Alopecia Areta Barbae

BEND NO RESULTS IN THE ASSESSMENT OF RISK SHARING

Article published in medical journals
26/01/2010
When you set a fixed price for a new drug-funded public health insurance, all the risk posed by uncertainty about the effectiveness and costs of treatment lies in the Insurance: more or less effective, or not produce expected savings in other resources, all spending is in charge of insurance.
venture contracts are designed to distribute the risk between the insurer and the pharmaceutical industry where there is high uncertainty about the effectiveness of treatment or the cost per year of life gained (quality-adjusted cost-effectiveness): the price of medicine is not fixed but is variable and subject to some measure of the expected results.
In February 2002 the British NHS, after an unfavorable report from NICE, agreed to include within coverage of the treatment of multiple sclerosis with beta interferon (Avonex, Betaferon and Rebif) and glatiramer acetate (Copaxone) conditional on a joint venture contract.
The agreement for the treatment of multiple sclerosis has many characteristics that are far from what could be a typical pattern of risk sharing: patients should continue treatment for an unusually long, ten years. The treatment is funded by the NHS until it considers that it is effective. The price paid will decrease if not met improvement targets set until this price is equivalent to a maximum cost-effectiveness of 36,000 pounds per year of life adjusted for quality.
A preliminary assessment at 2 years of initiation of treatment recently published in the British Medical Journal indicates that there is no improvement in the effectiveness (delay in disease progression) of patients treated with the drugs under contract venture . Possibly, the longer-term evaluations will be less sensitive to short-term changes in disease and important methodological issues must be resolved highlighted in this first evaluation.

So, if these results are maintained in the longer term, the absence of incremental effectiveness is sufficient to make decisions without taking into account incremental cost. Despite the study's scientific advisory board considers it premature to take decisions on prices before they have longer-term results, holding the preliminary results for further analysis, following the logic of the agreement, the entire financial risk could reach lie with the pharmaceutical companies.

This preliminary assessment and highlights, as one might predict, the difficulties in assessing an agreement of this kind that looks more like a large clinical trial on its effectiveness to a financing agreement of drugs.

A treatment for a disease whose effects can only be long-term monitoring and which can not have a control group is not exactly the best candidate for a joint venture contract. It seems advisable, therefore, very limited use and more appropriate conditions of such contracts.

Midnighthotvedios.com

GENERIC COMPETITION AND PROMOTION OF QUALITY

Article published in 26/01/2010 PHARMACEUTICAL MAIL

health spending needs are independent of the recession because they depend on the pace of adoption of medical and pharmaceutical innovation and the evolution of the population covered and their aging. In this context, the proper design of a generic policy can contribute to more efficient financing of the health system thanks to the effect of competition on the price of drugs whose term has ended allows more space to cover financial innovations with adequate health cost-effectiveness.

Since that 1997 allowed the entry of generic drugs in the English market, generics have become increasingly important due to the reduction of prices for the product brand as well as the growing market share in units (about 22% in 2008). Although the overall share is still comparatively small and is still a very broad sweep upwards taking into account the products whose term ends short term, this market share is significantly higher for drugs subject to reference pricing system (about 55%).

The current design of the so-called reference price system (PR) has served to gradually reduce and remarkable price of drugs for which there are generic and in this regard, it has been a measure to assess very positive. However, this policy has been very positive thanks to the absence of other measures to sensitize patients and prescribers of price differences and the need to prescribe and dispense lower-cost equivalent drugs, ie, was positive only because we have not known any better.

The current system of PR have some important limitations that may even limit the bet in the medium and long term generic. In this sense, the difficulties remain the responsibility of ex-factory prices between laboratories are passed on to retail prices, setting the lower price does not respect the condition to demonstrate ability to meet a certain market share by producers who offer that price, the exclusion of the public financing of products with a higher price point and the elimination of avoidable copayment charged to the user makes generic pay "the price of being a reference", etc..

The report from the General for Competition of the European Commission published in July last year warned of the budgetary consequences of delays in generic entry after the loss of patent exclusivity due to multiple strategic and innovative industry input protected line extensions a new patent that rapidly cannibalize the market for traditional presentation, litigation, advertising campaigns questioning the quality of generics as well as the unacceptable delays due to regulatory process itself (in appearance, Spain has much to improve).

addition, the Commission's report provides evidence that the systems themselves price regulation and public funding can erect barriers to a firm commitment to generics. It was observed that the price regulation policies reduce competition, the price is stagnating at a level higher than you would in the absence of regulation. On the other hand, the study notes that the frequent adjustment of the reference price, the mandatory replacement for the equivalent of a lower price, the maximum reimbursement based on the lowest price and to a lesser extent, the differential co-payments, contributing to a greater reduction price and faster and greater market share of generics.

take decisive action is necessary to promote competition in retail prices in this market, which would be far more useful than continue to base generic policy regulating its retail price of their redemption price and the alleged prohibition of discounts the selling price of lab, except the real volume discounts.

Careful observation and without prejudice to the successful outcome of the experience of the measures taken in recent years in some European countries can provide valuable lessons for the reform of the regulation of generic drugs in Spain: the Norwegian experience with abandonment PR system with the deepening of fixing the maximum reimbursement level referenced as a percentage of PVP from the mark before the expiry of the patent which can reach 85% after one year of the first generic entry, the case of Sweden, which also abolished the PR, and replaced by mandatory substitution and reimbursement of cheaper equivalent product combined with a co-preventable by the patient, and cases of Holland and Germany with the onset of selective employment experiences of competitive auctions to determine preferred laboratory, separating the pharmacy reimbursement price laboratory.

My Baby Has Blue Ring Around Iris

Article published in 21/01/2010
EXPANSION
The tsunami of economic recession is uncovering a striking deterioration in public finances. Will our children pay the debt we are leaving a legacy?
In a recession, spending more than you enter is used to help maintain economic activity and helps the drop in revenue is not higher. However, the large fiscal stimulus English is the main source of fiscal imbalance in English: the European Commission estimates that in 2009 the primary structural deficit is 8.2%!
If public expenditure is used productively and efficiently, our children will be richer and have greater well-being. Then, they will have problems to deal with debt and this will represent a smaller proportion of their wealth. In the medium and long term, the cost of the deficit depends on the quality of spending: what is spent (composition), results are achieved (effectiveness) and the cost of achieving those results (efficiency).
We have evidence that the composition of public expenditure is relevant to predict the effects of spending on growth: infrastructure and education, and health, promote growth. However, not enough direct spending productively, if expenditure is high and results obtained are low, the efficiency of public spending is low and the government accounts will not be sustainable in the long term. Herein lies the Achilles heel of the English public finances as their level of efficiency is the lowest in the eurozone.
A report by the European Commission in July last year indicates that the quality of English public spending in five of six categories of spending (education, R & D, infrastructure, public order and security and general services) is poor, with only good in health services. On average, the quality of English public spending is among the lowest in the eurozone countries. In public infrastructure have a high level of spending and poor results. In education, the level of spending is not the highest, but the results are poor. R & D spending is low but with very low efficiency. In universities, very poor results despite having a high number of staff, resulting in a significant inefficiency.
there is no time for excuses designed to further delay the urgent measures of independent evaluation of the efficiency of spending programs and reforms based on their results.