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Meshkani Z, Zarei L, Hajimoladarvish N, Arabloo J, Rezapour A, Farabi H, Moradi N. Private Demand for Covid-19 Vaccine: A Contingent Assessment from a Low-and Middle-income Country. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2021; 20:223-234. [PMID: 34903984 PMCID: PMC8653656 DOI: 10.22037/ijpr.2021.115008.15153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This study aimed to estimate Iranian willingness to pay (WTP) for a hypothetical COVID-19 vaccine and its determinants. A cross-sectional online survey was conducted from May 2nd to 20th, 2020 among the general population of Iran to estimate WTP for hypothetical COVID-19 vaccines. Four scenarios with different levels of efficacy and duration of protection were presented to respondents in the payment card scale of the contingent valuation method (CVM). With the corresponding WTPs under different scenarios, mean, trimmed mean, median WTP values, and vaccine demand was estimated. A semi-log regression model was employed to identify key factors. The vaccine acceptance rate and positive WTP were about 70% and 80%, respectively. The reluctant individuals believed free vaccination is a government responsibility. The highest trimmed mean and median WTP values were the US $15 and $4 for the vaccine with more than 80% efficacy and one-time vaccination. The median decreased to the US $2 in less effective scenarios. The vaccine demand was price-inelastic. Price, self-assessment virus risk, age, gender, education, income, and working in the health sector were significant factors. Given the price inelasticity of the COVID-19 vaccine, providing free vaccination by the Iranian government is highly recommended, particularly for low-income and vulnerable individuals.
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Affiliation(s)
- Zahra Meshkani
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Zarei
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Narges Hajimoladarvish
- Department of Economics, Faculty of Social Sciences and Economics, Alzahra University, Tehran, Iran
| | - Jalal Arabloo
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Hiro Farabi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Najmeh Moradi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
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Did the Introduction of Biosimilars Influence Their Prices and Utilization? The Case of Biologic Disease Modifying Antirheumatic Drugs (bDMARD) in Bulgaria. Pharmaceuticals (Basel) 2021; 14:ph14010064. [PMID: 33466766 PMCID: PMC7829887 DOI: 10.3390/ph14010064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 12/13/2022] Open
Abstract
The aim of this study is to evaluate the effect of the introduction of biosimilars in Bulgaria on the prices and utilization of biologic disease modifying antirheumatic drugs (bDMARD). It is a combined qualitative and quantitative analysis of time of entry of biosimilars on the national market and the respective changes in the prices and utilization during 2015-2020. We found 58 biosimilars for 16 reference products authorized for sale on the European market by the end of 2019, but for 2 of the reference products biosimilars were not found on the national market. Only inflammatory joint disease had more than one biosimilar molecule indicated for therapy. Prices of the observed bDMARD decreased by 17% down to 48%. We noted significant price decreases upon biosimilar entrance onto the market. In total, the reimbursed expenditures for the whole therapeutic group steadily increased from 72 to 99 million BGN. Utilization changed from to 0.5868 to 2.7215 defined daily dose (DDD)/1000inh/day. Our study shows that the entrance of biosimilars in the country is relatively slow because only half of the biosimilars authorized in Europe are reimbursed nationally. Introduction of biosimilars decreases the prices and changes the utilization significantly but other factors might also contribute to this.
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Mitkova Z, Petrova G. Utilization, Cost, and Affordability of Antihypertensive Therapy in Bulgaria. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2021; 20:403-416. [PMID: 34567170 PMCID: PMC8457736 DOI: 10.22037/ijpr.2020.113660.14418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ACE- inhibitors, angiotensin receptor blockers, beta-blockers, Ca- antagonists are recommended as first-line monotherapy for hypertension. The aim of the current study is to analyze expenditures paid by the National Health Insurance Fund (NHIF) after introducing the budget cap cost-containment measure and its impact on affordability and utilization. The study is a retrospective, observational analysis of expenditure on main groups' antihypertensive medicines: beta blockers, calcium channel blockers, ACE- inhibitors, and AT receptor blockers. The cost paid by the NHIF two years before (2016-2017), and after (2018-2019) the introduction of the budget cap measure was evaluated. Utilization and affordability data covering antihypertensive therapy were retrospectively calculated and analyzed during 2016-2019. The reimbursed expenditures on sartans, ACE-inhibitors, and β-blockers decreased in absolute terms in 2019 compared to that in 2016. There are no statistically significant differences, excluding the group of sartans. The result reveals decreasing utilization of ACE-inhibitors and β-blockers, which is the most significant for enalapril and bisoprolol. Affordability increases during the observed period because less than a working day income is sufficient for monthly therapy. Patients with hypertension in Bulgaria have access to affordable first-line antihypertensive medicines. Despite the stable and low prices, utilization mainly decreases. The reimbursed amount is reduced with a low rate or remains similar to that found at the beginning of the observed period. The results of the implemented budget cap as a measure to control NHIF cost are not evident and not fully expressed on the market for the first-line antihypertensive therapy.
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Affiliation(s)
- Zornitsa Mitkova
- Department of Organization and Economy of Pharmacy, Faculty of Pharmacy,Medical University of Sofia, Sofia, Bulgaria.
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Di Novi C, Leporatti L, Montefiori M. Older patients and geographic barriers to pharmacy access: When nonadherence translates to an increased use of other components of health care. HEALTH ECONOMICS 2020; 29 Suppl 1:97-109. [PMID: 32511871 DOI: 10.1002/hec.4031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Abstract
This paper studies whether geographic barriers can influence nonadherence to prescription drugs and its effect on patients' health. We used a multivariate probit model estimated by maximum simulated likelihood that considers individual unobserved heterogeneity, which may characterize the relationship between adherence, medical care utilization, and health outcome. We used administrative data from Liguria, Italy, the region with the highest rate of individuals over the age of 65 in Europe. Our sample included older individuals affected by cardiovascular diseases, which remain one of the leading causes of death in most OECD countries. Our results showed that geographic barriers to pharmacies negatively influence patients' adherence. According to our results, patients' nonadherence to pharmacological therapy is responsible for an increased probability of patients' mortality and the overuse of other medical services, namely, hospitalizations and emergency department visits. Nonadherence may thus represent a potential source of waste for the health care system.
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Affiliation(s)
- Cinzia Di Novi
- Department of Economics and Management, University of Pavia, Pavia, Italy
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Zarei L, Karimzadeh I, Moradi N, Peymani P, Asadi S, Babar ZUD. Affordability Assessment from a Static to Dynamic Concept: A Scenario-Based Assessment of Cardiovascular Medicines. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051710. [PMID: 32151039 PMCID: PMC7084506 DOI: 10.3390/ijerph17051710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 12/22/2022]
Abstract
The out-of-pocket payments for prescription medications can impose a financial burden on patients from low- and middle- incomes and who suffer from chronic diseases. The present study aims at evaluating the affordability of cardiovascular disease (CVD) medication in Iran. This includes measuring affordability through World Health Organization/Health Action International (WHO/HAI) methodology. In this method, affordability is characterized as the number of days’ wages of the lowest-paid unskilled government worker. The different medication therapy scenarios are defined in mono-and combination therapy approaches. This method adds on to WHO/HAI methodology to discover new approaches to affordability assessments. The results show the differences in the medicines affordability when different approaches are used in mono-and combination therapy between 6 main sub-therapeutic groups of CVD. It indicates the medicine affordability is not a static concept and it changes dynamically between CVD therapeutic subgroups when it used alone or in combination with other medicines regarding patients’ characteristics and medical conditions. Hypertension and anti-arrhythmia therapeutic groups had the most non-affordability and hyperlipidemia had the most affordable medicines. Therefore, affordability can be considered as a dynamic concept, which not only affected by the medicine price but significantly affected by a patient’s characteristics, the number of medical conditions, and insurance coverage.
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Affiliation(s)
- Leila Zarei
- Pharmacoeconomics and Pharma Management, Health Policy Research Center, Institute of Heath, Shiraz University of Medical Sciences, Shiraz, Fars, Iran;
| | - Iman Karimzadeh
- Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Fars, Iran;
| | - Najmeh Moradi
- Pharmacoeconomics and Pharma Management, Health Management and Economics Research Centre, Iran University of Medical Sciences, Tehran, Iran
- Correspondence: ; Tel.: +98-9127932540
| | - Payam Peymani
- Pharmacoepidemiology, Health Policy Research Center, Institute of Heath, Shiraz University of Medical Sciences, Shiraz, Fars, Iran;
- Department of Clinical Pharmacology & Toxicology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Sara Asadi
- Clinical Pharmacy, Shiraz University of Medical Sciences, Shiraz, Fars, Iran;
| | - Zaheer-Ud-Din Babar
- Medicines and Healthcare, Department of Pharmacy, University of Huddersfield, Queensgate, HD1 3DH Huddersfield, UK;
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Kikuti‐Koyama KA, Monteiro HL, Ribeiro Lemes Í, Morais LC, Fernandes R, Turi‐Lynch B, Codogno J. Impact of type 2 diabetes mellitus and physical activity on medication costs in older adults. Int J Health Plann Manage 2019; 34:e1774-e1782. [DOI: 10.1002/hpm.2892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/09/2019] [Accepted: 08/09/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Kelly Akemi Kikuti‐Koyama
- Laboratory of InVestigation in Exercise—LIVE, Department of Physical Education, School of Sciences and Technology São Paulo State University—UNESP Presidente Prudente Brazil
| | - Henrique Luiz Monteiro
- Physiotherapy Department, School of Sciences and Technology São Paulo State University—UNESP Presidente Prudente Brazil
| | - Ítalo Ribeiro Lemes
- Physiotherapy Department, School of Sciences and Technology São Paulo State University—UNESP Presidente Prudente Brazil
| | - Luana Carolina Morais
- Laboratory of InVestigation in Exercise—LIVE, Department of Physical Education, School of Sciences and Technology São Paulo State University—UNESP Presidente Prudente Brazil
| | - Rômulo Fernandes
- Laboratory of InVestigation in Exercise—LIVE, Department of Physical Education, School of Sciences and Technology São Paulo State University—UNESP Presidente Prudente Brazil
| | - Bruna Turi‐Lynch
- Laboratory of InVestigation in Exercise—LIVE, Department of Physical Education, School of Sciences and Technology São Paulo State University—UNESP Presidente Prudente Brazil
| | - Jamile Codogno
- Laboratory of InVestigation in Exercise—LIVE, Department of Physical Education, School of Sciences and Technology São Paulo State University—UNESP Presidente Prudente Brazil
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Venkatason P, Zaharan NL, Ismail MD, Wan Ahmad WA, Mahmood Zuhdi AS. Trends and variations in the prescribing of secondary preventative cardiovascular therapies for non-ST elevation myocardial infarction (NSTEMI) in Malaysia. Eur J Clin Pharmacol 2018; 74:953-960. [PMID: 29582106 PMCID: PMC5999133 DOI: 10.1007/s00228-018-2451-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 03/19/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE Information is lacking on prescribing of preventative cardiovascular pharmacotherapies for patients with non-ST elevation myocardial infarction (NSTEMI) in the Asian region. This study examined the prescribing rate of these pharmacotherapies, comparing NSTEMI to STEMI, and variations across demographics and clinical factors within the NSTEMI group in the multi-ethnic Malaysian population. METHODS This is a retrospective analysis of the Malaysian National Cardiovascular Disease Database-Acute Coronary Syndrome registry from year 2006 to 2013 (n = 30,873). On-discharge pharmacotherapies examined were aspirin, ADP-antagonists, statins, ACE-inhibitors, angiotensin-II-receptor blockers, and beta-blockers. Multivariate logistic regression was used to calculate adjusted odds ratio of receiving individual pharmacotherapies according to patients' characteristics in NSTEMI patients (n = 11,390). RESULTS Prescribing rates for cardiovascular pharmacotherapies had significantly increased especially for ADP-antagonists (76%) in NSTEMI patients. More than 85% were prescribed statins and antiplatelets but rates remained significantly lower compared to STEMI. Women and those over 65 years old were less likely to be prescribed these pharmacotherapies compared to men and younger NSTEMI patients. Chinese and Indians were more likely to receive selected pharmacotherapies compared to Malays (main ethnicity). Geographical variations were observed; East Malaysian (Malaysian Borneo) patients were less likely to receive these compared to Western region of Malaysian Peninsular. Underprescribing in patients with risk factors such as diabetes were observed with other co-morbidities influencing prescribing selectively. CONCLUSION This study uncovers demographic and clinical variations in cardiovascular pharmacotherapies prescribing for NSTEMI. Concerted efforts by policy makers, specialty societies, and physicians are required focusing on elderly, women, Malays, East Malaysians, and high-risk patients.
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Affiliation(s)
- Padmaa Venkatason
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nur Lisa Zaharan
- Department of Pharmacology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Muhammad Dzafir Ismail
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Wan Azman Wan Ahmad
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
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