Impact of Agricultural Policy on Wheat Crop in Egypt

This research aims to clarify price imbalances, and the size of subsidies or taxes imposed on producers and consumers of wheat crop in Egypt, besides identifying the impact of government intervention policies production, consumption, and government revenue. The results showed that the governmental burdens borne by the state in the event of its intervention or non-intervention reached the highest value of about 684.6 and 1353.3 million dollars in 2017, for both cases, respectively, the year that witnessed support by the state, while the highest value of government revenues amounted to about 686.2, 1651.9 million $in 2011 also for both cases, the year in which the highest implicit taxes were imposed. While Egypt bears governmental burdens in the event of the state’s intervention by imposing a tariff on imports, the results also showed that in the event of state intervention or non-intervention, the average net economic loss for the consumer as a result of importing the wheat crop during the period (2003-2020) was about 20, 18.1 million$, with values ranging from a minimum of about 0.3 million dollars in 2012 and a maximum of about 112.2 million $ in 2010. The reason for the high net economic loss of the consumer may be due to the gap between the volume of consumption at the border price than the volume of consumption at the farm price

Economic Study of Production and Consumption of Maize in Egypt

This research aims to comprehend the current situation of maize production and consumption in Egypt by studying production, and consumer indicators across the years (2003-2020), to determine the marketing problems that face farmers and find out their thoughts on the government agricultural policy. The results showed that from 2003 to 2020, the amount of land planted with maize in Egypt varied between two limits, with the lowest amounting to roughly 1657.8 thousand acres in 2003 and the highest amounting to roughly 2335.63 thousand acres in 2018, with the overall average of the cultivated area being about 2010.03 thousand acres during that time. When we looked at the production costs, we discovered that they had taken on an increasing and significant trend at a statistically significant level of 0.01, where the yearly increase in costs was equal to about 372.17 pounds/acre, at an increasing rate of about 10.84% of the average production costs during that time. By analyzing the relative importance of the marketing problems that maize growers in Egypt's ancient lands face, it was discovered that the problems of not receiving the crop's price right away takes the top spot, accounting for approximately 14.18% of the total, with the problems of market distance from the production sites and risk from price fluctuation coming in second and third, respectively

Public preferences for the allocation of societal resources over different healthcare purposes

Objective:Increasing healthcare expenditures require governments to make difficult prioritization decisions. Considering public preferences can help raise citizens’ support. Previous research has predominantly elicited preferences for the allocation of public resources towards specific treatments or patient groups and principles for resource allocation. This study contributes by examining public preferences for budget allocation over various healthcare purposes in the Netherlands.Methods:We conducted a Participatory Value Evaluation (PVE) choice experiment in which 1408 respondents were asked to allocate a hypothetical budget over eight healthcare purposes: general practice and other easily accessible healthcare, hospital care, elderly care, disability care, mental healthcare, preventive care by encouragement, preventive care by discouragement, and new and better medicines. A default expenditure was set for each healthcare purpose, based on current expenditures. Respondents could adjust these default expenditures using sliders and were presented with the implications of their adjustments on health and well-being outcomes, the economy, and the healthcare premium. As a constraint, the maximum increase in the mandatory healthcare premium for adult citizens was €600 per year. The data were analysed using descriptive statistics and a Latent Class Cluster Analysis (LCCA).Results:On average, respondents preferred to increase total expenditures on all healthcare purposes, but especially on elderly care, new and better medicines, and mental healthcare. Three preference clusters were identified. The largest cluster preferred modest increases in expenditures, the second a much higher increase of expenditures, and the smallest favouring a substantial reduction of the healthcare premium by decreasing the expenditure on all healthcare purposes. The analyses also demonstrated substantial preference heterogeneity between clusters for budget allocation over different healthcare purposes.Conclusions:The results of this choice experiment show that most citizens in the Netherlands support increasing healthcare expenditures. However, substantial heterogeneity was identified in preferences for healthcare purposes to prioritize. Considering these preferences may increase public support for prioritization decisions

The implementation of HTA in medicine pricing and reimbursement policies in Indonesia:Insights from multiple stakeholders

OBJECTIVES: This study aimed to identify the barriers and facilitators to improve the use of health technology assessment (HTA) for the selection of medicines listed in the e-Catalogue and the national formulary in Indonesia. METHODS: Semi-structured interviews were conducted to collect qualitative data. Purposive sampling was used to recruit the stakeholders consisting of policymakers, a pharmaceutical industry representative, healthcare providers, and patients. The data were analyzed using directed content analysis and following the COnsolidated criteria for REporting Qualitative studies (COREQ). RESULTS: The twenty-five participants interviewed agreed with the use of HTA for supporting the e-Catalogue and the national formulary and perceived the advantages of HTA implementation outweighed the disadvantages. Barriers mentioned were a lack of capability of local human resources, financial incentives, a clear framework and insufficient data. Strategies suggested to overcome the barriers were establishing (inter)national networks to build up capacity, setting up departments of HTA in several universities in Indonesia, and introducing a clear HTA framework. Facilitators mentioned were the ambition to achieve universal health coverage, the presence of legal frameworks to implement HTA in the e-Catalogue and the national formulary, and the demands for appropriate medicine policies. CONCLUSIONS: Several barriers are currently hampering broad implementation of HTA in medicine pricing and reimbursement policy in Indonesia. Solutions to these issues appear feasible and important facilitators exist

Using social media to collect patient perspectives on quality of life: A feasibility study

Background: Development of innovative drugs for melanoma is occurring rapidly. These drugs are often associated with marginal prolongation of overall survival, as well as increased toxicity profiles. Therefore, HTA agencies increasingly require information on health related quality of life (HRQoL) for the assessment of such drugs. Objectives: This study explored the potential of using social media to assess patient perspectives on HRQoL in melanoma, and whether current cancer-and melanoma-specific HRQoL questionnaires represent these patient perspectives. Methods: A web-based survey with open-ended questions to assess melanoma patients' perspectives regarding HRQoL was distributed on social media channels of Melanoma Patient Network Europe (Facebook, Twitter, and LinkedIn). Two researchers independently assessed completed surveys and conducted content analysis to identify key themes. Themes identified were subsequently compared with questions used in three current HRQoL questionnaires (EORTC QLQC30, EORTC QLQ-MEL38, FACT-M). Results: In total, 72 patients and 17 carers completed the survey. Patients indicated that family, having a normal life, and enjoying life were the three most important aspects of HRQoL. Carers indicated that being capable, having manageable adverse events, and being pain-free were the three most important aspects of HRQoL for patients. Respondents seem to find some questions from HRQoL questionnaires relevant (eg, “Have you felt able to carry on with things as normal?”) and others less relevant (eg, “Have you had swelling near your melanoma site?”). Additionally, wording may differ between patients and HRQoL questionnaires, whereby patients generally use a more positive tone. For example, FACT-M states “I have a lack of energy,” while patients rather focus on “having enough energy.” Conclusions: Social media may provide a valuable tool in assessing patient perspectives regarding HRQoL. However, differences emerge between patient and carer perspectives. Additionally, cancer-and melanoma-specific HRQoL questionnaires do not seem to correlate fully with patient perspectives

Conditional financing in health technology assessment practice: The Dutch experience

INTRODUCTION: In 2007, the National Healthcare Institute (ZIN) initiated conditional financing (CF) of expensive hospital drugs as an example of conditional reimbursement schemes (CRS). CF is a 4-year procedure encompassing initial HTA assessment (T = 0) followed by additional data collection via outcomes research (separately assessing appropriate use & cost-effectiveness in routine practice) and re-assessment (T = 4). This study aims to review performance and experiences with CF in the Netherlands to date. METHODS: All dossiers for drugs that underwent the full CF procedure were reviewed. Using a standardized data abstraction form, two researchers independently extracted information on procedural, methodological and decision-making aspects (that is, related to implemented outcomes research, evidence assessment and appraisal). A scoring algorithm was used to assess all three aspects. RESULTS: Fourty-seven candidates were nominated for CF; fourty-four underwent T = 0 assessments and eleven T = 4 assessments. The procedure extended beyond 4 years for 10/11 candidates. For the eleven candidates, applicants clearly defined study designs and data collection methods for outcomes research proposals addressing 16/22 research questions posed in T = 0 reports. ZIN provided discussion points and recommendations regarding research proposals for 18/22 research questions. Applicants implemented recommendations fully in 8/22 cases and partially in 12/22. Sufficient data was available at T = 4 to answer 15/22 research questions posed at T = 0. However, discussion points remained regarding implemented outcomes research for all eleven candidates at T = 4. ZIN advised to continue reimbursement for nine candidates and to stop reimbursement for two. For six of the nine candidates, reimbursement was continued on the basis of conditions relating to additional evidence generation beyond T = 4. CONCLUSIONS: Theoretically, CF provides a valuable option for enabling quick but conditional access to medicines in the Netherlands. However, procedural, methodological and decision-making considerations related to scheme design and implementation may affect its value in decision-making practice

Using Real-World Data in Health Technology Assessment (HTA) Practice:A Comparative Study of Five HTA Agencies

BACKGROUND: Reimbursement decisions are conventionally based on evidence from randomised controlled trials (RCTs), which often have high internal validity but low external validity. Real-world data (RWD) may provide complimentary evidence for relative effectiveness assessments (REAs) and cost-effectiveness assessments (CEAs). This study examines whether RWD is incorporated in health technology assessment (HTA) of melanoma drugs by European HTA agencies, as well as differences in RWD use between agencies and across time. METHODS: HTA reports published between 1 January 2011 and 31 December 2016 were retrieved from websites of agencies representing five jurisdictions: England [National Institute for Health and Care Excellence (NICE)], Scotland [Scottish Medicines Consortium (SMC)], France [Haute Autorité de santé (HAS)], Germany [Institute for Quality and Efficacy in Healthcare (IQWiG)] and The Netherlands [Zorginstituut Nederland (ZIN)]. A standardized data extraction form was used to extract information on RWD inclusion for both REAs and CEAs. RESULTS: Overall, 52 reports were retrieved, all of which contained REAs; CEAs were present in 25 of the reports. RWD was included in 28 of the 52 REAs (54%), mainly to estimate melanoma prevalence, and in 22 of the 25 (88%) CEAs, mainly to extrapolate long-term effectiveness and/or identify drug-related costs. Differences emerged between agencies regarding RWD use in REAs; the ZIN and IQWiG cited RWD for evidence on prevalence, whereas the NICE, SMC and HAS additionally cited RWD use for drug effectiveness. No visible trend for RWD use in REAs and CEAs over time was observed. CONCLUSION: In general, RWD inclusion was higher in CEAs than REAs, and was mostly used to estimate melanoma prevalence in REAs or to predict long-term effectiveness in CEAs. Differences emerged between agencies' use of RWD; however, no visible trends for RWD use over time were observed

Practical implications of using real-world evidence (RWE) in comparative effectiveness research: Learnings from IMI-GetReal

In light of increasing attention towards the use of real-world evidence (RWE) in decision making in recent years, this commentary aims to reflect on the experiences gained in accessing and using RWE for comparative effectiveness research as a part of the Innovative Medicines Initiative GetReal Consortium and discuss their implications for RWE use in decision-making

Alignment of European Regulatory and Health Technology Assessments: A Review of Licensed Products for Alzheimer's Disease

Aims: To facilitate regulatory learning, we evaluated similarities and differences in evidence requirements between regulatory and health technology assessment (HTA) bodies of Alzheimer's disease (AD) approved products.Methods: The European marketing authorisation application dossiers and European public assessment reports (EPARs) of the licensed AD drugs were screened to identify the phase III randomised controlled trials (RCTs) and outcomes used. We also screened the assessment reports of the National Institute of Health and Care Excellence (NICE, England) and the National Health Care Institute (ZiN, the Netherlands) to identify the studies and outcomes used in HTA assessments.Results: The application dossiers of donepezil, galantamine, rivastigmine, and memantine contained 16 phase III RCTs in total. These trials were also included in HTA assessments except that NICE excluded studies that were not published (n = 2) or trials that included patients with other types of dementia (n = 3). In the regulatory assessments the focus was on cognitive and global outcomes, and to some extent on function. In the HTA assessments of clinical effectiveness other domains were also covered including: function, behaviour and mood, and, occasionally, quality of life. In the economic analyses of NICE the domains cognition, function, and quality of life were included.Conclusion: There was a large overlap in inclusion of trials in regulatory and HTA assessments, although the focus on specific outcomes slightly differed. Understanding the methods and perceptions of both authorities can stimulate regulatory and HTA cross-talk and further alignment, and therefore more rapid patient access to new treatments