Country-specific Price Research Articles

Unrecorded alcohol use in 33 European countries: Analyses of a comparative survey with 49,000 people who use alcohol.

Using data from 33 European countries (including all EU member states), this study aimed to 1) estimate the prevalence of unrecorded alcohol use among past-week alcohol users, 2) describe how unrecorded alcohol use is associated with drinking patterns, and 3) estimate the contribution of unrecorded alcohol to the total amount of alcohol consumed annually in these countries. Data from 25,728 adults who drank alcohol in the past week and self-reported their use of unrecorded alcohol in 2021 were analysed. Prevalence of unrecorded alcohol use in the last week was estimated for those with low, medium, and high risk drinking categorised using the WHO-recommended risk thresholds and definition of risky single occasion drinking. Prevalence estimates were weighted for the country-specific gender, age, and geographical population distribution. An adjusted weighted proportion of unrecorded drinking occasions in total drinking occasions was calculated and compared to 2020 recorded annual per capita consumption estimates. Among past-week alcohol users, the average prevalence of past-week unrecorded alcohol use was 12.1% (95% CI: 11.7-12.5%), with considerable difference between countries (min: 2.0% in Malta; max: 27.0% in Greece). Unrecorded alcohol use was much more prevalent among people with high-risk alcohol use in the past week (24.2%, 95% confidence interval [CI]: 22.9-25.5%) compared to people with low- (6.5, 95% CI: 6.0-6.9%) or medium-risk alcohol intake in the past week (13.6%, 95% CI: 12.9-14.3%). Unrecorded alcohol accounted for 7% of per capita consumption in 2020. This is the first comparable assessment of unrecorded alcohol use across EU and affiliated countries. The findings add support to the observation that availability of unrecorded alcohol may contribute torisky drinking in Europe. The observed country variations may be related to differences in country-specific pricing policies and measures to reduce the production and consumption of unrecorded alcoholic beverages.

Cost per responder of biologic drugs used in the treatment of moderate-to-severe plaque psoriasis in France and Germany

Objective The treatment of moderate-to-severe plaque psoriasis has seen significant improvements in recent years with the advent of biologic drugs. The aim of this study was to assess the cost-effectiveness of anti-IL17 drugs and other biologic therapies used to treat moderate-to-severe plaque psoriasis in France and Germany over a one-year time horizon. Methods We developed a cost per responder model for biologic drugs used in psoriasis treatment. The model included anti-IL17s (brodalumab, secukinumab, ixekizumab and bimekizumab), anti-TNFs (adalimumab, etanercept, certolizumab and infliximab), an anti-IL12/23 (ustekinumab), and anti-IL23s (risankizumab, guselkumab and tildrakizumab). Efficacy estimates were collected through a systematic literature review of network meta-analyses on long-term Psoriasis Area and Severity Index (PASI) measures. Dose recommendations and country-specific prices were used to calculate drug costs. Biosimilar drug prices were used when available as a substitute for the originator drugs. Results After one year, brodalumab had the lowest cost per PASI100-responder in both France (€20,220) and Germany (€26,807) across all available biologic treatments. Among the anti-IL17s, brodalumab had a 23% lower cost per PASI100-responder vs. the nearest comparator in France (bimekizumab, €26,369), and 30% lower vs. nearest comparator in Germany (ixekizumab, €38,027). Brodalumab also had the lowest cost per PASI75- and PASI90-responder among the anti-IL17s in both France and Germany after one year. Adalimumab had the lowest cost per PASI100-responder among the anti-TNFs in both France (€23,418) and Germany (€38,264). Among the anti-IL-23s, risankizumab had the lowest cost per PASI100-responder in both France (€20,969) and Germany (€26,994). Conclusion Driven by its lower costs and high response rates, brodalumab was the most cost-effective treatment option for moderate-to-severe plaque psoriasis over a one-year time-horizon within the anti-IL17 class and when compared to all other biologics in France and Germany.

Do Natural Resources Really Cause Civil Conflict? Evidence from the New Global Resources Dataset

Scholars have long examined the relationship between natural resources and conflict at the country level. More recently, researchers have turned to subnational analyses, using either individual countries or subnational data for a small number of resources in sub-Saharan Africa. We introduce a new sub-national dataset of [Formula: see text] resources that adds many resource types, locations, and countries from Africa, the Middle East, Asia, Latin America, and Europe. To demonstrate the value of the new dataset, we examine how conflict incidence varies with the value of the collective set of resources in a given location using world prices. We then introduce new country-specific price data, which are more relevant for conflict dynamics. Since country-specific prices can be endogenous to conflict, we instrument country-specific prices using U.S. and world prices. We find that sub-national resource wealth is associated with higher levels of conflict using some specifications, though the results vary widely by data source and world region. Using an instrumental variables strategy lends the strongest support to this positive relationship, but only for African countries. Notably, across all of our models, we find that resources are negatively associated with conflict in Latin America, suggesting heterogeneity of effects worth future exploration.

The Welfare Effects of Spotify’s Cross-Country Price Discrimination

We calibrate a simple empirical logit model of world demand—and subscription pricing—at Spotify, with the use of available data on monthly prices and using streaming volumes by country to create measures of the numbers of users. We find that country-specific pricing increases revenue by 5.9% relative to uniform world pricing, while country specific pricing decreases world consumer surplus by 1.0%. Country-specific pricing within Europe increases revenue in Europe by 1.1%, and EU consumer surplus increases by 0.3% with country-specific pricing. Consumers in lower-income countries gain more from price discrimination than do the consumers in higher-income countries.

Integration and convergence in European electricity markets

This paper investigates the degree of integration among markets using wholesale electricity prices, which arises from the link between the long-run dynamics of fuel prices and electricity prices. We address the question of whether European electricity markets have experienced convergence patterns in recent years, using the stochastic definitions of convergence and common trend based on cointegration analysis. We apply a vector error correction model to a representative sample of electricity spot prices of European markets, including those of Italy, France, the Netherlands, Poland, and the integrated market of Germany and Austria. We analyze both the long- and the short-run system properties, studying their persistence profiles. The short-run analysis reveals the non-significance of adjustment coefficients of the market prices in the Netherlands and Poland. Moreover, the Netherlands Granger causes Poland and the integrated market of German and Austria, but the reverse is not true. A unidirectional Granger causality is also found for France and Germany and Austria toward Italy. Given the cointegrating equilibrium, all country-specific price dynamics converge toward the steady state, but most of the exogenous shocks have permanent effects. Forecast error variance decomposition analysis clearly highlights that orthogonalized shocks largely affect the variance of neighboring markets.

Cointegration Analysis of the Convergence Process in the European Electricity Markets

This paper investigates the degree of integration among markets using wholesale electricity prices. The reason arises from the link between the long-run dynamic of fuel prices and electricity prices. We address the question of whether European electricity markets have experienced convergence patterns in the last years using the stochastic definitions of convergence and common trend based on co-integration analysis. We apply a Vector Error Correction model to a representative sample of electricity spot prices of European markets, including those of Italy, France, the Netherlands, Poland, and the integrated market of Germany and Austria. We analyze both the long- and the short-run of system properties, studying their persistence profiles. The short-run analysis reveals the non–significance of adjustment coefficients of the market prices in the Netherlands and Poland. Moreover, the Netherlands Granger causes Poland and the integrated market German and Austria, but the reverse is not true. A unidirectional Granger causality has been found also for France and Germany and Austria toward Italy. Given the cointegrating equilibrium, all country-specific price dynamics converge toward the steady state, but most of the exogenous shocks have permanent effects. Forecast Error Variance Decomposition analysis clearly highlights that orthogonalized shocks largely affect the variance of neighboring markets.

Managing Payment Transaction Costs at Multinational Online Retailers

Providing cost- and credit-efficient payment services to customers in e-commerce is a critical success factor for retailer competitiveness. However, country-specific payment provision strategies for internationally operating retailers are difficult to pinpoint, as existing research on the economics of payment instruments mostly focuses on transactions within one country, neglect electronic payment instruments due to data limitations, or base cost estimations on aggregated statistics or survey data. This article copes with these challenges by using a unique transaction-level data set with more than 29.1 million actual sales transactions, and examines how retailer transaction costs of online payment instruments invoice, credit card, PayPal, and prepayment differ across 14 European countries. Therein, this study identifies transaction cost differences due to country-specific pricing of payment services. Moreover, empirical results reveal that culture difference accounts for variation in customer payment timing and hence, affects retailer transaction costs when offering payment services in e-commerce. The presented research results allow retailers to holistically evaluate the efficiency of their current payment portfolio, and in developing country-specific payment provision strategies in order to reduce transaction costs and working capital requirements.

Population Health and Cost-Effectiveness Implications of a "Treat All" Recommendation for HCV: A Review of the Model-Based Evidence.

The World Health Organization HCV Guideline Development Group is considering a “treat all” recommendation for persons infected with hepatitis C virus (HCV). We reviewed the model-based evidence of cost-effectiveness and population health impacts comparing expanded treatment policies to more limited treatment access policies, focusing primarily on evaluations of all-oral directly acting antivirals published after 2012. Searching PubMed, we identified 2,917 unique titles. Sequentially reviewing titles and abstracts identified 226 potentially relevant articles for full-text review. Sixty-nine articles met all inclusion criteria—42 cost-effectiveness analyses and 30 models of population-health impacts, with 3 articles presenting both types of analysis. Cost-effectiveness studies for many countries concluded that expanding treatment to people with mild liver fibrosis, who inject drugs (PWID), or who are incarcerated is generally cost-effective compared to more restrictive treatment access policies at country-specific prices. For certain patient subpopulations in some countries—for example, elderly individuals without fibrosis—treatment is only cost-effective at lower prices. A frequent limitation is the omission of benefits and consequences of HCV transmission (i.e., treatment as prevention; risks of reinfection), which may underestimate or overestimate the cost-effectiveness of a “treat all” policy. Epidemiologic modeling studies project that through a combination of prevention, aggressive screening and diagnosis, and prompt treatment for all fibrosis stages, it may be possible to virtually eliminate HCV in many countries. Studies show that if resources are not available to diagnose and treat all HCV-infected individuals, treatment prioritization may be needed, with alternative prioritization strategies resulting in tradeoffs between reducing mortality or reducing incidence. Notably, because most new HCV infections are among PWID in many settings, HCV elimination requires unrestricted treatment access combined with injection transmission disruption strategies. The model-based evidence suggests that a properly constructed strategy that substantially expands HCV treatment could achieve cost-effective improvements in population health in many countries.

Bevacizumab for Metastatic Colorectal Cancer: A Global Cost-Effectiveness Analysis.

In the U.S., the addition of bevacizumab to first-line chemotherapy in metastatic colorectal cancer (mCRC) has been demonstrated to provide 0.10 quality-adjusted life years (QALYs) at an incremental cost-effectiveness ratio (ICER) of $571,000/QALY. Due to variability in pricing, value for money may be different in other countries. Our objective was to establish the cost-effectiveness of bevacizumab in mCRC in the U.S., U.K., Canada, Australia, and Israel. We performed the analysis using a previously established Markov model for mCRC. Input data for efficacy, adverse events, and quality of life were considered to be generalizable and therefore identical for all countries. We used country-specific prices for medications, administration, and other health service costs. All costs were converted from local currency to U.S. dollars at the exchange rates in March 2016. We conducted one-way and probabilistic sensitivity analyses (PSA) to assess the model robustness across parameter uncertainties. Base case results demonstrated that the highest ICER was in the U.S. ($571,000/QALY) and the lowest was in Australia ($277,000/QALY). In Canada, the U.K., and Israel, ICERs ranged between $351,000 and $358,000 per QALY. PSA demonstrated 0% likelihood of bevacizumab being cost-effective in any country at a willingness to pay threshold of $150,000 per QALY. The addition of bevacizumab to first-line chemotherapy for mCRC consistently fails to be cost-effective in all five countries. There are large differences in cost-effectiveness between countries. This study provides a framework for analyzing the value of a cancer drug from the perspectives of multiple international payers. The cost-effectiveness of bevacizumab varies significantly between multiple countries. By conventional thresholds, bevacizumab is not cost-effective in metastatic colon cancer in the U.S., the U.K., Australia, Canada, and Israel.

Incomplete Asset Market View of the Exchange Rate Determination

We resolve a long-standing quest to unite the dynamics of the exchange rate with that of country-specific pricing by establishing a necessary and sufficient condition for their unity. Assuming arbitrage-free and perfectly integrated international financial markets, the exchange rate is equal to the ratio of countries' stochastic discount factor projectors if and only if every exchange rate risk is singly traded in markets, i.e., exchange rate risks are completely disentangled. Therefore, exchange rate risk entanglement presents a novel conceptual rationale for the observed perplexing disconnection between the levels of international risk sharing implied by prices (smooth exchange rates) and by quantities data (low cross-country consumption correlations). Our study completely characterizes when and how the influential asset market view of the exchange rate does not pose strong implications on the exchange rate dynamics.

Structural estimation of price adjustment costs in the European car market

This paper characterizes the price adjustment costs that are consistent with observed price dynamics in the European car market. We estimate a dynamic model of international multiproduct firms that set prices in different currencies while facing price adjustment costs. We find that large price adjustment costs are not needed to rationalize the substantial degree of price inertia we observe in the data. Intuitively, since GDP, wages and exchange rates exhibit such a large degree of autocorrelation, small adjustment costs can explain very persistent prices. Also, accounting for country-specific price sensitivity, wages, GDP and exchange rates, the price adjustment costs should differ substantially across producers and markets to match the data.

Bevacizumab (bev) for metastatic colorectal cancer (mCRC): A global cost-effectiveness analysis.

6518Background: In the United States, the addition of bev to 1st-line chemotherapy in mCRC provides an additional 0.10 quality-adjusted life years (QALYs) at an incremental cost-effectiveness ratio (ICER) of $571,240/QALY (Goldstein et al. Journal of Clinical Oncology, 2015). However, this estimate of value is not transferrable between countries due to variable international pricing strategies. Our objective was to establish the cost-effectiveness of bev in mCRC in 5 different countries: the US, the UK, Canada (CAN), Australia (AUS), and Israel (ISR). Methods: We performed the analysis on the basis of a previously published Markov model (Goldstein et al. JCO, 2015). Input data for efficacy, adverse events and quality of life were considered to be standard for all countries. We used country specific prices for all healthcare services, medications, and administration costs. For the UK, all costs were obtained from UK Department of Health, National Health Service and British National Formulary. For CAN, all ...

A cross-country analysis of residential electricity demand in 11 OECD-countries

We provide consistent, cross-country estimates of price and income elasticity for households in 11 OECD countries. Using survey data from 2011 on annual consumption of electricity and sample-derived average electricity price, we provide country-specific price elasticity estimates and average income elasticity estimates. For most countries in our sample, we find strong price responsiveness, with elasticities varying (in absolute value) between 0.27 for South Korea and 1.4 for Australia, and higher than 0.5 for most countries. Exploiting the presence of many attitudinal indicators in the dataset, we provide evidence that non-price related factors to affect energy demand; in particular, households' self-reported energy savings behaviour reduces demand between 2 and 4%. In contrast, we find very weak income responsiveness, with income elasticities varying from 0.07 to 0.16 and no evidence for heterogeneity across the countries in our sample. Our results regarding price elasticity are in contrast with those of many existing studies which find low-to-moderate price responsiveness, and adds to a few recent studies indicating more policy space for demand reduction than previously thought.

A Cross-Country Analysis of Residential Electricity Demand In 11 OECD-Countries

We provide consistent, cross-country estimates of price and income elasticity for the residential sector of 11 OECD countries. Using survey data from 2011 on annual consumption of electricity and sample-derived average electricity price, we provide country-specific price elasticity estimates and average income elasticity estimates. For most countries in our sample, we find strong price responsiveness, with elasticities varying between -0:27 for South Korea and -1:4 for Australia, with most countries elasticity being above (in absolute value) -0:5. Exploiting the presence of many attitudinal indicators, we find evidence for non-price related factors, in particular households’ self-reported energy saving behavior, to reduce energy demand between 2 and 4%. In contrast, we find very weak income response, with income elasticities varying from 0:07 to 0:14 and no evidence for heterogeneity across the countries in our sample. Our results regarding price elasticity are in contrast with many existing studies which find low-to-moderate price responsiveness, and adds to a few recent studies indicating more policy space for demand reduction than previously thought.

Shining a light in the black box of orphan drug pricing.

BackgroundThe pricing mechanism of orphan drugs appears arbitrary and has been referred to as a “black box”. Therefore, the aim of this study is to investigate how drug- and disease-specific variables relate to orphan drug prices. Additionally, we aim to explore if certain country-specific pricing and reimbursement policies affect the price level of orphan drugs.MethodsAnnual treatment costs per indication per patient were calculated for 59 orphan drugs with a publicly available price in Belgium, the Netherlands, Czech Republic, France, Italy and the United Kingdom. A multiple linear regression model was built with 14 drug- and disease-specific variables. A Mann-Whitney U test was used to explore whether there is a correlation between annual treatment costs of orphan drugs across countries with different pricing and reimbursement policies.ResultsRepurposed orphan drugs, orally administered orphan drugs or orphan drugs for which an alternative treatment is available are associated with lower annual treatment costs. Orphan drugs with multiple orphan indications, for chronic treatments or for which an improvement in overall survival or quality-of-life has been demonstrated, are associated with higher annual treatment costs. No association was found between annual treatments cost of orphan drugs across countries and the different pricing and reimbursement systems.ConclusionsThis study has shown that prices of orphan drugs are influenced by factors such as the availability of an alternative drug treatment, repurposing, etc. Current debate about the affordability of orphan drugs highlights the need for more transparency in orphan drug price setting.

EU pharmaceutical expenditure forecast

Background and ObjectivesWith constant incentives for healthcare payers to contain their pharmaceutical budgets, forecasting has become critically important. Some countries have, for instance, developed pharmaceutical horizon scanning units. The objective of this project was to build a model to assess the net effect of the entrance of new patented medicinal products versus medicinal products going off-patent, with a defined forecast horizon, on selected European Union (EU) Member States’ pharmaceutical budgets. This model took into account population ageing, as well as current and future country-specific pricing, reimbursement, and market access policies (the project was performed for the European Commission; see http://ec.europa.eu/health/healthcare/key_documents/index_en.htm).MethodIn order to have a representative heterogeneity of EU Member States, the following countries were selected for the analysis: France, Germany, Greece, Hungary, Poland, Portugal, and the United Kingdom. A forecasting period of 5 years (2012–2016) was chosen to assess the net pharmaceutical budget impact. A model for generics and biosimilars was developed for each country. The model estimated a separate and combined effect of the direct and indirect impacts of the patent cliff. A second model, estimating the sales development and the risk of development failure, was developed for new drugs. New drugs were reviewed individually to assess their clinical potential and translate it into commercial potential. The forecast was carried out according to three perspectives (healthcare public payer, society, and manufacturer), and several types of distribution chains (retail, hospital, and combined retail and hospital). Probabilistic and deterministic sensitivity analyses were carried out.ResultsAccording to the model, all countries experienced drug budget reductions except Poland (+€41 million). Savings were expected to be the highest in the United Kingdom (−€9,367 million), France (−€5,589 million), and, far behind them, Germany (−€831 million), Greece (−€808 million), Portugal (−€243 million), and Hungary (−€84 million). The main source of savings came from the cardiovascular, central nervous system, and respiratory areas and from biosimilar entries. Oncology, immunology, and inflammation, in contrast, lead to additional expenditure. The model was particularly sensitive to the time to market of branded products, generic prices, generic penetration, and the distribution of biosimilars.ConclusionsThe results of this forecast suggested a decrease in pharmaceutical expenditure in the studied period. The model was sensitive to pharmaceutical policy decisions.

PHP31 - Does Europe Reward Reformulations? A Data Driven Analysis of Value Preservation Through Reformulation

Reformulating existing drugs can improve patient convenience, compliance and create new uses for the product. However, reformulations cost millions of Euros - a risky investment without guaranteed exclusivity or returns. This study assessed whether markets reward incremental value creation through reformulation by comparing sales performance close to patent expiry for reformulated and non-reformulated products. IMS MIDAS data was interrogated to identify 829 small molecule, non-generic products which had peak sales above €5M and lost patent protection between 2001 and 2010 in EU-5 (France, Germany, Italy, Spain and UK). Ex-manufacturer sales value (€) 2 years after patent expiry was compared with sales value 4 years earlier to calculate percentage value erosion for each of the 829 products. A subset of 133 products which launched at least 1 reformulation close to patent protection expiry (launch between 3 years before and 1 year after patent protection expiry) were analysed to assess whether value erosion varied across countries or therapy areas. Mean ex-manufacturer sales value erosion of reformulated products (24%) was significantly less than non-reformulated products (37%, P<0.01). Reformulated product value erosion varied with country and therapy area. Germany saw highest number of reformulations launched yet only reformulations launched in Italy showed significantly less value erosion than non-reformulated products (P<0.01). Across therapy areas, reformulations were most common in nervous system, metabolism and anti-infective categories. However, reformulated anti-infective product value erosion was pronounced while musculoskeletal and nervous system products experienced significantly less value erosion than for non-reformulated products (both P<0.05). Overall, reformulated products do maintain more value than non-reformulated products following loss of patent protection. Chronic disorders e.g. nervous and musculoskeletal system disorders appear to be the most promising areas for reformulating. Future reformulation potential is tightly linked to country-specific pricing and market access policy decisions to recognise incremental value products.

The Risk Premium on the Euro Area Market Portfolio: The Role of Real Estate

Incomplete consumption risk sharing implies that the market risk premium is high in times of lack of risk sharing and vice versa. In the time period from 1980 to 2007, this implication of incomplete consumption risk sharing for the market price of risk is not mirrored in excess returns on stocks but in returns on real estate both in the Euro Area and in the U.S. This finding thus casts doubt on the common practice to approximate the market return by a stock index return in empirical tests of the Sharpe-Lintner capital asset pricing model. However, cross-sectional asset pricing tests suggest that there are fundamental differences between the Euro Area and the U.S. in this respect. The return on real estate does not add any explanatory power for domestic or foreign asset returns in excess of a stock index return in the U.S. The opposite reasoning applies to the Euro Area. Finally, this paper shows that the distinction between rather global and country-specific pricing factors does not seem to be important for the pricing of excess returns on foreign currencies.

Variations in hospitalisation costs for acute myocardial infarction – a comparison across Europe

The aim of this study was to determine whether between-country variations in hospital costs are larger than within-country variations and, furthermore, to explore reasons for this variability. For this purpose, we chose the primary treatment of patients with acute myocardial infarction (AMI) as an episode of care. We obtained hospitalisation costs and reimbursement rates from 45 hospitals in nine different EU member states (i.e. Denmark, England, France, Germany, Hungary, Italy, Netherlands, Poland, and Spain) for the year 2005. To further analyse the variations in hospital costs, we employed a hierarchical random effects model based on treatment and hospital characteristics and using purchasing power parities (PPPs) as a proxy for country-specific price levels. The between-country standard error was estimated at 2473 euros, whereas the within-country standard error was estimated at 1242 euros. Our regression analysis showed that percutaneous coronary intervention was associated with significantly increased hospitals costs compared to other treatment strategies. We were able to distinguish between three groups of countries with different cost levels based on the number of hospitals that were able to provide these services (i.e. percutaneous transluminal coronary angioplasty (PTCA) with intracoronary stenting). Excluding Hungary, Poland, and Spain, where none of the participating hospitals were able to provide these procedures, the between-country standard error decreased to 1632 euros, whereas the within-country standard error increased to 1416 euros. Finally, we observed exogenous price-level effects between countries and within countries for hospitals located in urban areas.