127 research outputs found
The Changing Nature of Pharmaceutical R&D - Opportunities for Asia?
During the 1990''s, the pharmaceutical R&D process has witnessed tremendous technological changes. The emergence of new tools like ''combinatorial chemistry'', ''high throughput screening'' and the in-creasing use of computer-aided in silico experiments has led to significant improvements of research efficiency. This paper discusses the economic impact of this trend. It is argued that the resulting radical improvements in R&D productivity have lowered the minimum efficient scale in pharmeceutical research. As a consequence, the main bottleneck in pharmaceutical research has shifted from the mechanical act of synthesising and screening a sufficient number of active compounds to scientific excellence. Empirical finding indicate that the latter can more easily be achieved in smaller, highly focused firms. Accordingly, the most efficient way to currently conduct pharmaceutical R&D may be a new ''division of labour'' in research between small, highly specialised firms conducting research and large firms focusing on the development, testing, and marketing or new drugs. This reopens a ''window of opportunity'' for Asian pharmaceutical firms who had lost out in the previous race to ever increasing size.economics of technology ;
The Determinants of Pharmaceutical R&D Expenditures: Evidence from Japan
During the past 20 years, the world pharmaceutical industry has experienced a dramatic increase in R&D intensity. We apply and extend a model developed by Grabowski and Vernon (2000) with a pooled data sample of the 15 publicly listed Japanese drug firms for the period 1987 to 1998. As in the reference paper, we find expected returns to be an important determinant of R&D spending in the Japanese drug industry, albeit considerably smaller than in the U.S., which is particularly obvious in the case of returns from newly introduced drugs. However, our results are sensitive to econometric model specification, in particular to controlling for serial correlation and to a dynamic specification of the baseline model. Likewise, estimates on financial constraints are sensitive to model specification, indicating that Japanese drug firms face small or no financial constraints. Our results are consistent with the general literature on R&D investment behaviour, yet raise some methodological questions with regard to the original study.R&D, investment, panel data estimation, pharmaceuticals, Japan
Treatment strategies for treatment naive HIV patients in Germany: evidence from claims data
A recent observational study of HIV patients in Germany suggests that treatment naive patients that are in a more advanced stage of their disease are more likely to receive a treatment regimen based on a boosted protease inhibitor (PI/r) compared with a non-nucleoside reverse-transcriptase-inhibitor (NNRTI) base regimen. To validate those results we analysed claims data of seven German sickness funds from 2009 to 2012 with approximately 4 million beneficiaries. Patients in a more advanced disease state (CDC class C) had a higher likelihood to receive a PI/r based regime rather than a NNRTI based regimen as their initial treatment. There was also a significant correlation between PI/r based regimen and number of comorbidities but not with age. Our results confirm a highly significant relationship between being in a more severe stage of HIV disease and a PI/r based treatment regimen
a meta-analysis and historical comparison
Background About one third of patients infected with human immunodeficiency
virus (HIV) also have chronic hepatitis due to hepatitis C virus (HCV). HCV
therapy with simeprevir, pegylated interferon alfa (PegIFNα) and ribavirin
(RBV) have been shown to be superior to PegIFNα + RBV alone in non-HIV
patients, but no randomized trials in patients with HCV genotype 1 (HCV-1) /
HIV coinfection are available. Methods This was a historical comparison of
study C212 (simeprevir + PegIFNα-2a + RBV in patients with HCV-1/HIV
coinfection) with studies in which HCV-1/HIV coinfected patients were treated
with PegIFNα-2a + RBV alone. A systematic literature search was performed to
identify eligible studies. Efficacy and safety results of PegIFNα-2a + RBV
studies were combined in random- and fixed-effects inverse-variance weighted
meta-analyses of proportions using the Freeman-Tukey double arcsin
transformation method, and compared with the results of study C212. Results
The literature search revealed a total of 2392 records, with 206 articles
selected for full-text review. Finally, 11 relevant articles reporting on 12
relevant study groups were included. Results on sustained virologic response
24 weeks after end of treatment (SVR24) were available from all 12 study
groups. Pooled SVR24 for PegIFNα-2a + RBV from the random-effects meta-
analysis was 28.2 % (95 % CI 23.8 % to 32.9 %). The comparison between study
C212 (SVR24 = 72.6 %; 95 % CI 63.1 % to 80.9 %) revealed substantial
superiority of simeprevir + PegIFNα-2a + RBV compared to PegIFNα-2a + RBV
alone, with an absolute risk difference of 45 % (95 % CI 34 to 55). This
finding was robust in a sensitivity analysis that only included historical
studies with a planned treatment duration of at least 48 weeks and the same
RBV dose as in study C212. No increases in the frequency of important adverse
event categories including anemia were identified, but these analyses were
limited by the low number of studies. Conclusion This historical comparison
provides first systematic evidence for the superiority of simeprevir +
PegIFNα-2a + RBV compared to PegIFNα-2a + RBV in patients with HCV-1 / HIV
coinfection. Given the limitations of the historical comparison for safety
endpoints, additional data on the comparative safety of simeprevir in patients
with HCV-1 / HIV coinfection would be desirable. Trial registration Identifier
for study TMC435-TiDP16-C212 (ClinicalTrials.gov): NCT01479868
Treatment strategies for treatment naive HIV patients in Germany: evidence from claims data
A recent observational study of HIV patients in Germany suggests that treatment naive patients that are in a more advanced stage of their disease are more likely to receive a treatment regimen based on a boosted protease inhibitor (PI/r) compared with a non-nucleoside reverse-transcriptase-inhibitor (NNRTI) base regimen. To validate those results we analysed claims data of seven German sickness funds from 2009 to 2012 with approximately 4 million beneficiaries. Patients in a more advanced disease state (CDC class C) had a higher likelihood to receive a PI/r based regime rather than a NNRTI based regimen as their initial treatment. There was also a significant correlation between PI/r based regimen and number of comorbidities but not with age. Our results confirm a highly significant relationship between being in a more severe stage of HIV disease and a PI/r based treatment regimen
Estimation of Health-State Utility Values and Factors Driving Health-Related Quality of Life in People Living with HIV and AIDS and Receiving cART in Germany: Baseline Analysis of a Cohort Study
HIV has become a chronic disease since widespread of combined antiretroviral therapy (cART). Understanding the influence of therapeutic and preventive interventions on health-related quality of life (HRQoL) of people living with HIV and AIDS (PLWHA) is important. Information about health state utilities and HRQoL in PLWHA after the introduction of cART is limited, especially in Germany. The study aims to estimate and describe health state utilities and HRQoL in PLWHA in Germany and explore the effects of patient characteristics, clinical and treatment factors. Utilities and HRQoL in PLWHA in Germany were measured with the generic EQ-5D-3L questionnaire. Health state utilities were calculated based on the EQ-5D descriptive system using the German EQ-5D-3L time trade-off (TTO) value set. HRQoL was calculated based on the EQ visual analogue scale (EQ-VAS). Extensive descriptive analyses were performed to represent utility values for different groups of the patients. Generalized linear models (GLMs) with beta-inflated distributions were used to determine patient characteristics and clinical factors that influence TTO utilities and VAS scores. 1056 PLWHA completed the EQ-5D-3L questionnaires at the beginning of the study. The mean TTO utility value is 0.912 (SD ± 0.154), and the mean VAS HRQoL is 84.32 (SD ± 18.55). “Anxiety/depression” and “pain/physical discomfort” are the most affected dimensions. A longer period of living with HIV, a lower CD4-cell count, having symptomatic HIV or AIDS and an increased number of changes in therapy are associated with decreased utilities and a lower probability of having HRQoL of perfect health. No significant effect of duration of regimen was found. Depression significantly decreases TTO utility values. Higher education, full-time employment and female gender are associated with higher utilities. The resulted EQ-VAS values for PLWHA in Germany are comparable with EQ-VAS estimates for the general population. The obtained estimates can be used as inputs for health economic evaluations of HIV-interventions. Addressing anxiety and depression may reduce the quality of life impairment in PLWHA. Impact of comorbidities needs further investigation. © 2021, The Author(s)
The choice between a ritonavir-boosted protease inhibitor- and a non-nucleoside reverse transcriptase inhibitor-based regimen for initiation of antiretroviral treatment - results from an observational study in Germany
Background: This study aims at identifying predictors of the treatment decision of German physicians with regard to a non-nucleoside reverse transcriptase inhibitor (NNRTI) or a ritonavir-boosted protease inhibitor (PI/r) -based initial treatment regimen. Methods: The study is based on a sub analysis of a nation-wide multi-centre, non-interventional, prospective cohort study. 133 patients were identified, who received antiretroviral first-line therapy. By means of a logistic regression, factors that determine the treatment strategy for treatment-naïve patients were analysed. Results: Compared to patients receiving a NNRTI-based initial regimen, patients treated with PI/r are slightly younger, less educated, in a later stage of HIV and have more concomitant diseases. Regression analysis revealed that being in a later stage of HIV (CDC-C) is significantly associated with a PI/r-based treatment decision. Conclusions: Our analysis is the first study in Germany investigating sociodemographic and disease-specific parameters associated with a NNRTI- or a PI/r-based initial treatment decision. The results confirm that the treatment decision for a PI/r strategy is associated with disease severity
Simeprevir with pegylated interferon alfa 2a plus ribavirin for treatment of hepatitis C virus genotype 1 in patients with HIV: a meta-analysis and historical comparison
Additional data on meta-analyses and historical comparisons. (DOCX 18 kb
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