Lower Income European Countries Research Articles

Reference Pricing as a Deterrent to Entry: Evidence from the European Pharmaceutical Market

External reference pricing (ERP), the practice of benchmarking domestic drug prices to foreign prices, generates an incentive for firms to withhold products from low-income countries. Using a novel moment inequality approach, we estimate a structural model to measure how ERP policies affect access to innovative drugs across Europe. We find that ERP increases entry delays in eight low-income European countries by up to one year per drug. The European Union could remove these delays without replacing ERP by compensating firms through lump-sum transfers at the cost of around €18 million per drug. (JEL L13, L51, L65)

SM2 The Consequences of Greater Net Price Transparency for Innovative Medicines in Europe: Insights from a Multi-Agent Simulation Model

Background: Price transparency of innovative medicines is a heavily debated topic and, despite no evidence suggesting that greater net price transparency (NPT) could benefit either the payers or the patients, it is believed by many stakeholders as a mechanism to promote competition and equity across markets. The aim of this study is to explore the effects of a policy requesting greater NPT in Europe on the achievable pharmaceutical pricing and access in different European countries. A computational multi-agent model representing the European country-level situation was developed to conduct counterfactual analyses of various NPT systems. In particular, the model considers only the case of manufacturers of in-patent pharmaceutical products acting as monopolists, hence not facing competition, when negotiating the price and reimbursement of new drugs. The results of the computational model indicate that lower-income markets could expect price increases under transparent conditions whereas higher-income markets could expect price decreases. A full NPT system encompassing higher- and lower-income European countries would not be viable as middle- and lower-income countries acting as rational economic agents would not give up their confidential agreement system with the pharmaceutical industry. A partial price transparency system could be a viable solution if entailing only the group of high-income countries committing to NPT and accepting a higher price than they could get in their present confidential rebate system, leaving all other countries free to opt for confidential discounts. Results from the computational model are fully in line with previous studies indicating an increasing imbalance between higher- and lower-income countries, with the latter likely to have to pay more for the same value that they get now. This goes against the spirit of Ramsey Pricing principles with which a mark-up would be implemented to countries featuring highly inelastic demand to ensure distributive justice amongst European markets.

Country of birth and mortality risk in hypertension with and without diabetes: the Swedish primary care cardiovascular database.

Hypertension and diabetes are common and are both associated with high cardiovascular morbidity and mortality. We aimed to investigate associations between mortality risk and country of birth among hypertensive individuals in primary care with and without concomitant diabetes, which has not been studied previously. In addition, we aimed to study the corresponding risks of myocardial infarction and ischemic stroke. This observational cohort study of 62 557 individuals with hypertension diagnosed 2001-2008 in the Swedish Primary Care Cardiovascular Database assessed mortality by the Swedish Cause of Death Register, and myocardial infarction and ischemic stroke by the National Patient Register. Cox regression models were used to estimate study outcome hazard ratios by country of birth and time updated diabetes status, with adjustments for multiple confounders. During follow-up time without diabetes using Swedish-born as reference, adjusted mortality hazard ratios per country of birth category were Finland: 1.26 (95% confidence interval 1.15-1.38), high-income European countries: 0.84 (0.74-0.95), low-income European countries: 0.84 (0.71-1.00) and non-European countries: 0.65 (0.56-0.76). The corresponding adjusted mortality hazard ratios during follow-up time with diabetes were high-income European countries: 0.78 (0.63-0.98), low-income European countries: 0.74 (0.57-0.96) and non-European countries: 0.56 (0.44-0.71). During follow-up without diabetes, the corresponding adjusted hazard ratio of myocardial infarction was increased for Finland: 1.16 (1.01-1.34), whereas the results for ischemic stroke were inconclusive. In Sweden, hypertensive immigrants (with the exception for Finnish-born) with and without diabetes have a mortality advantage, as compared to Swedish-born.

Reference Pricing as a Deterrent to Entry: Evidence from the European Pharmaceutical Market

External reference pricing (ERP), the practice of benchmarking domestic drug prices to foreign prices, generates an incentive for firms to withhold products from low-income countries. Using a novel moment inequality approach, we estimate a structural model to measure the extent to which ERP policies affect access to innovative drugs across Europe. We find that ERP increases entry delays in eight low-income European countries by up to one year per drug. The European Union could remove these delays without replacing ERP by compensating firms through lump-sum transfers at the cost of around 18 million euro per drug.

66 EFOMP: A global Player in the Education and Training of Medical Physics Experts

Introduction Promoting of education and training programmes is one of the columns of the mission of EFOMP. In this paper, I will briefly outline the initiatives taken from EFOMP in this field, namely: -The European School for medical Physics Experts (ESMPE) -The European Examination Board (EEB) - The participation of EFOMP in the EUTEMPE-RX network. ESMPE EFOMP organized in 2013 the first module which was targeted towards Medical Physicists who would like to achieve Medical Physics Expert status in the Nuclear Medicine subspecialty. Since then, nine editions of the school have been completed with more than 400 participants coming from all European countries (see Fig. 1). Download : Download high-res image (219KB) Download : Download full-size image The geographical distribution of participants demonstrate that this is perceived by participants as a European forum where state of the art information regarding technologies, methods and novelties in the field of medical Physics can be efficiently gathered and shared (see Fig. 2). Download : Download high-res image (270KB) Download : Download full-size image A distinctive tract of the school is to provide subsidized fees for a certain number of participants coming from low income European countries. ESMPE at the second European Congress of Medical Physics – August 22, 2018, Copenhagen, Denmark The main congress (ECMP2018) will take place from 23 to 25 August 2018 in Copenhagen. Satellite meetings will be held in conjunction with the ECMP2018 on the 22 of August. Among them, ESMPE organized three satellite meetings. 1. Statistics in Medical Physics 2. Fundamentals of Nuclear Medicine Dosimetry 3. IMRT&VMAT planning in practice EEB In many of EFOMP’s NMOs a local examination board has not been established. Currently medical physicists from such countries face difficulties in providing the necessary qualification evidence when they seek employment in other EU Member States. The EEB has been established to facilitate the harmonization of medical physics standards throughout Europe, so facilitating the mobility of medical physicists The EEB main aims are to introduce 2 European Diplomas in Medical Physics: • EDMP (European Diploma for Medical Physics) • EACMPE (European Accreditation Certificate for Medical Physics Experts) The first round of EEB exams for Diagnostic and Interventional radiology took place in Prague July 6 and 7 2017. The second EEB round of examinations will took place August 21 and 22 2018 in all three fields of Medical Physics and will be held in conjunction with the 2nd ECMP 2018 in Copenhagen. EUTEMPE-RX Eutempe-RX is a Network of excellent teaching centers, which provides dedicated courses at EQF level8. The course contents are driven by the ”Guidelines of the MPE project” with the support of a Scientific Advisory Board and they consist in balanced e-learning (40 hours workload) done through a Multicampus Educational and Training platform and face-to-face sessions (40 hours workload). The educational tools and methods includes: • Creation of ”groups of learners” and guided tasks prior to the face-to-face moments • Online communication & feedback between teachers and learners • Interactive self-assessment test • Up-to-date multimedia material • Solutions for practical training • Interactive exercises • Databases of Material

Policy objective of generic medicines from the investment perspective: The case of clopidogrel

The objective of generic drug policies in most countries is defined from a disinvestment perspective: reduction in expenditures without compromising health outcomes. However, in countries with restricted access of patients to original patented drugs, the objective of generic drug policies can also be defined from an investment perspective: health gain by improved patient access without need for additional health budget.This study examines the investment aspect of generic medicines by analyzing clopidogrel utilization in European countries between 2004 and 2014 using multilevel panel data models. We find that clopidogrel consumption was strongly affected by affordability constraints before the generic entry around 2009, but this effect decayed by 2014. After controlling for other variables, utilization had a substantially larger trend increase in lower-income European countries than in the higher-income ones. Generic entry increased clopidogrel consumption only in lower- and average-income countries but not in the highest-income ones. An earlier generic entry was associated with a larger effect.The case of clopidogrel indicates that the entrance of generics may increase patient access to effective medicines, most notably in lower-income countries, thereby reducing inequalities between European patients. Policymakers should also consider this investment aspect of generic medicines when designing pharmaceutical policies.

CV3 - Policy Objective of Generic Medicines from the Investment Perspective: The Case of Clopidogrel

The objective of generic drug policies in most countries is defined from a disinvestment perspective: reduction in expenditures without compromising health outcomes. However, in countries with restricted access of patients to original patented drugs, the objective of generic drug policies can also be defined from an investment perspective: health gain by improved patient access without need for additional health budget. This study examines the investment aspect of generic medicines by analyzing clopidogrel utilization in European countries between 2004 and 2014 using multilevel panel data models. We find that clopidogrel consumption was strongly affected by affordability constraints before the generic entry around 2009, but this effect decayed by 2014. After controlling for other variables, utilization had a substantially larger trend increase in lower-income European countries than in the higher-income ones. Generic entry increased clopidogrel consumption only in lower- and average-income countries but not in the highest-income ones. An earlier generic entry was associated with a larger effect. The case of clopidogrel indicates that the entrance of generics may increase patient access to effective medicines, most notably in lower-income countries, thereby reducing inequalities between European patients. Policymakers should also consider this investment aspect of generic medicines when designing pharmaceutical policies.

Implication of external price referencing and parallel trade on pharmaceutical expenditure: indirect evidence from lower-income European countries.

External price referencing (EPR) is applied more and more frequently worldwide by payers to control pharmaceutical prices. Together with the parallel trade of pharmaceuticals, EPR may result in lower pharmaceutical prices in higher-income countries and higher prices in lower-income countries, which implies that pharmaceutical expenditure grows more rapidly in the latter than in the former group. Our objective was to assess this hypothesis. We used hierarchical linear models on country-level panel data to show that-after controlling for compounding factors such as GDP, the proportion of the old-age population or life expectancy-the annual growth rate of pharmaceutical expenditure was 2.1% points larger in the lower- than in the higher-income members of the European Union between 2000 and 2008. This difference in trends became non-significant (0.6% points) after the onset of the global economic crisis. There was no significant difference between lower- and higher-income countries in the growth rate of non-pharmaceutical health expenditure in either period. Our results indirectly support the presence of price convergence of pharmaceuticals among European countries, and EPR and parallel trade may provide a reasonable explanation to the observed trend difference of pharmaceutical expenditure in the two groups of countries between 2000 and 2008. This higher growth rate of pharmaceutical expenditure put extra burden on public health care budgets in lower-income countries and resulted in disproportionately more cost-containment measures compared to higher-income countries after 2008. It remains to be seen whether the disappearance of the difference in trend growth rates due to special health policy interventions in countries with economic difficulties is temporary or permanent.

From patent counting towards the system of IP strategic indicators

The strategies of the European Union and its Member States suppose that intellectual property (IP) created as the result of R&D is the engine of economic growth and welfare in society. Studies based on the European Regional Innovation Scoreboard (RIS) have demonstrated that R&D investments, support to the high technology industry and patenting intensity of the public sector differ in high- and low-income European countries. This fact refers to the need for adequate IP strategic indicators’ system facilitating innovation in less developed countries. The paper aims to conceptualize and suggest a strategic indicators’ system of IP for a small efficiency-driven economy. In contrast to the rather modest level of patenting by industry, universities of the Baltic States file approximately 50% of PCT patent applications. Therefore, it is crucial to overcome barriers, hindering universities’ IP commercialization. Academia-Industry collaboration includes two types of IP strategies: Active non-linear and Passive linear behavioural models of universities and public sector. An essential part of the active approach focuses on the “soft measures” for networking with firms in collaborative platforms such as AIMday® at the Uppsala University in Sweden. The proposed IP strategy system involves qualitative and quantitative indicators at the state as well as university and company level. The comparison of academic publishing and patenting by the staffs of Tartu and Uppsala universities testifies to their rather same levels of productivity. Three times wider patent families of the inventions of Uppsala origin characterize actors’ market ambition as well as the strength of University-Industry linkages that are more developed in Uppsala than in Tartu. DOI: http://dx.doi.org/10.5755/j01.ee.27.3.13799

PHP24 - Principles of policy Framework in the Pharmaceutical wholesale and retail system in lower income European Countries

PHP24 - Principles of policy Framework in the Pharmaceutical wholesale and retail system in lower income European Countries

THU0150 Large differences in affordability and availability of synthetic dmards across 46 european countries

BackgroundIn the drug treatment for RA patients, EULAR recommends to initiate synthetic DMARDs immediately after diagnosis. However, it is questionable whether these treatments are equally available and affordable across European...

Inequities in access to biologic and synthetic DMARDs across 46 European countries

ObjectivesWe investigated access to biologic and synthetic disease modifying drugs (bDMARDs and sDMARDs) in patients with rheumatoid arthritis (RA) across Europe.MethodsA cross-sectional study at national level was performed in 49...

Measuring and explaining government efficiency in developing countries

Governments in developing countries play an important role in the growth process, most notably through their budgetary policies. This potentially beneficial role is, however, hindered by government expenditure inefficiency. This is illustrated in a basic model of public spending and economic growth. Government efficiency is estimated for 52 developing countries using data envelopment analysis and subsequently employed in a general to specific approach in order to identify its determinants. We find government expenditure efficiency is primarily determined by structural country variables and governance indicators. Economic policy determinants apparently count less. The Asian countries and low income European countries in the sample have a significantly higher and lower efficiency, respectively.

Immunocompetent cells in resistance to bacterial infections.

Objectives We investigated access to biologic and synthetic disease modifying drugs (bDMARDs and sDMARDs) in patients with rheumatoid arthritis (RA) across Europe. Methods A cross-sectional study at national level was performed in 49 European countries. A questionnaire was sent to one expert, addressing the number of approved and reimbursed bDMARDs and sDMARDs, prices and co-payments, as well as acceptability of bDMARDs (barriers). Data on socio-economic welfare (gross domestic product per capita (GDP), health expenditure, income) were retrieved from web-based sources. Data on health status of RA patients were retrieved from an observational study. Dimensions of access (availability, affordability and acceptability) were correlated with the country9s welfare and RA health status. Results In total, 46 countries (94%) participated. Six countries did not reimburse any of the five sDMARDs surveyed, and in ten countries no bDMARDs were reimbursed. While the price of annual treatment with an average sDMARD was never higher than GPD, the price of one year treatment with a bDMARD exceeded GPD in 26 countries. Perceived barriers for access to bDMARDs were mainly found among financial and administrative restrictions. All dimensions of access were positively correlated with the country9s economic welfare (coefficients 0.69 to 0.86 for overall access scores). Conclusions Patients with RA in lower income European countries have less access to bDMARDs and sDMARDs, with particularly striking unaffordability of bDMARDs in some of these countries. When accepting that sDMARDs and bDMARDs are equally needed across countries to treat RA, our data point to inequities in access to pharmacological treatment for RA in Europe.