Reimbursement Procedures Research Articles

Italy’s final position paper on biosimilars and new price and reimbursement pathway

The AIFA's position paper recognizes the relevance of biosimilars to ensure the sustainability of drug expenditure but the new price and reimbursement procedure may not favour their prompt market access.

Relative efficacy and effectiveness assessment of new pharmaceuticals in three EU member states: current practices and outcome agreement between Belgium, the Netherlands and France

Relative efficacy and effectiveness assessment (REA) of a pharmaceutical product is critical in reimbursement decisions. The Pharmaceutical Forum (2005-2008) asked European Union (EU) member states (MS) to strengthen the methodological quality and rigor of REA and identify any scope for common approaches. Here, we have compared REA practices and results within three EU MS with similar reimbursement procedures for the period 2007-2010 to describe the actual situation. Assessment procedures and reports from the Belgian, Dutch and French Agency websites were retrieved and corresponding products matched. The REA-outcome was coded as added therapeutic value (ATV) yes or no. The strength of agreement between the three MS was estimated and analyzed in relation to some explanatory variables. Of the 144 Belgian, 122 Dutch and 236 French assessment reports retrieved, ATV was granted in 35, 39 and 23 % of cases, respectively, with 72 matches between the three MS. In all MS the results of at least one randomized trial were available in >90 % of reports. Between two MS significant agreement was achieved in ≥ 72 % of cases; this was 54 % between the three MS. Differences in ATV existed for treatments in severe chronic diseases. Assessment procedures were poorly documented in Belgium and France. Our findings reveal that the three similar EU MS under study agree on the REA-outcome of only half of the new drugs. Differences in applied methodology (e.g. inferences from study results, handling of uncertainty) between MS may exist. We suggest that a joint REA approach would benefit from a common understanding and application of the scientific assessment process using shared guidelines.

Participant perspectives from the Indian Health Service Anticoagulation Training Program

The Indian Health Service Anticoagulation Training Program serves to improve patient safety through advanced anticoagulation management training. Although post-program evaluations of program content were conducted at the time of program delivery, little is known about translation of these learned skills into clinical practice. This research sought to describe levels of self-reported participant confidence in anticoagulation management; development, implementation, and performance management of both core and supplemental activities of anticoagulation clinics or services; and current anticoagulation clinical practices subsequent to participating in the Anticoagulation Training Program. A federal Indian Health Service healthcare facility in Oklahoma, USA. A cross-sectional, electronic mail survey was designed, pretested, and administered to 267 eligible Anticoagulation Training Program participants from 1999 to 2009. Data were analyzed using descriptive statistics and interpreted to identify areas of strength and opportunities for improvement. Information about confidence in anticoagulation management skills; development, implementation and improvement of both core and supplemental activities of anticoagulation clinics or services; and current anticoagulation clinical practices was collected. After training, over 90 % of participants reported agreement/strong agreement with statements about confidence in performing patient-care related anticoagulation activities. A smaller proportion (83.3-85.4 %) reported agreement/strong agreement with confidence in measuring, analyzing and reporting anticoagulation outcomes. Improvement activities were more common than development or implementation activities (65.4, 31.9 and 35.1 %, respectively). Not having well established reimbursement procedures, lack of dedicated clinic space, and lack of dedicated personnel salaries (47.3, 38.3 and 32.6 %, respectively) were reported as the most common barriers to developing, implementing or improving an anticoagulation clinic. Participants indicated that anticoagulation outcomes tracking was the most common supplemental development, implementation and improvement activity (37.9, 37.0 and 43.8 % respectively). Benchmarking was the least commonly reported outcomes-related activity by participants (33.6 %). Although there was only a modest gain in the number of established anticoagulation clinics after attending the Anticoagulation Training Program, approximately 21 % of participants reported using skills learned to establish other disease state management clinics. In general, a majority of participants reported high levels of confidence related to direct patient care activities after attending the Anticoagulation Training Program. However there is a need to raise confidence in performance improvement and outcomes management activities to align with current accreditation standards in anticoagulation management as the Anticoagulation Training Program evolves.

Rak nerkowokomórkowy — wyniki leczenia i skutki ekonomiczne wobec refundacyjnych możliwości w Polsce

In connection with restrictive reimbursement procedures concerning funding high-cost oncological therapies which have not yet been evaluated by the Health Technology Assessment Agency, healthcare providers are obliged to apply to a competent director of the Regional Branch of the National Health Fund for consent to fund treatment in a non-standard mode. Basic data reported for a public payer in the computerized system was completed with information from the Central Register of Insured concerning death, and allowed us to defi ne eff ects of these therapies, representing mean values of survival indicators. In the light of common knowledge of a clinical environment regarding frequent diff erences between experimental drug effi cacy obtained in clinical trials and eff ectiveness in a clinical practice, obtained in conditions of everyday clinical practice, initial data analysis was made for the range of average time of overall survival of renal-cell carcinoma patients, using a molecular targeted therapies which were funded by the National Health Fund in a non-standard mode from January 2009 to March 2012. The results of the analysis showed that in the case of most therapies a signifi cant percentage of patients treated in the period of the analysis is still alive. To reliably evaluate the overall survival of renal-cell carcinoma patients included in this analysis it is necessary to monitor additional treatment results and repeat the analysis after receiving the new data. Analysis of costs in recent years from the National Health Fund for molecular targeted drugs used in the treatment of renal-cell carcinoma showed an increasing trend, which is most likely to continue. Development of sequential treatment and measurable clinical eff ectiveness and cost-eff ectiveness of new therapies will have a signifi cant infl uence on this issue. In the light of the above, it is reasonable to start work relating to the central register of renal-cell carcinoma patients which allows monitoring of treatment results precisely and can give accurate clinical data regarding all histological subtypes of renal-cell carcinoma.

Will China's Cooperative Medical System fail again? Insight from farmer satisfaction survey

This paper studied the sustainability of China's New Rural Cooperative Medical System (NCMS) by evaluating the satisfaction rate of its participants-the farmers. The study related the overall satisfaction of the farmers to their satisfaction with the four different aspects of the program. It also identified which personal and program attributes affect the farmers' satisfaction rate. Survey data of 1278 households from 66 counties in Shandong Province of China were collected in 2011 using a multi-stage stratified cluster-sampling method. To overcome the nepotistic barriers in rural China, field surveys in each township were conducted by university students from the same place. Data were analyzed using multiple regressions and structural equation modeling method. The results showed that 86% of the farmers were either satisfied or very satisfied with the NCMS and 82% indicated their intention to continue participating in the program. Aside from its financial benefits, both the publicity and reimbursement procedure of the program were found to be significant factors in influencing the satisfaction of the farmers. Majority of the participants held positive opinions toward the NCMS, contradicting the negative assessments made by many previous studies. Given the high proportion of farmers willing to continue with the program, it is likely to be sustainable in the near future. Greater publicity and education efforts should be made to make the farmers better informed about the program, and measures should be taken to improve its reimbursement procedure and the setting of the premium level.

COGNOS

Care plans are intended to improve the independence and functioning of patients with cognitive dysfunction and support the caregivers involved. They are an integral part of the Belgian reimbursement procedure for cholinesterase inhibitors. This nationwide, multicenter, observational study examined the content and implementation of the care plan along with patient satisfaction in community-dwelling patients newly diagnosed with Alzheimer disease in Belgium. The patients' opinion of their quality of life was measured using Anamnestic Comparative Self-Assessment (ACSA) scale. A total of 720 participants (453 female) were enrolled with 86.0% (619/719) living at home alone or with their spouse/partner. Cognitive problems (627/717, 87.4%) were the main reason for initiation of the consultation. Most patients had a caregiver (646/719, 89.8%): generally the spouse/partner (351/646, 54.3%) or a child (232/646, 35.9%). A total of 511 patients (71.0%) were prescribed a cholinesterase inhibitor after the initial consultation. A total of 236 care plans were advised with 169 (71.6%) realized and 157 of these (92.9%) considered adequate. Most patients were satisfied with the help received in the care plan (service satisfaction range, 80.0% to 98.6% of patients). Quality of life as rated by the patient significantly increased between baseline (average ACSA score: 5.2±2.4) and follow-up (5.8±2.1). The use of care plans appears to improve management of care for Alzheimer disease patients.

Impact of use of Oral Anticancer Drugs on Activity of Italian Oncology Practices: Results of a Survey Conducted by the Italian Society of Medical Oncology (AIOM)

In recent years, the number of oral anticancer drugs used in clinical practice has rapidly increased. The Italian Society of Medical Oncology (AIOM) conducted a survey to describe the impact of the use of oral anticancer drugs on the daily activity of Italian oncology practices. A survey questionnaire was distributed to the coordinators of the regional sections of AIOM. A 6-month period was considered, from January 1, 2010 to June 30, 2010. The survey addressed (1) quantitative aspects of the use of oral anticancer drugs; (2) practical aspects in the management of patients treated with these drugs; (3) issues related to treatment costs and reimbursement procedures. Thirty-six questionnaires were received from institutions distributed throughout the Italian territory. Oral anticancer drugs (both chemotherapy and molecularly targeted agents) accounted for a significant proportion (17%) of prescribed treatments. Among the responding institutions, there were different dispensation procedures of oral drugs to patients: drugs were dispensed by the pharmacist (57%) or directly by the medical oncologist (23%) or nurse (20%). The medical oncologist played a major role in the communication with patients (73% alone and a further 24% in cooperation with other professional figures) and was the point of reference in the event of side effects in 97% of cases. In most cases, the reimbursement of drug costs was separated ("File F" procedure) from the flat fare received by the hospital for outpatient visits or day-hospital access. Optimal organization of oral anticancer treatment warrants the cooperation and integration of multiple professional figures. At least three figures are involved in patient management in the hospital: the medical oncologist, the nurse, and the hospital pharmacist. Oral anticancer treatments are associated with specific reimbursement issues: in the majority of cases, the cost of the drug is reimbursed separately from the cost of patient access.

The Role of Value-of-Information Analysis in a Health Care Research Priority Setting

The Dutch reimbursement procedure for expensive drugs requires the submission of a baseline cost-effectiveness (CE) analysis and a research plan for the period of temporary reimbursement to estimate the real-life cost-effectiveness after 4 years. The Dutch guidelines recommend a value-of-information analysis to identify the critical parameters to be studied in such an outcome study. Identify situations where sensitivity analyses are sufficient to establish the need for additional data collection and priority setting. We used a hypothetical Markov model with 3 groups of parameters. We performed deterministic and probabilistic sensitivity analyses (PSA) and analyzed the expected value of partial perfect information (EVPPI), for different configurations of input parameters and a range of threshold incremental cost-effectiveness ratios (λ). We introduced a multivariate (deterministic) sensitivity analysis and a partial PSA. Deterministic, partial PSA, and EVPPI analyses came to the same ranking of priorities for future research in most cases, irrespective of the place of the results on the CE plane. Rankings differed only when the statistical metrics that we calculated for each method were close together. When a clear ranking can be established, all methods lead to the same priority setting. If there is no clear ranking, we regard the parameters as equally important. Priority setting for future research depends on λ and the location of results on the CE plane. The EVPPI is needed to estimate the value of doing additional research, but to prioritize parameters for further research, extensive (partial probabilistic) sensitivity analyses and expected value of perfect information are often sufficient.

Primary Care Physicians’ Prevention Counseling With Patients With Multiple Morbidity

The prevalence of multiple health conditions, or multiple morbidity (MM), is increasing. Providing medical care for adults with MM presents challenges, including balancing disease management with prevention. We conducted in-depth semistructured interviews with 12 primary care physicians to explore their perspectives on prevention counseling among patients with MM. Participants described the complex relationship between disease management and prevention, highlighted the importance of patient motivation, and discussed various strategies to promote receptivity to prevention recommendations. The perceived potential benefits of prevention recommendations encouraged physicians to persist with such counseling, despite challenges presented by visit time constraints, reimbursement procedures, and concerns over futility. Physicians recommended the development of alternate care delivery and reimbursement models to overcome challenges of the existing health care system and to meet the prevention needs of patients with MM. We explore the implications of these findings for maximizing the health and quality of life of adults with MM.

Underrecognition and Undertreatment of Dementia in Italian Nursing Homes

To determine the prevalence of dementia diagnoses and the use of antidementia drugs in a cohort of Italian older nursing home (NH) residents. Cross-sectional study. The NH residents participating in 2 studies: the U.L.I.S.S.E. study and the Umbria Region survey. A total of 2215 nursing home residents. Each resident underwent a comprehensive geriatric assessment at baseline by means of the RAI MDS 2.0. Dementia diagnosis was based on ICD-9 codes. The prevalence of dementia diagnosis according to ICD-9 codes was 50.7% (n = 1123), whereas 312 subjects had cognitive impairment with a cognitive performance scale score ≥3 without a diagnosis of dementia. Only 56 NH residents were treated (5% of the sample) and the main drugs used were cholinesterase inhibitor, whereas only 1 subject was treated with memantine. Limiting our analysis to patients with mild to moderate Alzheimer's disease, who are those reimbursed by the public health care system for receiving antidementia drugs, the percentage rose to 11.3%. These findings demonstrate a high rate of underdiagnosis and undertreatment of dementia in Italian NH residents. Potential explanations include the lack of systematic assessment of cognitive functions, the limitations to antidementia drug reimbursement, the complexity of the reimbursement procedure itself, and the high prevalence of patients with severe dementia. Older NH residents still lack proper access to state-of-the-art diagnosis and treatment for a devastating condition such as dementia.

Establishing a Pediatric Cognitive Rehabilitation Program: Insurance Issues and Clinical Rationale

Technological and medical advances have greatly improved survival rates for many disorders; therefore, more attention is being given to functional outcomes in individuals who have been diagnosed with neurological diseases or disorders. One example of such an endeavor consists of a cognitive rehabilitation program to improve attentional abilities. The current study uses a modification of the original Cognitive Remediation Program to address attentional deficits in children with a variety of neurological disorders. The abbreviated program is designed as a focused, time-limited program that can be easily implemented in inpatient, partial day, or outpatient medical settings using third party payment to fund the program. This article seeks to inform psychologists about how to establish a cognitive rehabilitation program with emphasis placed on providing information about insurance reimbursement and billing procedures. Information is presented regarding billing codes, materials required for reimbursement, the denial/approval process, and percent of the Usual Customary Reasonable charge that was covered. Recommendations to improve the timeliness and efficiency of the reimbursement process, as well as to increase the amount of reimbursement, are highlighted. Directions for future research, including continued documentation of the effectiveness of cognitive rehabilitation programs to establish credibility for procurement of third party payment, are also offered.

Challenges and changes in the Polish healthcare system

The healthcare reform package submitted to the Polish parliament could lead to a radical and fundamental change in existing business models and in the rules on marketing activities. The most important provisions introduced by the new Reimbursement Act are: fixed markups and prices of reimbursed medicines, introduction of a pay-back system, risk-sharing mechanisms, tax on income from reimbursements, a maximum (total) reimbursement budget, new therapeutic and economic criteria for various levels of reimbursement. Undoubtedly the planned changes will improve the functioning of the reimbursement procedure by increasing the transparency of the process. Challenges facing health policy in Poland are not unique: similar have been identified in Hungary. Owing to the similarities between both countries in healthcare systems, clinical practice patterns and economic indicators, it seems to be reasonable to develop partnerships in creating relevant regional databases and registries, and in examination of the generalisability and transferability of health technology assessment findings.

Sleep Medicine

Program Description: Media coverage, physician education, and continued research on the long-term sequelae of obstructive sleep apnea/hypopnea syndrome (OSAHS) have created a huge increase in the number of patients seeking treatment. At the same time, disillusionment with the results of classic surgery such as UPPP and genioglossal advancement has deterred many otolaryngologists from attempting to treat this condition. As the demand for treatment increases, diagnosis of OSAHS will become an increasingly significant component of every ENT practice and surgical treatment will remain an option for selected patients. The purpose of this course is to 1) Explain options for attached and unattached PSG or portable system, 2) Review new techniques and new clinical research on OSAHS, 3) Present a clinical staging system that helps identify appropriate treatment and predict the success for individual patients, 4) Identify patients with mild to moderate disease and those who are CPAP intolerant who could benefit from minimally-invasive and non-invasive techniques, 5) Present non-invasive treatment options that can be incorporated into an ENT practice. In addition to classical OSAHS treatment, the course will review a variety of polysomnogram systems and the strengths and weakness of each system. Our experience with Provent, a non-CPAP, non-invasive treatment option, will also be discussed in addition to thermoplastic mandibular advancement devices. Simplified systems to setup a joint venture with dental specialists for custom-made devices will also be presented. Presenters will discuss the economics of establishing a comprehensive sleep apnea center. We will detail startup strategies and costs for establishing a multidisciplinary sleep apnea team and center. In addition, coding and reimbursement procedures will be explained to maximize revenue production. Audience discussion will be encouraged and ample time will be allotted for a question and answer session. Educational Objectives: 1) Learn how to incorporate sleep testing into an ENT practice. 2) Learn an algorithm for successful treatment of snoring and obstructive sleep apnea. 3) Understand the approach for proper identification and treatment of each anatomic site. 4) Identify patients who can be helped by multilevel minimally invasive techniques rather than classic surgery. 5) Learn how and when to incorporate custom-made mandibular advancement devices into an ENT/OSAHS practice.

Changes in European Cross-Border Cancer Research and Treatment

1% ( € 10 billion) of overall public health spending ( € 1,000 billion) in the 27 EU states. That may change with the Cross-Border Health Care Directive, which passed in January 2011 and goes into effect in 2013. As with the E112 form, the patient’s home country health service will require prior authorization for treatment, but only if a hospital stay is involved or the treatment is very expensive. According to the parliament report on the directive, “the aim is absolutely not to encourage cross-border health care as such but to ensure its availability, safety, and quality.” Under the directive, a patient’s request can be refused only if the treatment could quickly be obtained in the patient’s home country or for doubts about the qualifi cations of the physician in the other member state. Each member state must establish at least one national patient contact point for information on health providers, reimbursement procedures, and when prior authorization is necessary. Patients may choose between public or private facilities. However, the directive’s stipulation that patients bear any costs incurred beyond the level reimbursed by their home country might deter some patients. Long-term care and organ transplants are exempt. And the directive doesn’t cover travel and accommodation costs. The European Commission estimates that under the new rules, overall EU 27-state public health spending will go up by just € 30 million a year.

Appropriate doctor-seeking management model for hypertension patients under medical insurance in China's urban communities

Objective To probe into a doctor-seeking medical management model for China's urban hypertension patients under medical insurance, and enhance the level and quality of medical insurance management. Methods Hypertension patients were surveyed with a structured questionnaire, and the staff at community health centers and medical insurance management centers received qualitative interview. Results The hypertension patients are found to see doctors mostly at community health centers and tertiary hospitals; complaints among hypertension patients for existing medical insurance vary with their areas, mostly targeting on complicated reimbursement procedure, high threshold of medical insurance payment and low level of reimbursement. Recommendation Experiment with the single-disease payment for hypertension, with the total prepayment in per capita and per disease; greater efforts in hypertension control in communities, with more favorable medical insurance policies for communities;elevated collaboration with medical institutions at all levels, and building and standardizing the management information network for hypertension patients. Key words: Hypertension; Medical insurance; Doctor-seeking management

Off-label and unlicensed oncology medicine use in Turkey: a retrospective analysis of computer records of the Turkish Ministry of Health

Objectives The use of off-label medications is very common. A study published in 2006 found that off-label use was most common for cardiac medications and anticonvulsants. The study also found that 73% of off-label use had little or no scientific support. Off-label use can lead to restrictions regarding reimbursement. Regulatory agencies have created incentives to extend indications for approved drugs in order to remove them from the off-label area. In our analysis, off-label or unlicensed use of oncology medicines was evaluated so as to provide an understanding of Turkey's perspective within this area of medical provision. Methods Unlicensed or off-label medicine use in Turkey is controlled by the General Directorate of Pharmaceuticals and Pharmacy (GDPP) of the Turkish Ministry of Health. Oncology medicines are imported for these types of uses. A computer search was performed of GDPP's database. A patient base using off-label oncology medicines applications in the years 2008, 2009 and first 6 months of 2010 was searched. Key findings Our study showed that the use of unlicensed or off-label medicine has been rising in recent years and there was a huge difference between incidence and applications in haematologic and breast cancers. Conclusions It can be said that awareness of off-label medicine use is increasing in Turkey, with physicians able to reach scientific literature immediately via the Internet. It might also be said that physicians and pharmaceutical firms may try to avoid the reimbursement procedures of the Turkish Social Security Institution by using GDPP off-label use procedures. It is necessary to evaluate off-label and unlicensed use procedures a bit more strictly. Further analysis will be required in the future.

Clinical practice guidelines from the French health high authority: Nutritional support strategy in protein-energy malnutrition in the elderly

These guidelines were produced at the request of the General Directorate of Health within the scope of the French Nutrition and Health Program (PNNS). They concern the management of malnutrition in elderly persons living at home, in institutional care, or in hospital. They belong to a recent series of studies published by ANAES(1) or HAS. Preceding studies concerned the "Diagnostic assessment of protein-energy malnutrition in hospitalized adults" (ANAES, September 2003) and the work conducted by the Committee for the Assessment of Devices and Health Technologies (CEPP) on "Reimbursement procedures for dietary foods for special medical purposes for nutritional supplementation and home enteral nutrition" (HAS, September 2006). The objective of these guidelines is to develop a tool for identifying and managing elderly subjects who are malnourished or at risk of malnutrition.

The impact of patient advocacy: the case of innovative breast cancer drug reimbursement

Current research into patient advocacy focuses on attempts of patient groups to mobilise resources and to influence researchers, pharmaceutical companies and policy-makers. This paper adopts a 'framing political opportunities' approach to draw attention to other kinds of advocacy strategies. In a case study of breast cancer patient advocacy of Herceptin reimbursement, it is shown how patient groups tried to gain access to policy-making by means of three different opportunity-framing strategies. Articulation aims at creating awareness through public-agenda building. Negotiation aims at frame alignment between interdependent stakeholders by arranging meetings. Politicisation is a strategy to influence the agendas of political arenas. Patient organisations succeeded in creating awareness and support, which had a considerable impact on other stakeholders. These impacts in turn aided the politicisation of the issue. However, the final impact on reimbursement procedures was only partially achieved due to depoliticising counterstrategies based on persistent ideas buttressing a particular division of responsibilities in the organisation of healthcare. According to these ideas cost control in healthcare is a medical responsibility, not a political one.

Abstract B115: Barriers to HPV vaccination of Medicaid patients among Florida physicians

Abstract Background: Assessing barriers to human papillomavirus (HPV) vaccination among a sample of physicians seeing Medicaid patients is an important step in understanding the diffusion of HPV vaccination to medically underserved populations. Purpose: The primary aim of this study was to assess physician barriers to immunizing Florida Medicaid patients against HPV. Methods: A sample of 800 providers was randomly selected from the Florida Medicaid Master Provider File. The sampling frame was restricted to providers who had a physical address in Florida, had billed claims or had an assigned panel that included 25 or more 9- to 17-year-old girls in the past year, and had a specialty of Pediatrics (Peds), Obstetrics and Gynecology (OBGYN), or Family Medicine (FM) that included internal medicine, general practice, and preventive medicine. In October 2009, physicians were mailed a survey that evaluated key areas related to HPV vaccination, including: 1) demographic and practice characteristics, 2) HPV information and knowledge, 3) barriers to HPV vaccination, 4) vaccine practices, and 5) vaccine recommendation practices. Physician barriers to immunizing patients were assessed using a 13 item scale. Physicians were asked to rate their level of agreement with a series of barriers to HPV immunization for their Medicaid patients (1 = strongly disagree, 5 = strongly agree). Items were summed and averaged to create a mean barrier score (range: 1 −5). Differences in mean barrier scores by physician specialty were assessed using a one-way ANOVA. Additionally, frequencies were obtained for each item on the barrier scale. Results: After removing physicians who were ineligible (n = 43), undeliverable surveys (n = 65), and duplicate surveys (n = 4), the response rate was 67.44% (n = 464). Among physicians who answered all barrier items (n = 458), the overall mean barrier score was 2.70 (SD = 0.72). Stratified by specialty, the mean barrier score was 2.65 (SD = 0.72) for Peds, 3.01 (SD = 0.66) for FM physicians, and 2.60 (SD = 0.64) for OBGYNs. FM physicians had a significantly higher mean barrier score than both Peds and OBYGNs, F(2,436) = 7.30, p = 0.0008. The three most common barriers to HPV vaccination where physicians reported they “strongly agree” were lack of adequate reimbursement (21.56%, n = 94), concerns about vaccine safety (19.18%, n = 84), and lack of timely reimbursement (17.66%, n = 77). Conclusions: Results indicate relatively low overall barriers to immunizing Medicaid patients against HPV. Physician reimbursement issues appear to be top barriers to immunizing Medicaid patients. Additionally, specialty appears to impact perceived barriers to HPV vaccination, with FM physicians indicating greater barriers than Peds or OBGYNs. These findings suggest that improvement in reimbursement procedures may increase HPV vaccination among medically underserved groups. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B115.

Identifying and Rewarding Pharmaceutical Innovation: Application in an EU Member State

The European Pharmaceutical Forum (EPF) issued “good practice” recommendations on the need to identify and reward valuable innovation. We investigated the compliance of the Belgian reimbursement procedure with the specific EPF recommendations by analyzing all 110 submissions for added therapeutic value (ATV) in the period 2002–2007. Prior to the reimbursement decision, a relative assessment of the therapeutic value was done with a binary outcome (ATV granted or refused).