: 33231825 PMCID: PMC7683583 DOI: 10.1007/s10198-020-01248-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 05/05/2023]
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, Italy.
| | | | - Michele Zanetti
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, Italy
| |
Collapse
|
36
|
Garattini L, Padula A, Freemantle N. Do European pharmacists really have to trespass on medicine? Eur J Health Econ 2021; 22:1-4. [PMID: 32279164 DOI: 10.1007/s10198-020-01185-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/01/2020] [Indexed: 05/20/2023]
Affiliation(s)
- Livio Garattini
- Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, Ranica, Italy.
| | - Anna Padula
- Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, Ranica, Italy
| | - Nicholas Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| |
Collapse
|
37
|
Garattini L, Padula A, Mannucci PM. Community and hospital pharmacists in Europe: encroaching on medicine? Intern Emerg Med 2021; 16:7-10. [PMID: 32920655 PMCID: PMC7487142 DOI: 10.1007/s11739-020-02496-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022]
Abstract
Pharmacy has been historically regarded as a discipline between health and chemistry devoted to drug development, production, and compounding. These tasks have been almost lost with the industrial manufacturing, and dispensing remains the main activity of pharmacists. Hospital pharmacists are usually employees in their workplace, while the professional framework of community pharmacists is very different, being pharmacies predominantly private shops in almost all European countries. In the last years pharmacists have strongly advocated that the focus of their services should switch from 'product' to 'patient'. Clinical pharmacy and pharmaceutical care are the two most cited concepts to support this shift. Clinical pharmacy was originally defined as the area of pharmacy concerned with the science and practice of rational medication use, pharmaceutical care as the responsible provision of drug therapies to achieve definite outcomes. The practice of clinical pharmacy should embrace the philosophy of pharmaceutical care. The new wave of pharmacists' patient-centered care in Europe still seems to be a reaction against the loss of their traditional professional role after the drug manufacturing revolution. To depict a realistic scenario for progress, it is worth differentiating between hospital and community. Hospital pharmacists should strengthen their pivotal role of medication gatekeepers to improve among clinicians the appropriateness of drug prescriptions and generate savings in expenditures. Any proposal for clinical services provided by community pharmacists is inevitably affected by the issue of their potential remuneration, especially in countries where the remuneration for reimbursable drugs is still a proportion of the retail price.
Collapse
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy.
| | - Anna Padula
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy
| | | |
Collapse
|
38
|
Zampirolli Dias C, Godman B, Gargano LP, Azevedo PS, Garcia MM, Souza Cazarim M, Pantuzza LLN, Ribeiro-Junior NG, Pereira AL, Borin MC, de Figueiredo Zuppo I, Iunes R, Pippo T, Hauegen RC, Vassalo C, Laba TL, Simoens S, Márquez S, Gomez C, Voncina L, Selke GW, Garattini L, Kwon HY, Gulbinovic J, Lipinska A, Pomorski M, McClure L, Fürst J, Gambogi R, Ortiz CH, Canuto Santos VC, Araújo DV, Araujo VE, Acurcio FDA, Alvares-Teodoro J, Guerra-Junior AA. Integrative Review of Managed Entry Agreements: Chances and Limitations. Pharmacoeconomics 2020; 38:1165-1185. [PMID: 32734573 DOI: 10.1007/s40273-020-00943-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Managed entry agreements (MEAs) consist of a set of instruments to reduce the uncertainty and the budget impact of new high-priced medicines; however, there are concerns. There is a need to critically appraise MEAs with their planned introduction in Brazil. Accordingly, the objective of this article is to identify and appraise key attributes and concerns with MEAs among payers and their advisers, with the findings providing critical considerations for Brazil and other high- and middle-income countries. METHODS An integrative review approach was adopted. This involved a review of MEAs across countries. The review question was 'What are the health technology MEAs that have been applied around the world?' This review was supplemented with studies not retrieved in the search known to the senior-level co-authors including key South American markets. It also involved senior-level decision makers and advisers providing guidance on the potential advantages and disadvantages of MEAs and ways forward. RESULTS Twenty-five studies were included in the review. Most MEAs included medicines (96.8%), focused on financial arrangements (43%) and included mostly antineoplastic medicines. Most countries kept key information confidential including discounts or had not published such data. Few details were found in the literature regarding South America. Our findings and inputs resulted in both advantages including reimbursement and disadvantages including concerns with data collection for outcome-based schemes. CONCLUSIONS We are likely to see a growth in MEAs with the continual launch of new high-priced and often complex treatments, coupled with increasing demands on resources. Whilst outcome-based MEAs could be an important tool to improve access to new innovative medicines, there are critical issues to address. Comparing knowledge, experiences, and practices across countries is crucial to guide high- and middle-income countries when designing their future MEAs.
Collapse
Affiliation(s)
- Carolina Zampirolli Dias
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Ludmila Peres Gargano
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Pâmela Santos Azevedo
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Marina Morgado Garcia
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Maurílio Souza Cazarim
- Department of Pharmaceutical Sciences, Pharmacy School, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Minas Gerais, Brazil
| | - Laís Lessa Neiva Pantuzza
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
| | - Nelio Gomes Ribeiro-Junior
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - André Luiz Pereira
- Gerência de Planejamento, Monitoramento e Avaliação Assistenciais Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marcus Carvalho Borin
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Isabella de Figueiredo Zuppo
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | | | - Tomas Pippo
- Pan American Health Organization (PAHO), Brasília, Brazil
| | - Renata Curi Hauegen
- National Institute of Science and Technology for Innovation on Diseases of Neglected Populations (INCT-IDPN), Center for Technological Development in Health (CDTS), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Carlos Vassalo
- Facultad de Ciencias Médicas, Universidad Nacional del Litoral, Santa Fe, Argentina
| | - Tracey-Lea Laba
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Haymarket, Sydney, NSW, Australia
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Louvain, Belgium
| | - Sergio Márquez
- Economista, Administradora de los Recursos del Sistema General de Seguridad Social en Salud (ADRES), Bogotá, Colombia
| | - Carolina Gomez
- Think Tank "Medicines, Information and Power", National University of Colombia, Bogotá, Colombia
| | | | | | - Livio Garattini
- CESAV, Centre for Health Economics, IRCCS Institute for Pharmacological Research 'Mario Negri', Ranica, Bergamo, Italy
| | - Hye-Young Kwon
- Division of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, United Kingdom
- College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Jolanta Gulbinovic
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, Vilnius, Lithuania
| | - Aneta Lipinska
- Agency for Health Technology Assessment and Tariff System (AOTMiT), Warsaw, Poland
| | - Maciej Pomorski
- Agency for Health Technology Assessment and Tariff System (AOTMiT), Warsaw, Poland
| | - Lindsay McClure
- Procurement, Commissioning and Facilities, NHS National Services Scotland, Edinburgh, UK
| | - Jurij Fürst
- Health Insurance Institute, Ljubljana, Slovenia
| | | | | | | | - Denizar Vianna Araújo
- Secretariat of Science, Technology and Strategic Inputs, Ministry of Health, Brasília, Brazil
| | - Vânia Eloisa Araujo
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- Pontifical Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Francisco de Assis Acurcio
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Juliana Alvares-Teodoro
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Augusto Afonso Guerra-Junior
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil.
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil.
| |
Collapse
|
39
|
Affiliation(s)
- Livio Garattini
- Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, Via GB Camozzi 3, 24020, Ranica, BG, Italy.
| | - Michele Zanetti
- Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, Via GB Camozzi 3, 24020, Ranica, BG, Italy
| | - Nicholas Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| |
Collapse
|
40
|
Garattini L, Padula A. Correction to: Defensive medicine in Europe: a 'full circle'? Eur J Health Econ 2020; 21:815. [PMID: 32613284 DOI: 10.1007/s10198-020-01210-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The Editorial "Defensive medicine in Europe: a 'full circle'?"
Collapse
Affiliation(s)
- Livio Garattini
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, 24020, Ranica, Italy.
| | - Anna Padula
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, 24020, Ranica, Italy
| |
Collapse
|
41
|
Garattini L, Freemantle N. Comment on: 'Value-Based Pricing Alternatives for Personalised Drugs: Implications of Asymmetric Information and Competition'. Appl Health Econ Health Policy 2020; 18:453-454. [PMID: 32016830 DOI: 10.1007/s40258-020-00552-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Livio Garattini
- Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, Ranica, Italy.
| | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| |
Collapse
|
42
|
Affiliation(s)
- Livio Garattini
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, 24020, Ranica, Italy.
| | - Anna Padula
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, 24020, Ranica, Italy
| |
Collapse
|
43
|
|
44
|
Abstract
Individuals may have conflicts of interest (CoI) when they choose between the duties of their jobs and their own private interests. In medicine, CoI are potentially ubiquitous and their disclosure has now become the most frequent strategy to address them in professional lives. In the medical literature, CoI are classified into two different types-financial and non-financial. Financial CoI are easy to identify and can bias any kind of results in research; so, their disclosure is very important. The unsolvable dilemma is where to set the lowest limit for sums received from industry. Non-financial CoI are a very large category intrinsically related to the individuals concerned, ranging from family relationships to religious beliefs, and the mere disclosure of many of them can raise privacy and ethical issues. Two opposite narratives characterize the debate on financial CoI caused by pharmaceutical industry. The critical side argues that, because the primary goal of pharmaceutical industry is inevitably to promote its products, the best strategy is to stay away from financial CoI. On the other hand, the defensive side claims that financial CoI are boosted by ideology but meaningless in real practice, since any kind of interest can raise a potential conflict. A missing point in the debate on financial CoI is that health care is a classical example of 'market failure' in the economic theory. Since health cannot be considered a 'consumer good', the economic paradigm of 'free market' does not fit for healthcare products. To conclude, even though transparency on financial CoI cannot itself deter the risk of bias, rejecting it would be an even bigger mistake. At variance, mandatory disclosure of non-financial CoI risks to be confusing and questionable in many cases, paradoxically distracting attention from the potential bias created by financial CoI.
Collapse
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy.
| | - Anna Padula
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy
| | | |
Collapse
|
45
|
Affiliation(s)
- Livio Garattini
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, 24020, Ranica, Italy.
| | - Anna Padula
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, 24020, Ranica, Italy
| |
Collapse
|
46
|
Badinella Martini M, D'Ascenzo F, Zaninelli A, Garattini L, Mannucci PM. The dark age of Italian general practice research - An Italian matter. Eur J Intern Med 2020; 73:98-99. [PMID: 31843354 DOI: 10.1016/j.ejim.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 12/07/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | - Fabrizio D'Ascenzo
- Department of Medical Sciences, "Città Della Salute e Della Scienza" Hospital, University of Turin, Turin, Italy
| | - Augusto Zaninelli
- District of Primary Care, Local Health Authority Bergamo (ATS Bergamo), Bergamo, Italy
| | - Livio Garattini
- "Angelo e Angela Valenti" Centre for Health Economics (CESAV), IRCCS "Mario Negri" Institute for Pharmacological Research, Milan, Italy
| | - Pier Mannuccio Mannucci
- Scientific Direction, IRCCS "Ca' Granda Maggiore Policlinico" Hospital Foundation, Milan, Italy
| |
Collapse
|
47
|
|
48
|
Affiliation(s)
- Livio Garattini
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, 24020, Ranica, Italy.
| | - Anna Padula
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, 24020, Ranica, Italy
| |
Collapse
|
49
|
|
50
|
Garattini L, Freemantle N. Comment on: 'NICE, in Confidence: An Assessment of Redaction to Obscure Confidential Information in Single Technology Appraisals by the National Institute for Health and Care Excellence'. Pharmacoeconomics 2020; 38:121-122. [PMID: 31848899 DOI: 10.1007/s40273-019-00875-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Livio Garattini
- Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, c/o Villa Camozzi, 24020, Ranica, BG, Italy.
| | - Nicholas Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| |
Collapse
|