How do drug prices respond to a change from external to internal reference pricing? Evidence from a Danish regulatory reform

Studies the effects of a switch from external reference pricing to internal reference pricing that was implemented in Denmark in April 2005. Abstract We study the effects of a change in the way patient reimbursements are calculated on the prices of pharmaceuticals using quasi-experimental data for Denmark which switched from external (where reimbursements are based on prices of similar products in foreign countries) to internal reference pricing (where they are based on the cheapest domestic substitute). We analyze three therapeutic classes with different treatment durations and show that the reform led to substantial price decreases for our lifelong treatment and to less substantial price reductions for our medium duration treatment while we do not find significant effects on our acute treatment. Moreover, the reform did only affect generics and did not impact original products or parallel imports

Regulation of Pharmaceutical Prices: Evidence from a Reference Price Reform in Denmark

On April 1, 2005, Denmark changed the way references prices, a main determinant of reimbursements for pharmaceutical purchases, are calculated. The previous reference prices, which were based on average EU prices, were substituted to minimum domestic prices. Novel to the literature, we estimate the joint effects of this reform on prices and quantities. Prices decreased more than 26 percent due to the reform, which reduced patient and government expenditures by 3.0 percent and 5.6 percent, respectively, and producer revenues by 5.0 percent. The prices of expensive products decreased more than their cheaper counterparts, resulting in large differences in patient benefits from the reform.pharmaceutical markets; regulation; co-payments; reference pricing; asymmetric welfare effects

How do drug prices respond to a change from external to internal reference pricing? : evidence from a Danish regulatory reform

We study the effects of a change in the way patient reimbursements are calcu- lated on the prices of pharmaceuticals using quasi-experimental data for Denmark which switched from external (where reimbursements are based on prices of similar products in foreign countries) to internal reference pricing (where they are based on the cheapest domestic substitute). We analyze three therapeutic classes with differ- ent treatment durations and show that the reform led to substantial price decreases for our lifelong treatment and to less substantial price reductions for our medium duration treatment while we do not find significant effects on our acute treatment. Moreover, the reform did only affect generics and did not impact original products or parallel imports

Phytoplankton natural community competition experiments: A reinterpretation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109924/1/lno19853020436.pd

Regulation of pharmaceutical prices : evidence from a reference price reform in Denmark

On April 1, 2005, Denmark changed the way references prices, a main determinant of reimbursements for pharmaceutical purchases, are calculated. The previous reference prices, which were based on average EU prices, were substituted to minimum domestic prices. Novel to the literature, we estimate the joint effects of this reform on prices and quantities. Prices decreased more than 26 percent due to the reform, which reduced patient and government expenditures by 3.0 percent and 5.6 percent, respectively, and producer revenues by 5.0 percent. The prices of expensive products decreased more than their cheaper counterparts, resulting in large differences in patient benefits from the reform

Chronic obstructive pulmonary disease and the risk of cardiovascular diseases

Previous large epidemiological studies reporting on the association between chronic obstructive pulmonary disease (COPD) and cardiovascular diseases mainly focussed on prevalent diseases rather than on the incidence of newly diagnosed cardiovascular outcomes. We used the UK-based General Practice Research Database (GPRD) to assess the prevalence and incidence of cardiovascular diseases in COPD patients aged 40-79 between 1995 and 2005, and we randomly matched COPD-free comparison patients to COPD patients. In nested-case control analyses, we compared the risks of developing an incident diagnosis of cardiac arrhythmias, venous thromboembolism, myocardial infarction, or stroke between patients with and without COPD, stratifying the analyses by COPD-severity, using COPD-treatment as proxy for disease severity. We identified 35,772 patients with COPD and the same number of COPD-free patients. Most cardiovascular diseases were more prevalent among COPD patients than among the comparison group of COPD-free patients. The relative risk estimates of developing an incident diagnosis of cardiac arrhythmia (OR 1.19, 95% CI 0.98-1.43), deep vein thrombosis (OR 1.35, 95% CI 0.97-1.89), pulmonary embolism (OR 2.51, 95% CI 1.62-3.87), myocardial infarction (OR 1.40, 95% CI 1.13-1.73), or stroke (OR 1.13, 95% CI 0.92-1.38), tended to be increased for patients with COPD as compared to COPD-free controls. The findings of this large observational study provide further evidence that patients with COPD are at increased risk for most cardiovascular disease

Current fire regimes, impacts and the likely changes – IV: tropical Southeast Asia

The Southeast Asian region is experiencing some of the world’s highest rates of deforestation and forest degradation, the principle drivers of which are agricultural expansion and wood extraction in combination with an increased incidence of fire. Recent changes in fire regimes in Southeast Asia are indicative of increased human-causd forest disturbance, but El Niño–Southern Oscillation (ENSO) events also play a role in exacerbating fire occurrence and severity. Fires are now occurring on a much more extensive scale - in part because forest margins are at greater risk of fire as a result of disturbance through logging activities, but also as a result of rapid, large-scale forest clearance for the establish-ment of plantations. Millions of hectares have been deforested and drained to make way for oil palm and pulpwood trees, and many plantation companies, particularly in Indonesia, have employed fire as a cheap land clearance tool; uncontrolled fires have entered adjacent forests or plantation estates, and burnt both the forest biomass and, in peatland areas, underlying peat. Forest fires cause changes to forest structure, biodiversity, soil and hydrology. Repeated fires over successive or every few years lead to a progressive decline in the number of primary forest species. Fire leads to reduction in both aboveground and below ground organic carbon stocks and also changes carbon cycling patterns. In non-peatland areas, losses of carbon from fire affected forest vegetation exceed greatly soil carbon losses, but on carbon-rich substrates, e.g. peat, combustion losses can be considerable. Peatland fires make a major contribution to atmospheric emissions of greenhouse gases, fine particular matter and aerosols and thus contribute to climate change as well as presenting a problem for human health. The scale of emissions is unlikely to reduce in coming decades, since climate modelling studies have predicted that parts of this region will experience lower rainfall in future and greater seasonality. Protecting the rainforests of this region from further fire disasters should be at the top of the global environmental agenda, with highest priority given to peatland areas

Potential and distribution of transplanted hematopoietic stem cells in a nonablated mouse model

Increasingly, allogeneic and even more often autologous bone marrow transplants are being done to correct a wide variety of diseases. In addition, autologous marrow transplants potentially provide an opportune means of delivering genes in transfected, engrafting stem cells. However, despite its widespread clinical use and promising gene therapy applications, relatively little is known about the mechanisms of engraftment in marrow transplant recipients. This is especially so in the nonablated recipient setting. Our data show that purified lineage negative rhodamine 123/Hoechst 33342 dull transplanted hematopoietic stem cells engraft into the marrow of nonablated syngeneic recipients. These cells have multilineage potential, and maintain a distinct subpopulation with stem cell characteristics. The data also suggests a spatial localization of stem cell niches to the endosteal surface, with all donor cells having a high spatial affinity to this area. However, the level of stem cell engraftment observed following a transplant of stem cells was significantly lower than that expected following a transplant of the same number of unseparated marrow cells from which the purified cells were derived, suggesting the existence of a nonstem cell facilitator population, which is required in a nonablated syngeneic transplant setting