Pharmaceutical Expenditure Research Articles

Analysis of the consumption of nutritional supplements by practitioners of physical activity in fitness centers / Análise do consumo de suplementos nutricionais por praticantes de atividade física em academias de ginástica

The consumption of nutritional supplements and pharmaceuticals has increased in an abusive way all over the world. The concern with body esthetics and ease of sale has led the population to use indiscriminately what can harm health. The aim of the study was to analyze the use of nutritional supplements by bodybuilders in gyms in order to know if there is consumption and if there was prior knowledge about the effects caused by food supplements and by who was recommended (whether a qualified professional or own initiative). The research was conducted through a multiple-choice questionnaire applied to 100 individuals who regularly practice bodybuilding, between 18 and 30 years old, in gyms in São José do Rio Preto, São Paulo, Brazil. Among those interviewed, 75% used nutritional supplements; 30% got nominations from Personal Trainers or even friends 28%; 24% used the internet as a source of information; 88% do not know the effects caused by overuse; 29% use whey protein (Whey Protein) and 25% use BCAA amino acids (Branch Chain Amino Acids); 16% thermogenic and 10% creatine. Based on the results, it can be concluded that the consumption of nutritional supplements is frequent, usually without guidance from a trained professional and incorrectly or even excessively by users. This increases the concern about the use of food supplements without the supervision of a nutritionist.

Analysis of the consumption of nutritional supplements by practitioners of physical activity in fitness centers / Análise do consumo de suplementos nutricionais por praticantes de atividade física em academias de ginástica

The consumption of nutritional supplements and pharmaceuticals has increased in an abusive way all over the world. The concern with body esthetics and ease of sale has led the population to use indiscriminately what can harm health. The aim of the study was to analyze the use of nutritional supplements by bodybuilders in gyms in order to know if there is consumption and if there was prior knowledge about the effects caused by food supplements and by who was recommended (whether a qualified professional or own initiative). The research was conducted through a multiple-choice questionnaire applied to 100 individuals who regularly practice bodybuilding, between 18 and 30 years old, in gyms in São José do Rio Preto, São Paulo, Brazil. Among those interviewed, 75% used nutritional supplements; 30% got nominations from Personal Trainers or even friends 28%; 24% used the internet as a source of information; 88% do not know the effects caused by overuse; 29% use whey protein (Whey Protein) and 25% use BCAA amino acids (Branch Chain Amino Acids); 16% thermogenic and 10% creatine. Based on the results, it can be concluded that the consumption of nutritional supplements is frequent, usually without guidance from a trained professional and incorrectly or even excessively by users. This increases the concern about the use of food supplements without the supervision of a nutritionist.

Pharmaceutical expenditure: what has changed in ten years in Italian Health Care System?

Abstract Introduction In the last 20 years, Italian pharmaceutical policies have moved to contain public expenditure. This study analyses the trajectory of retail pharmaceutical expenditures to investigate whether there has been a switch from public to private expenditure, how the composition of private and public expenditure has changed, and whether there are correlations with supply/demand variables. These research questions have received little attention in the literature. Methods This study used secondary data from Italy covering the period 2010 to 2019. A time-trend analysis was performed using the average annual percent change (AAPC) as the summary measure for the rate of change over the period 2010/19. The AAPC was estimated by fitting a linear regression model for the logarithm of each aggregate indicator. Kendall's τ coefficient investigates the correlation between the 2010-19 pharmaceutical expenditure items and other relevant health statistics (ages, categories of practising physicians, Gini coefficient, etc.). Results Italy's public pharmaceutical expenditure did not change significantly between 2010 and 2019 (AAPC = +0.03%, 95% CI = -1.4% to + 1.4%), nor did private spending (AAPC = +0.6%, 95% CI = -0.2% to + 1.3%). Public expenditure without the direct distribution of drugs in class A experienced a slowdown (-3.9%), and public expenditure with the direct distribution of drugs in class A exhibited a significant increase (+8.4%). The regression analysis evaluates the relationship between supply/demand variables and pharmaceutical expenditures. A significant result relates to the positive correlation between income inequality and out-of-pocket expenses for over-the-counter drugs (τ = 0.62, p-value = 0.046). Conclusions Pharmaceutical spending has increased over time, especially for drugs reimbursable by the NHS but paid for by citizens. This could be an alarm for a public healthcare system that should be able to guarantee healthcare services to all citizens. Key messages Public expenditure with the direct distribution of drugs in class A exhibited a significant increase (+8.4%). There has been increasing expenditure on drugs reimbursable by the NHS but paid for by citizens.

Effects of Volume-Price Contracts on Pharmaceutical Prices: A Retrospective Comparative Study of Public Hospitals in Hubei of China.

Background: Pharmaceutical expenditure has been increasing worldwide. Many countries have attempted to contain the increase through collective bargaining, including in China. In 2015, the Chinese government introduced a new policy to empower regional governments to reduce pharmaceutical prices through its existing tendering system which enables a lower price for products with higher procurement volumes. Xiangyang municipality in Hubei province took a lead in piloting this initiative. Objectives: This study aimed to evaluate the effects of the volume-price contract initiative on pharmaceutical price procured by the public hospitals in Xiangyang. Methods: A retrospective comparative design was adopted. The price of cardiovascular medicines (349 products under 164 International Nonproprietary Names) procured by the public hospitals in Xiangyang was compared with those procured in Yichang municipality in Hubei. A total of 15,921 procurement records over the period from January 2017 to December 2018 were examined (Xiangyang started the volume-price contract initiative in January 2018). Generalized linear regression models with a difference-in-differences approach which could reflect the differences between the two cities between January 2018 and December 2018 were established to test the effects of the volume-price contract initiative on pharmaceutical prices. Results: On average, the procurement price for cardiovascular medicines adjusted by defined daily dosage in Xiangyang dropped by 41.51%, compared with a 0.22% decrease in Yichang. The difference-in-differences results showed that the volume-price contract initiative resulted in a 36.24% drop (p = 0.006) in the price (30.23% for the original brands, p = 0.008), in addition to the therapeutic competition effect (31.61% reduction in the price, p = 0.002). The top 100 domestic suppliers were highly responsive to the initiative (82.80% drop in the price, p = 0.001). Conclusion: The volume-price contract initiative has the potential to bring down the price of pharmaceutical supplies. Higher responses from the domestic suppliers are evident.

Investigation the determinants of pharmaceutical expenditure share of GDP in Iran and selected OECD countries

AimThis study estimated the GDP share of pharmaceuticals in Iran based on the drivers of pharmaceutical expenditure and compared it with that of 31 members of the Organisation for Economic Cooperation and Development (OECD).Subject and methodsThe factors contributing to pharmaceutical expenditure were identified through literature review and studied by 8 experts to classify the factors. Then, using the panel data method, a model was built to estimate the GDP share of pharmaceutical expenditure based on the extracted factors of the selected countries in Iran’s model. To explain the observed differences, several regression analyses were performed based on cross-sectional data. The analyses were performed using EVIEWS software, version 10.ResultsThe explanatory variables for the selected countries in the panel model (R2 = 0.98) were specified. Government health expenditure (β = 0.1432), the share of generic drugs (β = − 0.0143), gross domestic product (GDP) per capita (β = − 0.0058) and the rate of disability-adjusted life-years (DALY) (β = 0.0028) contributed most to pharmaceutical expenditure. In comparison, in the Iranian estimation model (R2 = 0.84), government health expenditure (β = 0.0536) and the share of generic drugs (β = 0.0369) had a significant impact on pharmaceutical expenditure. In the estimation model with more estimators for Iran (R2 = 0.99), government health expenditure (β = 0.1694), disease prevalence (β = 0.0537), the share of generic drugs (β = 0.0102), the DALY rate (β = 0.0039), GDP per capita (β = − 0.0033), and the drug price index (β = 0.0007) contribute most to pharmaceutical expenditure.ConclusionIn the models of the study, factors related to the structure of the healthcare system and the pharmaceutical system contributed most to pharmaceutical expenditure as a share of GDP. Moreover, disease profiles show its predictive role in the second model for Iran.

Medicines use in Italy. 2020 OsMed National Report.

The 2020 National Report "Medicines use in Italy", produced by the National Observatory on the Use of Medicines (OsMed) of the Italian Medicines Agency (AIFA), describes the Italian pharmaceutical assistance through different available information flows that allow to recompose pharmaceutical territorial and hospital assistance, concerning both the national health service and private citizens. In the Report the results of numerous analyzes, both general and focused on specific therapeutic categories and classes, relating to pharmaceutical expenditure and consumption, are reported, but it is also present an in-depth analysis about monitoring registries and conditional reimbursement agreements, and a comparison between the most relevant Italian data and those of nine other European countries.

Exploring the Optimal Allocation Decision-Making of Expenditure Budget in Hospitals Under Multi-Objective Constraints: Evidence from Urban Public Hospitals, China

Hospitals in many countries face the need for balancing different categories of expenditures to achieve multiple goals within a limited budget. This study established a two-stage fuzzy linear programming (FLP) estimation model to explore the optimal allocation decision-making of expenditure budget under the multi-objective constraints. Taking all urban public hospitals in Henan province of China as a sample, the optimal allocation decision-making of total expenditure budget was tested with the human resources expenditures (HE) as the dependent variable. And the outcome was compared with the actual expenditure data of these hospitals between 2010 and 2016. The study found that when the HE achieves the maximum and minimum feasible scale, the expenditure scales of the budget allocation categories including pharmaceutical expenditures, medical supplies expenditures, and other expenditures were all within a reasonable range. Among them, the observed promoting space for HE was 3.78 billion yuan. The results show that the FLP method can help urban public hospitals to make better total expenditure budget allocation decisions, which can maintain their reasonable expenditure structure under the hospitals’ development goals and the government’s regulatory requirements.

Integration between general practice and hospital specialty for drug prescription appropriateness: the Diabetes Project of the Local Health Service Tuscany Centre

According to standards of medical care in diabetes, sulphonylureas and glinides are suggested to be abolished in the treatment of type 2 diabetes, due to their long-term adverse effects. In 2019, the Local Health Service – ASL Toscana Centro (TC) – promoted a collaboration among diabetologists, general practitioners (GPs) and pharmacists. In detail, the prescription of hypoglycemic drugs was retrieved through codes (ATCA10). After the presentation of the relative data and the recommendation/training of the diabetologist, the GPs were urged to abolish sulphonylureas and glinides, replacing them with newly generation drugs. Comparison with data in 2020 showed a significant drop in prescription of such drugs. Moreover, this project has allowed an estimate of the diabetic population within ASL TC additionally tracking other drugs, such as statins, which generally should be co-prescribed with hypoglycemic agents in the care of the diabetic patients. In conclusion, this experience has increased the knowledge relating to the most recent standards of diabetic care in general practice, promoted the appropriateness in the use of newly drugs, generated epidemiological data, and helped in better planning the long-term pharmaceutical expenditure. KEY WORDS general practice; educational training; stardards of care; sulphonylureas and glinides; statins.

Analysis of the Korean generic medicine market: Factors affecting the market share of generic medicines.

This study probed the market share of generic medicines by patients’ age and sex, type of medical facilities, route of administration, number of generic brands, market size (drug expenditure), and therapeutic class and investigated factors associated with a high market share of generic medicines in Korea. We analyzed using national health insurance data between 2010 and 2019. The dependent variable was the generic medicine market share, measured as the number of prescriptions and expenditures. Multivariable regression analysis was conducted using the numbers of generic brands, market size by each ingredient and therapeutic class, relative price, the number of prescriptions, and therapeutic class. Total pharmaceutical expenditures have increased due to the high use of single‐source drugs. The number of prescriptions and expenditures for generic medicines were 0.3 billion prescriptions and $7.8 billion, respectively, accounting for 46.5% and 46% of the total market. Multivariate analysis showed that the number of prescriptions (>20 thousand) and the market size of main active ingredients (>$1 million) were associated with an increased market share, whereas the number of generic brands (compared to <3) was associated with reduced generic medicine market share. In conclusion, we found that supply policies to promote the market entry of generic medicines by mandating price consistency between generic medicines and off‐patent original medicines had limitations in increasing the generic medicine market share. Policy should be put in place both to ensure the timely market entry of generic medicines and to promote the use of cheaper generic medicines.

The Effects of Cost Containment and Price Policies on Pharmaceutical Expenditure in South Korea.

Policy-makers have proposed and implemented various cost-containment policies for drug prices and quantities to regulate rising pharmaceutical spending. Our study focused on a major change in pricing policy and several incentive schemes for curbing pharmaceutical expenditure growth during the 2010s in Korea. We constructed the longitudinal dataset from 2008-2017 for 12 904 clinics to track the prescriber behavior before and after the implemented policies. Applying an interrupted time series model, we analyzed changes in trends in overall monthly drug expenditure and antibiotic drug expenditure per prescription for outpatient claims diagnosed with three major diseases before and after the policies' implementation. Significant price reductions and incentives for more efficient drug prescriptions resulted in an immediate decrease in monthly drug expenditures in clinics. However, we found attenuated effects over the long run. The top-spending clinics showed the highest rate of increase in drug costs. Future policy interventions can maximize their effects by targeting high-spending providers.

Perceptions from pharmaceutical stakeholders on how the pharmaceutical budget is allocated in South Africa

BackgroundSouth Africa faces a heavy burden of disease, which impacts resource allocation. The needs of South Africa require efficient translation into pharmaceutical expenditure for medicine provision, to ensure availability of medicines. Given that South Africa faces various challenges with medicine provision accompanied by rising pharmaceutical expenditure, this study aimed to report on the considerations and methods used to determine the healthcare budget for South Africa, and how it is translated into pharmaceutical expenditure for medicines provision on the Standard Treatment Guidelines and Essential Medicines List and non-essential medicines in the public sector.MethodQualitative, semi-structured interviews guided by a discussion guide were conducted with seven pharmaceutical officials involved in the budget and resource allocation process, between October 2019 and March 2020. Interviews were recorded and transcribed verbatim. Once the interviews were coded by the first author they were verified by the other authors. Data were thematically analysed.ResultsThis study depicted the knowledge and participation of pharmaceutical services in the budget process. The National and Provincial Department of Health have improved pharmaceutical budgeting by making strides towards a collaborative, informed, and more evidence-based approach. Pharmaceutical services have roles in advising on requirements; commenting where necessary, constantly monitor and taking accountability for their budget. The main considerations that determined the budget included population size and growth, historical expenditure, the extra heavy burden of disease and incidence rate, demand data and forecasting. The local and provincial pharmacy and therapeutics committee play a vital role in monitoring the budget and expenditure; ensuring adherence to guidelines; controlling the extent to which non-Essential Medicine List items are used and advising accordingly.ConclusionThis was the first study to report on the decision and thought processes of the healthcare budget and its translation into pharmaceutical expenditure for medicine provision in South Africa. Many factors were considered to inform the budget, with the Standard Treatment Guideline and Essential Medicines List being the principal guide for medicine provision. This process was well-controlled and monitored by the pharmaceutical therapeutics committee. Documenting the South African experience can assist other countries in their budget decisions for medicines.

Carbamazepine Levels Related to the Demographic Indicators in Groundwater of Densely Populated Area

Consumption of pharmaceuticals by people is growing. Carbamazepine (CBZ) is an extensively used anti-epileptic drug that is recalcitrant to degradation. As a result, CBZ has been widely detected in the aquatic ecosystem due to its daily consumption and drainage in sewage systems. Leakages from sewage networks and septic tanks may represent one of the main sources of CBZ in groundwater. In this study, CBZ concentrations in groundwater and their correlations with the demographic structure of the population were investigated in the densely populated Milan urban area. Seventy-six demographic variables were retrieved from the Italian Population and Housing census. Twenty-one groundwater samples were collected from unconfined and semi-confined aquifers of the Milan area and the concentration of CBZ was measured. Groundwater CBZ levels in both aquifers were associated with the demographic data within a circular buffer with a radius of 1.5 km. All data were analyzed using a multivariate statistical approach. The results showed a significant association (p &lt; 0.05) between CBZ concentrations and specific demographic segments of the population. Higher CBZ concentrations were found to be associated with the population aged 70 years and over (aging index), and with families having children aged under 5 years (family index). In addition, the divorce index was correlated with the high concentration of CBZ, whereas the educated and sexagenarian population showed a negative correlation. Our results indicated that the contamination of CBZ follows the same pattern in unconfined and semi-confined aquifers, which are used for drinking water purposes in Milan area. Therefore, changing the CBZ consumption pattern or replacing CBZ with other drugs may strongly influence groundwater contamination of the investigated area.

How can we improve patients\u2019 access to new drugs under uncertainties? : South Korea\u2019s experience with risk sharing arrangements

BackgroundNew drugs including cancer drugs and orphan drugs are becoming increasingly more expensive. Risk sharing arrangements (RSAs) could manage the risk based on both financial impact and the health outcome of new drugs if reimbursed. To improve patients’ access to new drugs under uncertainties, many developed countries have adopted RSAs. In this study, we aimed to understand the effects of RSAs in South Korea on patients’ access.MethodsWe reviewed current status of RSA drugs in South Korea. The number of appraisals and time gap between market approval and reimbursement per RSA drug were considered to quantify improvement of patients’ access as they showed how rapidly decisions on reimbursement of RSA drugs were derived. Then, we applied a comparative analysis to determine whether the RSA drugs in South Korea were reimbursed in the UK, Italy, and Australia. Most data for this study were obtained from websites of the governmental department/agencies responsible for appraisal of drug reimbursement in each country. And literatures related to RSAs were investigated as well.ResultsThe eligibility for Korean RSAs had two key components - drugs for cancer and rare diseases and not having other alternative treatments. As of the first half of 2019, there were 39 RSA drugs reimbursed in South Korea, the majority of which were financial-based schemes. Refund and expenditure cap were the representative types (89.7%). After introduction of RSAs, the time gap and number of appraisals were decreased. Based on the indications of RSA drugs, the level of drug coverage in South Korea was found lower than Italy, similar to the UK, and higher than Australia.ConclusionsRSAs in South Korea significantly enhanced patients’ access to new drugs and led to the alleviation of patients’ out-of-pocket expenses. The drug coverage of South Korea had a level comparable to that of other countries. This study provides implications for countries that have a dual mission of containing pharmaceutical expenditure and improving access to new drugs.

Regenerative Medicine in South Korea: Bridging the Gap Between Authorization and Reimbursement

Regenerative medicine (RM) has considerable potential to address the needs of aging-related and uncurable diseases. However, its incorporation into reimbursement of health insurance benefits poses many challenges, including uncertain evidence and insufficient investment. This paper examines the wide gap between manufacturers, regulatory bodies, and health technology bodies regarding reimbursements for RMs focused cell therapy products. In this mixed-methods study, we first analyzed the sales of RMs approved in South Korea. In addition to exploring beliefs related to the market value of RMs, in-depth interviews were conducted with 24 experts (17 from bio-industries, two from the regulatory body, three from a health technology assessment (HTA) body, and two from the Pharmaceutical Benefit Coverage Assessment Committee [PBCAC]). Lastly, we surveyed PBCAC members about the market value of RMs. In total, 15 of the 20 developed cell therapy products are on the market in South Korea, and amounted to 0.24% of total pharmaceutical expenditures in 2018. We identified a wide gap between stakeholders and regulators regarding the market value and pricing of RMs. The interviewees from the pharmaceutical manufacturer association raised the issue of rising manufacturing costs and proposed a specific pricing policy for RMs. To bridge the gap between approval and reimbursement, stakeholders demand an alternative framework of value-based pricing. Conditional health insurance reimbursement may be an alternative to the traditional process in order to generate evidence of the effects of RMs using “risk-based” or “outcome-based” approaches.

Disposal of pharmaceuticals wastes by the population of an outcrop area of the Guarani Aquifer System in Southern Brazil

Pharmaceutical waste is considered emerging pollutant that can contaminate water sources and underground water, besides is serious problem for waste management in Brazil. The objective of this study was to evaluate the pharmaceutical consumption for human use and the way expired and unused medicines are disposed by the population. The study was carried out in two neighborhoods of the Lages, under outcrop of the Guarani Aquifer, in southern Brazil. In this descriptive and quantitative study, data collection occurred between August and October of 2018 via a questionnaire completed by 309 participants. The questions addressed about sociodemographic data, information on the medicine consumption, disposal of pharmaceuticals residue and about the basic sanitation in the neighborhood. The pharmaceuticals class most used were anti-hypertension and diuretics, indicating an elevated occurrence of non-transmittable chronic illnesses. About 68% of participants stated that there are leftovers of medications after medical treatment and 70.2% that there is expired medication at household. The disposal of leftover and expired pharmaceutical was in domestic waste, followed by discharged into domestic sewage. Only a small percentage (&lt;15%) of the participants adequately dispose of their medication waste. The inadequate disposal of household pharmaceutical in the study area can result in contamination by chemical substances of the Guarani Aquifer and superficial waters.

Repositioning of Bulgaria on the European map as a tourist destination offering a competitive tourist product through health tourism (balneo-spa/medical spa, spa and wellness)

The role of health tourism has been growing exponentially in the last years. Health tourism is an emerging, global, complex and rapidly changing segment that needs to be managed with modern management tools in the present era. Health tourism comprises around 5% of general tourism in the EU-28 and contributes approximately 0.3% to the EU economy (8). Health tourism has a much higher domestic share than general tourism does. Increasing the share of health tourism may reduce tourism seasonality, improve sustainability and labor quality, and may help to reduce health costs through prevention measures and decreased pharmaceutical consumption (9). Health tourism is increasing its role as a significant contributor to the development not only of regional but also of national economy (6). Despite certain tendencies in preference for individual tourism, it is expected that health tourism and health tourism destination will continue to increase their influence and take bigger part in the tourism mix in the future. In the National strategy for sustainable development of the tourism on the territory of Bulgaria /2014-2030/ the Ministry of Tourism determines tourism as a leading, structuring national industry. Tourism is a stable factor contributing to the constant optimization of Bulgarian economy through a significant share in the GDP – 12-18%. Strategic aims of Bulgaria’s are: increasing the competitiveness of the destination Bulgaria on the international tourism market by increasing the quality of the tourist product, strong brand of the destination and product specialization and diversification. One of the main priorities of the Ministry of Tourism is increasing the share of the specialized types of tourism – balneo (medical spa), spa and wellness concretely, leading to an year-round and more intensive workload (4). Aim The authors are convinced that Bulgaria has all the necessary conditions and prerequisites to present itself more purposefully and on a larger scale as a year-round tourist destination, offering a quality tourist product, placing the main focus on health tourism (medical spa, spa and wellness), which is successfully combined with all major forms of tourism (sea, mountain, cultural, gourmet, golf/. The authors support the relevant idea of the Ministry of Tourism to adapt and upgrade the existing National Strategy for Sustainable Tourism Development in Bulgaria /with a horizon of 2040 - 2050/ by placing a strong focus on health tourism, especially relevant in the world pandemic of COVID-19, when the role of health tourism (prevention and prophylaxis) in Bulgaria is recognized by all competing European countries.

Adherence to a generic medicine policy: A developing country's experience

Escalating pharmaceutical expenditure is a global phenomenon, and Ghana has not been spared. To attend to the increasing cost of healthcare resulting from the high cost of drugs, the government of Ghana took a strategic decision to reduce its expenditure on healthcare without compromising the quality of care. The government directed that all medicines be prescribed by their generic names only at all health facilities. The purpose of this study is to assess the extent to which physicians adhere to the policy by assessing physicians' generic medicine prescribing patterns across the healthcare system in selected facilities in the Greater Accra Region. Questionnaires were administered to 87 physicians in 13 selected health facilities in Ghana. The results were analyzed using SPSS. The study's findings revealed that 74.7% of physicians adhere to the policy, and there is a likely relationship between knowledge of the policy and its implementation. Also, there is no significant relationship between health facility, physician's experience, disease diagnosis stage, and the prescribing of generic medicines. There is a need for regular review of the policy with aggressive and wellstructured in-service training on the subject and the introduction of pharmacists' substitution rights.

The economic burden of colorectal cancer across Europe: a population-based cost-of-illness study

Colorectal cancer is one of the leading causes of cancer morbidity and mortality in Europe. We aimed to ascertain the economic burden of colorectal cancer across Europe using a population-based cost-of-illness approach. In this population-based cost-of-illness study, we obtained 2015 activity and costing data for colorectal cancer in 33 European countries (EUR-33) from global and national sources. Country-specific aggregate data were acquired for health-care, mortality, morbidity, and informal care costs. We calculated primary, outpatient, emergency, and hospital care, and systemic anti-cancer therapy (SACT) costs, as well as the costs of premature death, temporary and permanent absence from work, and unpaid informal care due to colorectal cancer. Colorectal cancer health-care costs per case were compared with colorectal cancer survival and colorectal cancer personnel, equipment, and resources across EUR-33 using univariable and multivariable regression. We also compared hospital care and SACT costs against 2009 data for the 27 EU countries. The economic burden of colorectal cancer across Europe in 2015 was €19·1 billion. The total non-health-care cost of €11·6 billion (60·6% of total economic burden) consisted of loss of productivity due to disability (€6·3 billion [33·0%]), premature death (€3·0 billion [15·9%]), and opportunity costs for informal carers (€2·2 billion [11·6%]). The €7·5 billion (39·4% of total economic burden) of direct health-care costs consisted of hospital care (€3·3 billion [43·4%] of health-care costs), SACT (€1·9 billion [25·6%]), and outpatient care (€1·3 billion [17·7%]), primary care (€0·7 billion [9·3%]), and emergency care (€0·3 billion [3·9%]). The mean cost for managing a patient with colorectal cancer varied widely between countries (€259-36 295). Hospital-care costs as a proportion of health-care costs varied considerably (24·1-84·8%), with a decrease of 21·2% from 2009 to 2015 in the EU. Overall, hospital care was the largest proportion (43·4%) of health-care expenditure, but pharmaceutical expenditure was far higher than hospital-care expenditure in some countries. Countries with similar gross domestic product per capita had widely varying health-care costs. In the EU, overall expenditure on pharmaceuticals increased by 213·7% from 2009 to 2015. Although the data analysed include non-homogenous sources from some countries and should be interpreted with caution, this study is the most comprehensive analysis to date of the economic burden of colorectal cancer in Europe. Overall spend on health care in some countries did not seem to correspond with patient outcomes. Spending on improving outcomes must be appropriately matched to the challenges in each country, to ensure tangible benefits. Our results have major implications for guiding policy and improving outcomes for this common malignancy. Department for Employment and Learning of Northern Ireland, Medical Research Council, Cancer Research UK, Health Data Research UK, and DATA-CAN.

Pharmaceutical policies in post-communist Albania: Progress and challenges toward European Union membership

Aim: Shifting from a communist regime to a democratic system has affected health system fundamentally in most of the Western Balkan countries including Albania. Albania became a European Union (EU) candidate country in 2014. Since then, one of the main concerns has been to approximate the legislation with the EU framework. The aim of this paper is to review the evolvement of pharmaceutical legislation in Albania and challenges toward achieving full approximation to the EU’s respective legislation. Methods: We used qualitative techniques, especially means of conventional content analysis and two sources to collection data. First, we consulted the Albania’s National Publications Office webpage and analysed all available legislation regarding “pharmacy”, “medicine” and “pharmaceutical products” from 1994 to 2021. Then, we analysed the National Integration Plans that have been published by the Government of Albania from 2014 to 2021. Results: The decrease of the price margin system goes in parallel with the increase of the pharmaceutical expenditure, including out-of-pocket expenditure on medicines and lack of adequate and sensitive reimbursement policies. The main pillars of the pharmaceutical sector in Albania are well-covered legally but not fully in concordance with the EU framework. Conclusion: There is a need to foster laws implementation that regulate the opening of pharmacies; a detailed regulation on pharmacovigilance; and a regulation on medicinal products for paediatric use. Also, the existing legal framework should be aligned with the European one. Medicine pricing methods should go in the same line with the decrease of out-of-pocket expenditure.

Comparative analysis of indicators that determine the effectiveness of the implementation of socio-economic determinants of health in Europe and Ukraine

The introduction of national strategies aimed at improving the well-being of the population of the country is one of the current approaches to reforming the public policies of the countries of the world. It is the socioeconomic determinants of health that determine the conditions in which people are born, grow, live and getting old, as well as the spheres of influence on these conditions, such as public policy, state of economic development, demographic trends, etc.&#x0D; The aim. In this way, our research has focused on a comparative analysis of macroeconomic indicators that determine the effectiveness of socioeconomic determinants of healthсare in Europe and Ukraine, that are used to provide scientific justification for the construction of humanistic models for the provision of pharmaceutical care to the population in the context of the rapid stratification of Ukrainian society according to socioeconomic indicators.&#x0D; Materials and methods. The research methodology is based on the principles of systems analysis and an interdisciplinary scientific and systemic approach. The study used the empirical method, the method of comparative analysis and synthesis of statistical data, the graphical method.&#x0D; Results. A comparative analysis of the socioeconomic determinants of health in the countries of the European region and in Ukraine was carried out on three levels of indicators: the level of health-care expenditure, the structure of health-care expenditure and expenditure on medicines.&#x0D; The analysis revealed that in 2019, the average health expenditure of the countries analyzed was 8.2 % of GDP. Only two of the 34 countries - Ukraine and Turkey - have a rate below the 5 % that recommended by WHO.&#x0D; Public health financing schemes and compulsory health insurance are the main funding mechanisms in all countries, with the exception of Cyprus. Ukraine, Russia, Greece, Latvia and Bulgaria have the largest share of direct costs to patients as a source of health care financing.&#x0D; The results of the analysis of the medicine expenditure indicator as a proportion of total health expenditure showed that the highest level was in Bulgaria (35.4 %), the lowest in Denmark (6.4 %). Overall, five countries have high levels of pharmaceutical expenditures.&#x0D; In most European countries, the cost of purchasing medicines has been found to range from 346 to 619 USD per person per year. The highest value of this indicator from the European region is in Switzerland (894 USD per person), and the lowest is in Ukraine (73 USD).&#x0D; Based on the results of the comparative analysis, the countries were grouped according to key indicators into three categories - high, medium and low.&#x0D; Conclusions. A comparative analysis of key indicators of the socio-economic determinants of health in the country of the European region has been carried out