The need for cost-effective choices to treat patients with bipolar 1 disorders including asenapine

Bipolar 1 disorders (BPD) are a chronic disorder with prevalence rates up to 2.6% of the adult population or higher and appreciable direct and indirect costs. As a result, a concern to health authorities especially given the low age of onset. Consequently, a need to treat BPD patients well and improve their quality of life. Pharmacotherapy includes mood stabilisers and atypical antipsychotics (AAPs). AAPs have different mechanisms of action and side-effects so treatment needs to be tailored. Asenapine in clinical trials is as effective as olanzapine with less metabolic side-effects. Chitnis and colleagues have shown in routine care that asenapine also reduces hospital and emergency room admissions making it cost neutral in BPD, which is of interest to health authorities and clinicians

Western European markets for biosimilar drugs : worth differentiation

This paper discusses pharmaceutical expenditure in OECD countries

Challenges associated with high prices of new cancer medicines : potential ways forward for CEE countries based on HTA principles

This presentation discusses the costs to health systems of cancer care

Combating COVID-19 : lessons learnt particularly among developing countries and the implications

We believe COVID-19 was first identified in Wuhan, China, in December 2019. By 19 July 2020 there were already 14.349 million cases and over 603,000 deaths worldwide give a case fatality ratio among confirmed cases of 4.21%. this includes Bangladesh with 204,525 confirmed cases by 19 July and 2618 deaths; however, recognising appreciable underreporting. Since COVID-19 is principally spread through droplet infection and physical contact, with an appreciable number of patients asymptomatic and currently no vaccine, current prevention strategies have centred on active testing, lockdown, closure of borders coupled with quarantining, sanitisation and social distancing

Ongoing Initiatives to Improve the Quality and Efficiency of Medicine Use within the Public Healthcare System in South Africa; A Preliminary Study

Introduction: South Africa has an appreciable burden of both communicable and non-communicable diseases as well as high maternal, neonatal, and child morbidity. In recent years there have been significant strides with improving the public health system, and addressing current inequalities, with the right to health a constitutional provision in South Africa. Initiatives include the introduction of National Health Insurance, programmes to enhance access to medicines for patients with chronic diseases, as well as activities to improve care in hospitals, including improving pharmacovigilance. Consequently, the objective of this paper is to review ongoing initiatives within the public healthcare sector in South Africa and their influence to provide future direction.Method: Principally a structured review of current and planned activities.Results: There have been a number of major activities and initiatives surrounding the availability and access to medicines in the public system in recent years in South Africa. This includes a National Surveillance Centre and an innovative early warning system for the supply of medicines as well as the development of a National Health Care Pricing Authority and initiatives to improve contracting. There have also been developments to improve the supply chain including instigating Medicine Procurement Units in the provinces and enhancing forecasting capabilities. Access to medicines is improving though the instigation of stable chronic disease management initiatives to increase the number of external pick-up points for medicines. There are also ongoing programmes to enhance adherence to medicines as well as enhance adherence to the Standard Treatment Guidelines and the Essential Medicines List with their increasing availability. In addition, there is a movement to enhance the role of health technology assessment in future decision making. Hospital initiatives include increased focus on reducing antimicrobial resistance through instigating stewardship programmes as well as improving adverse drug reaction reporting and associated activities.Conclusion: Overall, there are an appreciable number of ongoing activities within the public healthcare system in South Africa attempting to ensure and sustain universal healthcare. It is too early to assess their impact, which will be the subject of future research

Bioequivalence of narrow therapeutic index drugs and immunosuppressives

Stricter bioequivalence criteria are in place for generics where there are narrow therapeutic indexes such as generic immunosuppressives, enhancing their acceptance despite limited published studies. No serious issues have been reported to date with generic ciclosporine despite being on the market in Europe for more than 10 year

Do newly marketed generic medicines expand markets using descriptive time series analysis and mixed logit models? Korea as an exemplar and its implications

Introduction: There have been concerns in Korea that the availability of cheaper generics can appreciably increase prescribed volumes thereby negating their beneficial effects on overall pharmaceutical expenditure. Objectives: Explore market changes after newly entered generics including market expansion and substitution effects, and to examine factors contributing to the prescribing of newly entered generics using atorvastatin as an exemplar. This is because previous studies have shown market expansion had occurred following generic atorvastatin. Methods: Explore market expansion effects by extracting all statins users from July 2008 to June 2010 from the nationally representative dataset of 2008, combined with the National Health Insurance Claims data, with atorvastatin’s patent expiring in July 2008. The data consisted of medical visit episodes of patients who had been prescribed statins at least once during the observational period. Patients who had been prescribed any statin before the observation period were classified as the previously treated group and those who had not as the newly treated group. Descriptive time series analysis was conducted and the mixed logit model applied to understand factors contributing to generic atorvastatin prescriptions. Results: Market expansion was observed after generic atorvastatin availability with an appreciable increase in number of newly treated patients, whereas substitution effect was found among previously treated patients. Newly treated patients tended to get significantly lower daily doses (p<0.0001). According to the mixed logistic analysis, newly treated patients were more likely to be prescribed generic atorvastatin (OR=2.58; 95% CI, 2.05-3.26) than their counterparts. Clinicians and secondary hospitals were also key drivers of generic atorvastatin (ORs were 10.41 and 9.81, respectively). Conclusions: Newly marketed generic statins in Korea resulted in an expanding market by substantially increasing the number of new patients with clinics and hospitals appreciably using newly marketed generics. However lower doses of statins were prescribed. Policy makers do recognize that generic availability can save costs so should be encouraged. However, this is a concern when generic availability appreciably expands the market, potentially increasing the financial burden. This needs to be addressed. Additionally in Korea, the quality of prescribing should be monitored, especially focusing on clinics and secondary hospital

Diretrizes Metodológicas : Avaliação de Desempenho de Tecnologias em Saúde

In recent years, significant advances have been registered in the health area with the discovery of new technologies. These advances have been accompanied by a rise in treatment costs and have put health spending among the largest expenditures of public and family systems around the world. Despite the undeniable scientific advances, many health technologies launched in the international market do not have the expected benefits and, in some situations, still introduce iatrogenies. In order to respond to the need to measure, evaluate and select the products, equipment, medicines and health procedures that merit use in health systems, scientific methods have been developed to assist the process of incorporating health technologies. A set of standardized analyzes of effectiveness, safety, effectiveness, efficiency and costs has contributed in a relevant way to the processes that incorporate new technologies. However, post-incorporation studies published in the international literature that present disturbing results are not rare in that many of these technologies, when used in real life, do not actually have the benefits reported by manufacturers. For this reason, many challenges still permeate the little explored process of evaluating the performance of the technologies available and the consequent need to establish a process of divestment and reinvestment in health