Financing options for the provision of assistive products

Having predictable, stable and adequate financial resources is essential for achieving universal coverage of essential health products and services, including assistive products. Access to such resources would enable governments and participating organizations to initiate and maintain a system for providing assistive products and associated services, as well as to grow the scope and scale of their operations over time. While limited funding is not the only reason to explain the shortfall in the provision of assistive products globally, unpredictable and inadequate public funding has been cited as the primary cause of poor access to these products in many countries. Several financing options have been presented in this paper that could be considered by decision-makers to initiate or supplement the financing of assistive products

Economic Evaluation Plan (EEP) for A Very Early Rehabilitation Trial (AVERT): An international trial to compare the costs and cost-effectiveness of commencing out of bed standing and walking training (very early mobilization) within 24 h of stroke onset with usual stroke unit care

Rationale: A key objective of A Very Early Rehabilitation Trial is to determine if the intervention, very early mobilisation following stroke, is cost-effective. Resource use data were collected to enable an economic evaluation to be undertaken and a plan for the main economic analyses was written prior to the completion of follow up data collection. Aim and hypothesis To report methods used to collect resource use data, pre-specify the main economic evaluation analyses and report other intended exploratory analyses of resource use data. Sample size estimates: Recruitment to the trial has been completed. A total of 2,104 participants from 56 stroke units across three geographic regions participated in the trial. Methods and design: Resource use data were collected prospectively alongside the trial using standardised tools. The primary economic evaluation method is a cost-effectiveness analysis to compare resource use over 12 months with health outcomes of the intervention measured against a usual care comparator. A cost-utility analysis is also intended. Study outcome: The primary outcome in the cost-effectiveness analysis will be favourable outcome (modified Rankin Scale score 0-2) at 12 months. Cost-utility analysis will use health-related quality of life, reported as quality-adjusted life years gained over a 12 month period, as measured by the modified Rankin Scale and the Assessment of Quality of Life. Discussion: Outcomes of the economic evaluation analysis will inform the cost-effectiveness of very early mobilisation following stroke when compared to usual care. The exploratory analysis will report patterns of resource use in the first year following stroke

Prices, Costs, and Affordability of New Medicines for Hepatitis C in 30 Countries: An Economic Analysis

<div><p>Introduction</p><p>New hepatitis C virus (HCV) medicines have markedly improved treatment efficacy and regimen tolerability. However, their high prices have limited access, prompting wide debate about fair and affordable prices. This study systematically compared the price and affordability of sofosbuvir and ledipasvir/sofosbuvir across 30 countries to assess affordability to health systems and patients.</p><p>Methods and Findings</p><p>Published 2015 ex-factory prices for a 12-wk course of treatment were provided by the Pharma Price Information (PPI) service of the Austrian public health institute Gesundheit Österreich GmbH or were obtained from national government or drug reimbursement authorities and recent press releases, where necessary. Prices in Organisation for Economic Co-operation and Development (OECD) member countries and select low- and middle-income countries were converted to US dollars using period average exchange rates and were adjusted for purchasing power parity (PPP). We analysed prices compared to national economic performance and estimated market size and the cost of these drugs in terms of countries’ annual total pharmaceutical expenditure (TPE) and in terms of the duration of time an individual would need to work to pay for treatment out of pocket. Patient affordability was calculated using 2014 OECD average annual wages, supplemented with International Labour Organization median wage data where necessary. All data were compiled between 17 July 2015 and 25 January 2016. For the base case analysis, we assumed a 23% rebate/discount on the published price in all countries, except for countries with special pricing arrangements or generic licensing agreements.</p><p>The median nominal ex-factory price of a 12-wk course of sofosbuvir across 26 OECD countries was US$42,017, ranging from US$37,729 in Japan to US$64,680 in the US. Central and Eastern European countries had higher PPP-adjusted prices than other countries: prices of sofosbuvir in Poland and Turkey (PPP$101,063 and PPP$70,331) and of ledipasvir/sofosbuvir in Poland (PPP$118,754) were at least 1.09 and 1.63 times higher, respectively than in the US (PPP$64,680 and PPP$72,765). Based on PPP-adjusted TPE and without the cost of ribavirin and other treatment costs, treating the entire HCV viraemic population with these regimens at the PPP-adjusted prices with a 23% price reduction would amount to at least one-tenth of current TPE across the countries included in this study, ranging from 10.5% of TPE in the Netherlands to 190.5% of TPE in Poland. In 12 countries, the price of a course of sofosbuvir without other costs was equivalent to 1 y or more of the average annual wage of individuals, ranging from 0.21 y in Egypt to 5.28 y in Turkey. This analysis relies on the accuracy of price information and infection prevalence estimates. It does not include the costs of diagnostic testing, supplementary treatments, treatment for patients with reinfection or cirrhosis, or associated health service costs.</p><p>Conclusions</p><p>Current prices of these medicines are variable and unaffordable globally. These prices threaten the sustainability of health systems in many countries and prevent large-scale provision of treatment. Stakeholders should implement a fairer pricing framework to deliver lower prices that take account of affordability. Without lower prices, countries are unlikely to be able to increase investment to minimise the burden of hepatitis C.</p></div

The cost of treatment coverage with sofosbuvir or ledipasvir/sofosbuvir of different proportions of patients with viraemic HCV infection (for point estimates and uncertainty intervals) as a proportion of PPP-adjusted current total pharmaceutical expenditure.

<p>The cost of treatment coverage with sofosbuvir or ledipasvir/sofosbuvir of different proportions of patients with viraemic HCV infection (for point estimates and uncertainty intervals) as a proportion of PPP-adjusted current total pharmaceutical expenditure.</p

PPP-adjusted financial impact of treatment coverage for all patients with viraemic HCV infection (for point estimates and uncertainty intervals) with sofosbuvir or ledipasvir/sofosbuvir.

<p>PPP-adjusted financial impact of treatment coverage for all patients with viraemic HCV infection (for point estimates and uncertainty intervals) with sofosbuvir or ledipasvir/sofosbuvir.</p

Comparison of nominal and PPP-adjusted prices of sofosbuvir and ledipasvir/sofosbuvir.

<p>Fig 1 shows the nominal (USD FOREX) and PPP-adjusted (USD PPP) prices of (A) sofosbuvir and (B) ledipasvir/sofosbuvir, with and without a 23% rebate (or price reduction). Dark blue bars show the nominal prices of the medicines assuming a 23% rebate. Light blue bars show the nominal prices of the medicines without rebate. Dark green bars show the PPP-adjusted prices of the medicines assuming a 23% rebate. Light green bars show the PPP-adjusted prices of the medicines without rebate.</p

Financial impact of treatment coverage for the entire estimated population of people with HCV who require treatment with sofosbuvir or ledipasvir/sofosbuvir.

<p>Fig 3 shows the financial impact of covering the entire estimated population of people with HCV who require treatment with (A) sofosbuvir or (B) ledipasvir/sofosbuvir. Financial impact on national budgets is measured by multiplying the PPP-adjusted cost of the medicines (USD PPP) and the point estimates of adult population with HCV viraemia, as reported by Gower et al. [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002032#pmed.1002032.ref001" target="_blank">1</a>]. Error bars indicate the financial impact in each country based on the upper and lower estimates of the total adult viraemic population, as reported by Gower et al. The dotted curves indicate countries that may require more than PPP$5 billion, PPP$20 billion, PPP$50 billion, and PPP$150 billion to treat 100% of their total adult viraemic population.</p