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Incze A, Kaló Z, Espín J, Kiss É, Kessabi S, Garrison LP. Assessing the Consequences of External Reference Pricing for Global Access to Medicines and Innovation: Economic Analysis and Policy Implications. Front Pharmacol 2022; 13:815029. [PMID: 35462921 PMCID: PMC9019924 DOI: 10.3389/fphar.2022.815029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 03/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background: External reference pricing (ERP) is used to set pharmaceutical prices to improve affordability, but its application may have negative consequences on patient access—thus, equity—across countries and on global innovation. With the United States contemplating ERP, negative effects could be magnified. Our aim: identify and quantify some major consequences of ERP. Research design, methods: Besides relying on databases and ERP modelling, we developed a heart failure case study. 4-step approach: 1) review ERP policies; 2) establish worldwide “price corridor”; 3) quantify patient access and health outcomes impact by ERP; 4) estimate ERP impact on innovation. Results: Our ERP referencing analysis highlights its perverse effects especially in lower-income countries. As counterstrategies to protect their revenues, manufacturers often implement tight list price corridors or launch avoidance/delays. Consequences include suboptimal patient access—hence, worse outcomes—illustrated by our case study: 500,000 + QALYs health loss. Additionally, the ensuing revenue reduction would likely cause innovation loss by one additional medicine that would have benefitted future patients. Conclusion: This research provides key insights on potential unintentional consequences of medicine price setting by ERP worldwide and under a new proposal for the United States. Our results can inform stakeholder discussions to improve patient access to innovative medicines globally.
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Affiliation(s)
- András Incze
- Department of Healthcare Management, Baden-Wuerttemberg Cooperative State University, Loerrach, Germany.,Akceso Advisors AG, Basel, Switzerland
| | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University/Syreon Research Institute, Budapest, Hungary.,Syreon Research Institute, Budapest, Hungary
| | - Jaime Espín
- Andalusian School of Public Health, Granada, Spain
| | - Éva Kiss
- Akceso Advisors AG, Basel, Switzerland
| | | | - Louis P Garrison
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute Department of Pharmacy, University of Washington, Seattle, WA, United States
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AlRuthia Y, Alotaibi F, Jamal A, Sales I, Alwhaibi M, Alqahtani N, AlNajrany SM, Almalki K, Alsaigh A, Mansy W. Cost Effectiveness of ACEIs/ARBs versus Amlodipine Monotherapies: A Single-Center Retrospective Chart Review. Healthcare (Basel) 2021; 9:healthcare9070798. [PMID: 34202109 PMCID: PMC8304800 DOI: 10.3390/healthcare9070798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this retrospective chart review study was to examine the cost effectiveness of angiotensin-converting enzyme inhibitors (ACEIs); angiotensin receptor blockers (ARBs); and dihydropyridine calcium channel blockers (CCBs) such as amlodipine, monotherapies in the management of essential hypertension among adult patients (≥18 years) without cancer, cardiovascular disease, and chronic kidney disease in the primary care clinics of a university-affiliated tertiary care hospital. Patients were followed up for at least 12 months from the initiation of therapy. Propensity score bin bootstrapping with 10,000 replications was conducted to generate the 95% confidence intervals (CI) for both treatment outcome (e.g., reduction of the systolic (SBP) and diastolic blood pressures (DBP) in mmHG) and the cost (e.g., costs of drugs, clinic visits, and labs in Saudi riyals (SAR)). Among the 153 included patients who met the inclusion criteria, 111 patients were on ACEIs/ARBs, while 44 patients were on amlodipine. On the basis of the bootstrap distribution, we found that the use of ACEIs/ARBs was associated with an incremental reduction of SBP of up to 4.46 mmHg but with an incremental cost of up to SAR 116.39 (USD 31.04), which results in an incremental cost effectiveness ratio (ICER) of SAR 26.09 (USD 6.95) per 1 mmHg reduction with 55.26% level of confidence. With regard to DBP, ACEIs/ARBs were associated with an incremental reduction of DBP of up to 5.35 mmHg and an incremental cost of up to SAR 144.96 (USD 38.66), which results in an ICER of SAR 27.09 (USD 7.23) per 1 mmHg reduction with 68.10% level of confidence. However, ACEIs/ARBs were less effective and costlier than amlodipine in reducing SBP and DBP with 44.74% and 31.89% levels of confidence, respectively. The findings of this study indicate that the use of ACEI or ARB as a monotherapy seems to be more effective than amlodipine monotherapy in the management of essential hypertension in primary care settings with minimal incremental cost.
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Affiliation(s)
- Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (F.A.); (I.S.); (M.A.); (N.A.); (S.M.A.); (K.A.); (A.A.); (W.M.)
- Correspondence: (Y.A.); (A.J.); Tel.: +966-114-677-483 (Y.A.); Fax: +966-114-677-480 (Y.A.)
| | - Fahad Alotaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (F.A.); (I.S.); (M.A.); (N.A.); (S.M.A.); (K.A.); (A.A.); (W.M.)
| | - Amr Jamal
- Family and Community Medicine Department, College of Medicine, King Saud University, P.O. Box 3145, Riyadh 12372, Saudi Arabia
- Correspondence: (Y.A.); (A.J.); Tel.: +966-114-677-483 (Y.A.); Fax: +966-114-677-480 (Y.A.)
| | - Ibrahim Sales
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (F.A.); (I.S.); (M.A.); (N.A.); (S.M.A.); (K.A.); (A.A.); (W.M.)
| | - Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (F.A.); (I.S.); (M.A.); (N.A.); (S.M.A.); (K.A.); (A.A.); (W.M.)
| | - Nawaf Alqahtani
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (F.A.); (I.S.); (M.A.); (N.A.); (S.M.A.); (K.A.); (A.A.); (W.M.)
| | - Sina M. AlNajrany
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (F.A.); (I.S.); (M.A.); (N.A.); (S.M.A.); (K.A.); (A.A.); (W.M.)
| | - Khalid Almalki
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (F.A.); (I.S.); (M.A.); (N.A.); (S.M.A.); (K.A.); (A.A.); (W.M.)
| | - Abdulaziz Alsaigh
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (F.A.); (I.S.); (M.A.); (N.A.); (S.M.A.); (K.A.); (A.A.); (W.M.)
| | - Wael Mansy
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (F.A.); (I.S.); (M.A.); (N.A.); (S.M.A.); (K.A.); (A.A.); (W.M.)
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Xu Q, Yang N, Feng S, Guo J, Liu QB, Hu M. Cost-effectiveness analysis of combining traditional Chinese medicine in the treatment of hypertension: compound Apocynum tablets combined with Nifedipine sustained-release tablets vs Nifedipine sustained-release tablets alone. BMC Complement Med Ther 2020; 20:330. [PMID: 33153455 PMCID: PMC7643403 DOI: 10.1186/s12906-020-03091-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 09/17/2020] [Indexed: 11/17/2022] Open
Abstract
Background We evaluated the long-term cost-effectiveness of antihypertensive traditional Chinese medicines (TCMs) and to compare the cost-effectiveness of a combined treatment consisting of compound Apocynum tablets and Nifedipine sustained-release tablets with the cost-effectiveness of treatment with Nifedipine sustained-release tablets alone. Methods A Markov model was used to simulate the potential incremental cost-effectiveness per quality-adjusted life year (QALY) to be gained from compound Apocynum tablets and Nifedipine sustained-release tablets compared with Nifedipine sustained-release tablets alone. Model parameter estimates were informed by previously published studies. The direct medical costs of outpatients with hypertension were estimated from the health care provider’s perspective. A 5% annual discount rate was applied to both costs and QALYs. Results TCMs combined with Nifedipine sustained-release tablets group generated a total 20-year cost of 11,517.94 RMB (US $1739.87), whereas Nifedipine sustained-release tablets alone group resulted in a 20-year cost of 7253.71 RMB (US $1095.73). TCMs combined with Nifedipine sustained-release tablets group resulted in a generation of 12.69 QALYs, whereas Nifedipine sustained-release tablets alone group resulted in 12.50. The incremental cost-utility ratio was 22,443.32 RMB (US $3390.23) per QALY. Considering the threshold of 1 GDP per capita in China in 2018 (US $9764.95), the combination of compound Apocynum tablets and Nifedipine sustained-release tablets was a cost-effective strategy. One-way and probabilistic sensitivity analysis showed unchanged results over an acceptable range. Conclusions Combining Traditional Chinese Medicines with chemical medicines is more cost-effective strategy in the treatment of hypertension.
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Affiliation(s)
- Qian Xu
- West China School of Pharmacy Sichuan University, 17, Renmin South Road, 3rd Section, Chengdu, 610041, Sichuan, China
| | - Nan Yang
- West China School of Pharmacy Sichuan University, 17, Renmin South Road, 3rd Section, Chengdu, 610041, Sichuan, China
| | - Shuang Feng
- West China School of Pharmacy Sichuan University, 17, Renmin South Road, 3rd Section, Chengdu, 610041, Sichuan, China
| | - Jianfei Guo
- Division of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Qi-Bing Liu
- Department of Pharmacology, School of Pharmaceutical Science, Hainan Medical University, Haikou, Hainan, China.
| | - Ming Hu
- West China School of Pharmacy Sichuan University, 17, Renmin South Road, 3rd Section, Chengdu, 610041, Sichuan, China.
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