The Implementation of Managed Entry Agreements in Central and Eastern Europe : Findings and Implications

Funding Information: In Bosnia and Herzegovina, both The Federation of Bosnia and Herzegovina and the Republic of Srpska, also have special funds and budgets in place for the financing of expensive medicines, which are innovative and under patent. Similar earmarked funds are available in Scotland (the New Medicines Fund funded by the Pharmaceutical Price Regulation Scheme [PPRS] rebates) [35] and England (the Cancer Drugs Fund) [36]. However, support for such earmarked funds is mixed. While they facilitate access, critics raised issues about fairness towards other disease areas and patient groups that are not eligible for special funding [3, 39]. Further, the views of a Patient and Clinician Engagement meeting in Scotland [37] and the end-of-life criteria in England [38] offer opportunities for special considerations affecting medicines for end-of-life and very rare conditions to be taken into account in the health technology assessment process. Funding Information: The authors would like to acknowledge Dr. Jan Jones from the Scottish Medicines Consortium, Scotland, for contributing to the discussion with information on Scotland, Drs. Lyudmila Bezmelnitsyna and Anastasia Isaeva for contributing to data collection in Russia and Dr. Kate?ina Podrazilov? from SZP ?R for providing information on the Czech Republic. Alessandra Ferrario was a Research Officer at the LSE Health at the time this research was conducted. She is now a postdoctoral Research Fellow at the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA. Email: [email protected] No sources of funding were used for this study. The authors declare they have no conflicts of interest. However, Di?na Ar?ja, Maria Dimitrova, Jurij F?rst, Ieva Grei?i?t?-Kuprijanov, Iris Hoxha, Arianit Jakupi, Erki Laidm?e, Vanda Markovic-Pekovic, Dmitry Meshkov, Guenka Petrova, Maciej Pomorski and Patricia Vella Bonanno work directly for national health authorities or are advisers to them. Alessandra Ferrario, Tomasz Bochenek, Ileana Mardare, Dominik Tomek, Luka Voncina, Alan Haycox, Panos Kanavos,?Olga L?blov?, and Brian Godman are academics and independent researchers also working with national and regional health authorities and others to improve the quality and efficiency of prescribing, and Tarik Catic, D?vid Dank?,and Tanja Novakovic are involved with pharmaceutical, pharmacoeconomics and outcomes research groups in their countries. Olga L?blov? has also carried out remunerated consultancy activities for A&R Partners, Baxter AG and Instytut Arcana and Ileana Mardare has signed a consulting contract with Ewopharma A.G. Romania. The content of the paper and the conclusions are those of each author and may not necessarily reflect those of any organisation that employs them. Publisher Copyright: © 2017, The Author(s).Background: Managed entry agreements (MEAs) are a set of instruments to facilitate access to new medicines. This study surveyed the implementation of MEAs in Central and Eastern Europe (CEE) where limited comparative information is currently available. Method: We conducted a survey on the implementation of MEAs in CEE between January and March 2017. Results: Sixteen countries participated in this study. Across five countries with available data on the number of different MEA instruments implemented, the most common MEAs implemented were confidential discounts (n = 495, 73%), followed by paybacks (n = 92, 14%), price-volume agreements (n = 37, 5%), free doses (n = 25, 4%), bundle and other agreements (n = 19, 3%), and payment by result (n = 10, >1%). Across seven countries with data on MEAs by therapeutic group, the highest number of brand names associated with one or more MEA instruments belonged to the Anatomical Therapeutic Chemical (ATC)-L group, antineoplastic and immunomodulating agents (n = 201, 31%). The second most frequent therapeutic group for MEA implementation was ATC-A, alimentary tract and metabolism (n = 87, 13%), followed by medicines for neurological conditions (n = 83, 13%). Conclusions: Experience in implementing MEAs varied substantially across the region and there is considerable scope for greater transparency, sharing experiences and mutual learning. European citizens, authorities and industry should ask themselves whether, within publicly funded health systems, confidential discounts can still be tolerated, particularly when it is not clear which country and party they are really benefiting. Furthermore, if MEAs are to improve access, countries should establish clear objectives for their implementation and a monitoring framework to measure their performance, as well as the burden of implementation.publishersversionPeer reviewe

Seismic design and analysis of masonry-infilled frames

A simple analytical procedure, which can be used by practicing engineers, for the seismicdesign of masonry-infilled frames is presented. The analysis procedure, based on the experimental and analytical studies reported in the literature, accounts for the effect of infills in all three stages, namely, in computing seismic loading, in predicting response of the infilled frame, and in determining the strength of the infilled frame. Seismic loading is computed using the dynamic properties of the structure rather than arbitrary empirical relationships as recommended in design codes. Recommendations regarding the choice of infilled frame idealization, structural damping ratio, earthquake design spectrum,structural irregularity, and computational aids are made. Practical guidelines, which can be implemented during the construction phase and which have beneficial effects on the behaviour of infilled frames, are provided. Application of the proposed analytical procedure in a design situation is demonstrated through a numerical example, and it is shown that infills can be accounted for in the seismic design of frames during the normal course of design.Peer reviewed: YesNRC publication: Ye

Seismic analysis of infilled frames

A numerical example illustrates the steps associated with the seismic design of masonry infilled frames. The example accounts for the effect of the infill in all the design stages: computing seismic loading, predicting the response and assessing the strength of the infilled frame. Numerical results show that the normal design procedures can account for infills in the seismic design of frames.Un exemple num\ue9rique permet d?illustrer les diff\ue9rentes \ue9tapes qui sont associ\ue9es \ue0 la conception parasismique des ossatures avec remplissage de ma\ue7onnerie. L?exemple en question prend en compte l?incidence du remplissage \ue0 tous les stades de la conception : calcul de la charge sismique, pr\ue9diction de la r\ue9ponse et \ue9valuation de la r\ue9sistance de l?ossature \ue0 remplissage. Les r\ue9sultats num\ue9riques r\ue9v\ue8lent que les proc\ue9dures normales de conception peuvent prendre en compte les remplissages dans la conception parasismique des ossatures.Peer reviewed: YesNRC publication: Ye

Seismic analysis of masonry-infilled frames

Peer reviewed: YesNRC publication: Ye