Assessing the impact of wastage on pediatric vaccine immunization formulary costs using a vaccine selection algorithm

Pediatric immunization is an important factor in providing protection against numerous common preventable diseases. The success of the pharmaceutical industry in developing new pediatric vaccines has resulted in a crowded recommended immunization schedule requiring several clinic visits over the first 12 years of life. Operations research models have been developed and used to make economically sound procurement choices from among a growing number of competing vaccine products. One factor that has not been incorporated into such models is the economic impact of wastage on such decisions. This paper reports results obtained from a vaccine selection algorithm that incorporates vaccine wastage data. The lowest overall cost formularies comparing no wastage costs with wastage costs are presented. A sensitivity analysis of the vaccine formulary with respect to the wastage rates associated with each available vaccine is provided. The maximum permissible wastage rate for each vaccine is determined for which the vaccine earns a place in the lowest overall cost formulary. This research provides health maintenance organizations and healthcare providers information that can be used to gain a better understanding of wastage and its impact on pediatric formulary costs.     

Building the Outcomes-Based Formulary

The traditional formulary review process possesses limitations that impair a Pharmacy and Therapeutics committee’s ability to thoroughly evaluate products, including the lack of emphasis on a product’s impact on humanistic outcomes and the use of cost comparisons which fail to evaluate the budgetary impact on all aspects of medical expenses. Emerging formulary submission guidelines offer some improvements to these traditional reviews, but fail to address several key issues; most notably these guidelines do not impart provisions for the completion of needed outcomes research.Designed to facilitate the collaboration of the manufacturer, health plan, and outcomes research organization in the design, conduct, and completion of outcomes research, WellPoint Pharmacy Management’s Outcomes-Based Formulary helps to limit or eliminate gaps of information in the product portfolio while ensuring that the patient population studied matches that of the health plan. The Outcomes-Based Formulary will provide a participating health plan’s Pharmacy and Therapeutics committee with a wealth of information, including effectiveness and humanistic data, with which the most informed formulary decisions can be made.     

Trends in food availability in Portugal in 1966–2003

BACKGROUND: Dietary intake has changed considerably in South European countries, but whether those changes were similar between countries is currently unknown. AIM OF THE STUDY: To assess the trends in food availability in Portugal and four other Mediterranean countries from 1966 to 2003. METHODS: Food and Agricultural Organization food balance sheets from Portugal, France, Italy, Greece and Spain. Trends were assessed by linear regression. RESULTS: The per capita availability of calories has increased in Portugal, France, Greece, Italy and Spain in the past 40 years. Portugal presented the most rapid growth with an annual increase of 28.5 +/- 2.2 kcal (slope +/- standard error), or +1000 kcal overall. In animal products, Portugal had an annual increase of 20.7 +/- 0.9 kcal, much higher than the other four countries. Conversely, the availabilities of vegetable and fruit only showed a slight growth of 1.0 +/- 0.1 kcal/year and 2.5 +/- 0.4 kcal/year, respectively, thus increasing the ration of animal to vegetable products. Olive oil availability increased in all countries with the notable exception of Portugal, where a significant decrease was noted. Wine supply decreased in all five countries; in contrast, beer supply started to take up more alcohol share. Percentage of total calories from fat increased from nearly 25% to almost 35% in Portugal during the study period, mainly at the expenses of calories from carbohydrates, whereas the share of protein showed just a slight increase. Furthermore, fat and protein were increasingly provided by animal products. CONCLUSIONS: Portugal is gradually moving away from the traditional Mediterranean diet to a more Westernized diet as well as France, Greece, Italy and Spain. Noticeably, the trends of diet transition were observed relatively faster in Portugal than in the other four Mediterranean countries.     

药物经济学评估与药品定价和支付机制的关系及其对中国的启示

世界各国医疗服务费用都在不断增加,给各国政府带来了极大的经济负担。导致医疗服务费用增长的主要原因之一是由于药品市场在定价与支付,以及在价格调整过程中未尽完善。随着药物经济学评估的发展,越来越多的国家注意到药物经济学评估在上述过程中可发挥的作用。自1993年澳大利亚政府首先将药物经济学评估用于定价和支付机制开始,各国纷纷建立了类似的评估指南作为规范药品的定价和支付的指导。同时也使药物经济学评估成为政府与制药行业之间沟通的桥梁。     

Trends in mortality from primary pleural tumor and incidence of pleural mesothelioma in Italy: a particularly serious situation

We present: a) an analysis of the past mortality from Primary Pleural Tumors (PPT) occurred in Italy between 1968 and 1992 by an age-cohort-period model, using a Poisson regression model, estimating the risk of dying by birth cohort, the Lifetime Cumulative risk (25-84 years) by birth cohort, the risk by calendar period and testing the full model (age-cohort-period effects); b) a summary of the incidence of mesothelioma as recorded in Italy by Cancer Registries and Mesothelioma Registries. The highest Lifetime Cumulative Risk of dying from TTP is recorded for the birth cohort 1946-'50 (6.2 per thousand among males, 1.64 among females). Whereas the risk by birth cohort becomes flat among females born after 1936, among males the risk is increasing up to the youngest birth cohorts. By calendar period, the highest risk of dying is observed in the last period (1991-'92). The inclusion in the full model of the calendar period term increases significantly the goodness-of-fit of the model among females, but not among males. The highest incidence of mesothelioma in both genders registered by 150 Cancer Registries all over the world is currently recorded among the population of Genoa and Trieste, where large ship-building plants are located. Even higher incidence mesothelioma rates have been recently recorded in other areas of Italy. The trend in PPT mortality in Italy could have been influenced, but not explained, by the increased awareness over time of the disease, but it fits well with the pattern occurring in most industrialized countries of western Europe, with the unprotected industrial use of asbestos which occurred in Italy, and also with the gender characteristics of the work-force employed in asbestos-exposing activities. A ban of asbestos use has been introduced in Italy in 1992. However, considering that asbestos seems to act as an initiator for mesothelioma, the trend in male mortality for PPT will not peak until two or three decades.     

Future European health care: cost containment, health care reform and scientific progress in drug research

The cost of the development of a new pharmaceutical product from its conception and synthesis through to the regulatory approval process has more than quadrupled in the last 20 years. Both clinical and total development times have increased substantially. To amortize the costs incurred, the pharmaceutical industry has taken an international dimension. The incentives for pharmaceutical firms to discover and develop new drugs depend on the length of the development and regulatory review process plus the potential market size. Recent regulatory, economic and political changes may have significant implications for the future of new drug developments in Europe. The European Union industrial policy felt that there is a need for convergence in the area of pricing. It is recommended that the policy should aim to contain growth in pharmaceutical expenses by means specific to reimbursement rather than direct price controls. By encouraging doctors to prescribe and customers to use generics, competition is enhanced to bring down drug prices. More emphasis is being laid by government in educating customers to cost-awareness and cost-benefit ratios with regard to pharmaceuticals. Concerning clinical trials, European harmonization has been achieved by significant developments: the rights and integrity of the trial subjects are protected; the credibility of the data is established; and the ethical, scientific and technical quality of the trials has improved. Future European health care forecasts a whole change in the pharmaceutical business. Important issues in cost and outcome measurement should be carefully planned and considered in drug development. Due to important mergers and acquisitions, the pharmaceutical sector will consist mainly of important multinational corporations. In this way, valuable new products may be brought to the market.     

我国网售处方药报销面临的问题及对策分析——基于美国药品福利管理模式

我国医药电子商务发展已有十余年历史,然而在B2C(Business-to-Customers)业务尤其是处方药的互联网交易业务领域发展缓慢,其中,处方的审核及报销是相关部门制定政策时面临的主要问题之一。药品福利管理模式是美国广泛用于药品费用支出管理的一种手段,目前已经形成较为完善的运营方式和服务体系,在处方报销、处方集管理、疾病健康管理、药品利用评价等多个方面起到了重要作用。本文将基于文献分析法,深入讨论我国网售处方药中处方报销存在的问题,并借鉴美国药品福利管理模式,结合我国国情,最终构建出处方报销过程中以药品福利管理公司为核心的药品信息网络和处方报销流程。     

Predictability of drug expenditures: an application using morbidity data

The growth of pharmaceutical expenditure and its prediction is a major concern for policymakers and healthcare managers. This paper explores different predictive models to estimate future drug expenses, using demographic and morbidity individual information from an integrated healthcare delivery organization in Catalonia for years 2002 and 2003. The morbidity information consists of codified health encounters grouped through the Clinical Risk Groups (CRGs). We estimate pharmaceutical costs using several model specifications, and CRGs as risk adjusters, providing an alternative way of obtaining high predictive power comparable to other estimations of drug expenditures in the literature. These results have clear implications for the use of risk adjustment and CRGs in setting the premiums for pharmaceutical benefits.     

Current national initiatives about drug policies and cost control in Europe: the Italy example

Pharmaceutical expenditure is a challenge to the financial compatibility of health systems because it is growing faster (+11% per year in the last 5 years in Italy) than any other health sector. In order to curb public pharmaceutical expenditure 2 interventions are commonly used: delisting (de-reimbursement) and reference price, with the difference being paid by patients. The Italian Ministry of Health implemented a set of interventions with the general aim of pharmaceutical governance based on the following criteria: (a) to assure a complete coverage of all clinically and epidemiologically relevant diseases; (b) to provide health professionals with a range of different active drugs with the same therapeutic indications within the same therapeutic class; and (c) to identify a reimbursement threshold in order to save public money by narrowing the (wide) price differentials among drugs with comparable efficacy and safety. In this context, interventions have been undertaken at several levels including drug price reduction, generic drug promotion, delisting of drugs reimbursed, and direct distribution of medicines (by hospital services). Furthermore, a new National Pharmaceutical Formulary has been implemented. Medicines have been classified into homogeneous categories (ie, medicines with the same main indication(s) and with similar clinical efficacy and safety profile). Within each homogeneous category, a reimbursement level (cutoff) was then identified and, accordingly, pharmaceutical companies were asked to adjust their price. This adjustment was based on price per daily drug dose (DDD), cumulative expenditure (at least 50%), and cumulative utilization (at least 60%). This readjustment, at no cost for patients, is expected to save more than Euro 280 million of public money. Seventy-seven percent of this saving will be due to price readjustment of antiulcers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, and some antibiotics (mainly cephalosporins). The Italian system was able to cover all relevant diseases and ensured citizens and health professionals a choice among a wide range of valid pharmacological therapies. At the same time it was able to save public money by narrowing wide price differentials among drugs with comparable clinical properties. The set of interventions yielded a new national formulary that was able to have a significant influence on the trend of drug expenditure in Italy. This experience can be a useful reference for other European and non-European states.     

Pricing and reimbursement of pharmaceuticals in Italy

In Italy the price setting of medicines reimbursed by the National Health Service is regulated at the central level by AIFA, the national regulatory authority. Prices of non reimbursed medicines are indeed freely established, with some limitations, by pharmaceutical companies. To contain pharmaceutical expenditure and rationalise the whole sector the following measures have been introduced in the past years: a threshold to public pharmaceutical expenditure (PPE); a reference price system (RPS) for off-patent medicines; a pay-back mechanism as an alternative to price cut. In 2008 Italy launched a reform of the pharmaceutical expenditure governance system with the aim to introduce stability and promote development and competitiveness in the pharmaceutical sector.     

Managing psychotropic drug costs: will formularies work?

Payers of pharmaceutical benefits are increasingly turning to drug formularies in an attempt to control rising pharmacy costs, including those for psychotropic drugs. In this paper I examine several issues that policymakers should consider when addressing formulary design for psychotropic drugs: heterogeneity within mental health disorders and limited information about treatment effectiveness for individual patients; the potential for plans to try to use formularies to avoid adverse selection and implications for psychotropic coverage; the interaction of Medicaid formulary policy and manufacturers' incentives for psychotropic innovation; and incentives created by mental health institutions that decrease formularies' potential effectiveness in controlling psychotropic drug costs.     

Pharmaceutical expenditure in Spain: cost and control.

In recent years, the Spanish government has been battling to keep pharmaceutical expenditures under control. Its measures include control of prices, introduction of a "negative list" of drugs no longer reimbursed, increased cost-sharing, and introduction of overall budgets for pharmaceutical expenditures. Although the average prices of old pharmaceutical products declined by 39 percent over the last 15 years and consumption in value increased by only 10 percent, real pharmaceutical expenditures in Spain increased by 264 percent over that period. The main reason for the continuing rise in these expenditures and the failure of cost-containment measures is the introduction of new, more expensive drugs, which often fail to offer any real therapeutic advantages over products already on the market. This situation is exacerbated by a lack of effective demand-side measures such as budgets for doctors and lack of a generics market.     

Impacts of chronic non-communicable diseases on households’ out-of-pocket healthcare expenditures in Sri Lanka

This article examines the effects of chronic non-communicable diseases (NCDs) on households’ out-of-pocket health expenditures in Sri Lanka. We explore the disease specific impacts on out-of-pocket health care expenses from chronic NCDs such as heart diseases, hypertension, cancer, diabetics and asthma. We use nationwide cross-sectional household income and expenditure survey 2012/2013 data compiled by the department of census and statistics of Sri Lanka. Employing propensity score matching method to account for selectivity bias, we find that chronic NCD affected households appear to spend significantly higher out-of-pocket health care expenditures and encounter grater economic burden than matched control group despite having universal public health care policy in Sri Lanka. The results also suggest that out-of-pocket expenses on medicines and other pharmaceutical products as well as expenses on medical laboratory tests and other ancillary services are particularly higher for households with chronic NCD patients. The findings underline the importance of protecting households against the financial burden due to NCDs.     

National transparency assessment of Kuwait's pharmaceutical sector

ObjectivesCorruption is one of several factors that may hinder the access to pharmaceuticals. Since Kuwait has the highest per-capita spending on pharmaceuticals in the region, we wanted to evaluate the level of transparency in its pharmaceutical sector using an established assessment tool adapted by the World Health Organization.MethodsStandardized questionnaires were conducted via semi-structured interviews with key informants to measure the level of transparency in eight functions of the public pharmaceutical sector.ResultsThe scores for the degree of vulnerability to corruption reflected marginal to moderate venerability to corruption for most pharmaceutical sectors. The perceived strengths included availability of appropriate laws, the presence of clear standard operating procedures, and the use of an efficient registration/distribution system. Weaknesses included lack of conflict of interest guidelines and written terms of reference, absence of pharmacoeconomic studies, and inconsistencies in law enforcement.ConclusionsFindings reveal that few functions of Kuwait pharmaceutical sector remain fairly vulnerable to corruption. However, the willingness of Kuwait Ministry of Health to adopt the assessment study and the acknowledgement of the weaknesses of current processes of the pharmaceutical sector may assist to achieve a transparent pharmaceutical system in the near future.     

2007～2011年某院循环系统疾病住院病人构成及医疗费用分析

目的为加强单病种成本核算工作,控制医疗成本,对某院2007～2011年循环系统疾病住院病人构成及医疗费用变化情况进行分析。方法以2007—2011年循环系统疾病收治病人为研究对象,采用动态数列分析法对病人构成及医疗费用进行分析。结果2007～2011循环系统疾病住院病人逐年增加,人均住院医疗费用逐年增长。结论循环系统疾病住院病人的性别、年龄、主要诊断分类、住院日、手术操作等是影响住院医疗费用的因素;药品费和治疗费是医疗费用的主要组成部分。应控制好药品费和治疗费占医疗总费用的比例,并防止检查费等其它费用项目的不合理增加。     

The new pharmaceutical policy in Italy

Pressed by an impressive series of corruption scandals and by a change of attitude towards cost-containment, the Italian pharmaceutical sector's regulatory environment was radically changed in 1994. Regulatory power was concentrated on a national technical body (CUF) and a new set of measures was taken, including a nationwide drug expenditure budget, a redefinition of both the positive list and the cost-sharing rules, and new price-setting models. As a result, in the period 1993-1996, nominal expenditures decreased by about L 1600 billion (ECU 83.6 billion at 1997 exchange rate), that is from 13.3% to 11.0% of current National Health Service (NHS) expenditure. While in the 1980s Italy was one of the most generous countries in funding pharmaceuticals, it is now one of the most parsimonious. Although the overall pharmaceutical market shrank in 1994 and 1995, a substantial part of NHS drug-bill savings resulted from cost-shifting from the public sector to patients, mainly because physicians have not aligned their prescribing behaviour to the new positive list. The new Italian approach to containing pharmaceutical costs has been certainly effective, at least in the short run. However, new relevant issues are emerging regarding the fall of NHS pharmaceutical coverage, the centralised nature of the Italian pharmaceutical policy and the gap between scientific based policies and actual prescribing behaviours.     

The impact of pharmaceutical policy measures: An endogenous structural-break approach

Pharmaceutical spending in many countries has seen a steep increase in recent years. Governments have adopted several measures to reduce pharmaceutical expenditure growth, ranging from increased co-payments to price decreases determined administratively. Promotion of generic consumption has also ranked high in political priorities. We adopt a novel time series approach to the detection of which policy measures have a noticeable impact. The number and timing of the structural breaks are endogenously determined. As an illustration, we assess the overall impact of the several policy measures on total pharmaceutical spending, using monthly data from January 1995 to August 2008 for the Portuguese market. Our findings suggest that, in general, policy measures aimed at controlling pharmaceutical expenditure have been unsuccessful. Two breaks that were identified coincide with administratively determined price decreases. Measures aimed at increasing competition in the market had no visible effect on the dynamics of Government spending in pharmaceutical products. In particular, the introduction of reference pricing had only a transitory effect of less than one year, with historical growth resuming quickly. The consequence of this policy ineffectiveness is a transfer of financial burden from the Government to the patients, with no apparent effect on the dynamics of total pharmaceutical spending.     

An analysis of the pharmaceuticals market in Vietnam

This article sheds a light on the Vietnamese pharmaceutical market. The progress that has been made in the recent years following the opening of the Vietnamese regime to the western world, although not easy, brought a certain number of opportunities for domestic firms and foreign investors. The pharmaceutical Vietnamese industry started to emerge at the beginning of the 1990s. Although, the consumption of drugs is low, it does reach the sum of $ 5.5 per capita. As the majority of these products are imported, foreign companies tend to dominate the market both in volume and in diversity. The state has always played an important role with the implementation of a strict price control strategy and most national drug companies remain state-owned. The production and consumption of drugs were also largely influenced by state policies as the latter also control hospitals. In the second half of the eighties, the progressive liberalisation of the country allowed private drug pharmacies to appear and advertisement campaigns became legal. Because the lack of specific products like antibiotics was clear, the government increased the flow of imports, including private imports by citizens. Sources of imports have become more diverse, although France remains an important source of supply. Fournier, Lipha and Pierre Fabre are among the French drug manufacturers located in Vietnam. Other foreign companies include from India, South Korea, Thailand and Germany. Joint ventures were also created with French and Japanese companies. The import of medical materials is subjected to authorisations from the Ministry of Health and the Ministry of Foreign Trade as it is necessary to obtain a licence to do so. Licences are issued on the basis of the production of drugs that do not currently exist on the local market. But Vietnam also exports pharmaceutical products to Laos, Cambodia, and Cuba. Local resources constitute an important source of new products and have stirred a strong interest among pharmaceutical researchers. A strong decentralisation process characterises the pharmaceutical sector, with pharmacies in the provinces and districts while wholesalers remain located in Hanoi and Saigon. The presence of many middlemen has contributed to an increase in prices. Today, a concentration of pharmacies is still noted in inner cities while the suburbs and the villages still have difficulties supplying drugs for inhabitants. Solutions have been implemented such as the opening of new pharmacies and additional professional training for pharmacists. Prices were lowered while the quality of the supply chain was improved. Local production is encouraged as hospitals are prompted to prescribe Vietnamese products. The modernisation of the Vietnamese pharmaceutical industry is also visible through the importation of medical materials and an increase in the number of private hospitals financed with both the help of local and foreign investors, mainly through joint-ventures, most often in Saigon and Hanoi. The renovation of local hospitals was also possible with the help of France and Japan. Columbia Gia Dinh International, located in Saigon, is one of the very few US/Vietnamese medical institutions created with a local partner, the Gia Dinh hospital. The recovery of the economy will accelerate the creation of new projects designed to improve local medical infrastructures. Other private companies, some of which are based in Singapore, have been specifically designed to deliver care to expatriates working in Vietnam. Insurance coverage has been provided in Vietnam since in 1992. Other improvements concern the implementation of "Good Manufacturing Practices" (GMP) and "Good Laboratory Practices" and "Good Storage Practices". Most norms were implemented at the end of the 90s in joint companies linking foreign investors and local partners or in independent foreign drug manufacturers based in Vietnam. Special areas were created to receive high tech investments in the medical and pharmaceutical field. Prices should diminish as competition on the market increases and new products are placed on the market to achieve economies of scale. But investment in medical research is still strongly needed.     

医药价格改革对医疗费用和医保支出的影响——基于江苏省南京市区级公立医院的分析

目的：评价南京区级公立医院医药价格改革方案的合理性和可行性。方法：通过对南京市区级公立医院医药价格改革前后医疗费用数据的测算调研,模拟分析医保基金支出等重点指标的变化。结果：已试点的江宁区医院门诊和住院次均费用均下降,个人负担率住院持平、门诊有升有降。经模拟测算,即将推进改革的其它4个区级医院门诊和住院药占比、次均门诊费用均有所下降,次均住院费用上升,住院费用个人负担下降3.21个百分点,住院费用医保统筹基金增加支出占实际基金支出的7.74％。结论：医药价格改革减轻了患者个人负担;医保基金支出增加,风险有待防范;医药价格结构调整趋向合理,医疗技术和医护服务价值得到体现,补偿率偏高地区个人和医保统筹基金支出均增加。建议：破除“以药补医”机制,引导参保人员合理分流,推进医保支付方式改革,医保基金市级统筹、城乡统筹相结合,促进县级公立医院改革良性发展。