Lowest-priced Generics Research Articles

Atorvastatin best value for hypercholesterolaemia in Spain

Atorvastatin best value for hypercholesterolaemia in Spain

Cost-effectiveness of simvastatin in people at different levels of vascular disease risk: economic analysis of a randomised trial in 20 536 individuals

Statin therapy reduces the rates of heart attack, stroke, and revascularisation among a wide range of individuals. Reliable assessment of its cost-effectiveness in different circumstances is needed. 20,536 adults (aged 40-80 years) with vascular disease or diabetes were randomly allocated 40 mg simvastatin daily (10,269) or placebo (10,267) for an average of 5 years. Comparisons were made of hospitalisation and statin costs (2001 UK prices) during the scheduled treatment period between all simvastatin-allocated versus all placebo-allocated participants. Cost-effectiveness was estimated among different categories of participant. Allocation to simvastatin was associated with a highly significant 22% (95% CI 16-27; p<0.0001) proportional reduction in hospitalisation costs for all vascular events, with similar proportional reductions in every subcategory of participant studied. During an average of 5 years, estimated absolute reductions in vascular event costs per person allocated 40 mg simvastatin daily ranged from UK 847 pounds sterling (SE 137) in the highest risk quintile studied to 264 pounds sterling (48) in the lowest. Mean excess cost of statin therapy among participants allocated simvastatin was 1497 pounds sterling (8), with similar absolute increases in every subcategory. Costs of preventing a major vascular event with 40 mg simvastatin daily ranged from 4500 pounds sterling (95% CI 2300-7400) among participants with a 42% 5-year major vascular event rate to 31,100 pounds sterling (22,900-42,500) among those with a 12% rate (corresponding to 5-year major coronary event rates of 22% and 4%, respectively). Statin therapy is cost effective for a wider range of individuals with vascular disease or diabetes than previously recognised (particularly with lower-priced generics). It would be appropriate to consider reducing the estimated level of vascular event risk at which statin therapy is recommended.

Understanding Segmentation in Pharmaceutical Industry

Pharmaceutical industry in Indian scenario occupies a critical status that of knowledge industry with strong orientation to science and related medical concepts. Currently Indian pharmaceuticals market is estimated to be around 4.5 billion US dollars with annual growth of the order of 9% (CAGR* ∼ 10%). As a typical feature of developing country, we are still fighting with infections, so Antibiotics class is the largest therapeutic area, contributing around24% to the market. Indian pharma market is highly competitive with me too's and low priced generics as key representing features. This leads us to emphasize on need of using segmentation concept appropriately and effectively.

Is predation rational? Is it profitable? ? A reply

We appreciate the respondents' encomiums to our theoretical expertise. But we beg to differ from our critics' interpretation of the facts in the Liggett case. First, the evidence of predatory intent, predatory conduct, and predatory impact in strewn throughout the extensive court records. Commenting on this evidence, the District Court found Liggett's complaint "buttressed by numerous Brown & Williamson (B&W) documents written by top executives. These documents, indicating B&W's anticompetitive intent, are more voluminous and detailed than any other reported case. This evidence not only indicates B&W wanted to injure Liggett, it also details an extensive plan to slow the growth of the generic cigarette segment" (District Court, p. 354). These documents - prepared by high-ranking B&W officials, including a vice-president for finance, a senior financial analyst, and a special company-wide 'task force' - reveal a systematically organized, brilliantly articulated plan for containing competition in low-priced generics, and for preventing this product innovation from disturbing the oligopolistic stability of the cigarette industry generally. The B&W documents were so explicit, and emphasized the predation campaign so frequently, that the District judge "later called the documents 'smoking guns' and mused that 'I don't think [Liggett] would have imagined some of this stuff that's been written down'."1 The Supreme Court agreed, acknowledging the existence of "sufficient evidence in the record from which a reasonable jury could conclude that for a period of approximately 18 months, B&W's prices on its generic cigarettes were below its costs . . . and that this below-cost pricing imposed losses on Liggett that Liggett was unwilling to sustain ..." (Supreme Court, p. 2592). Second, when it came to assessing the predation charge, however, the courts ignored the evidence that rendered predatory "recoupment" feasible. The courts disregarded what they earlier had explicitly acknowledged: persistently high concentration, high barriers to entry, and decades of tacitly collusive, noncompetitive oligopolistic behavior. Neither the decision of the District Court, nor the Court of Appeals, nor the Supreme Court rested on contextual evidence of predation and recoupment. Instead, all relied upon an unproved theoretical assertion that preda