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Nayroles G, Frybourg S, Gabriel S, Kornfeld Å, Antoñanzas-Villar F, Espín J, Jommi C, Martini N, de Pouvourville G, Tolley K, Wasem J, Toumi M. Unlocking the potential of established products: toward new incentives rewarding innovation in Europe. J Mark Access Health Policy 2017; 5:1298190. [PMID: 28740616 PMCID: PMC5508393 DOI: 10.1080/20016689.2017.1298190] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/10/2017] [Indexed: 06/07/2023]
Abstract
Background: Many established products (EPs - marketed for eight years or more) are widely used off-label despite little evidence on benefit-risk ratio. This exposes patients to risks related to safety and lack of efficacy, and healthcare providers to liability. Introducing new indications for EPs may represent a high societal value; however, manufacturers rarely invest in R&D for EPs. The objective of this research was to describe incentives and disincentives for developing new indications for EPs in Europe and to investigate consequences of current policies. Methods: Targeted literature search and expert panel meetings. Results: Within the current European-level and national-level regulatory framework there are limited incentives for development of new indications with EPs. Extension of indication normally does not allow the price to be increased or maintained, the market protection period to be extended, or exclusion from a reference price system. New indication frequently triggers re-evaluation, resulting in price erosion, regardless of the level of added value with the new indication. In consequence, manufacturers are more prone to undertake R&D efforts at early to mid-stage of product life cycle rather than with EPs, or to invest in new chemical entities, even in therapeutic areas with broad off-label use. This represents a potentially missed opportunity as developing new indications for EPs offers an alternative to off-label use or lengthy and expensive R&D for new therapies, opens new opportunities for potentially cost-effective treatment alternatives, as well as greater equity in patients' access to treatment options. Conclusion: There are potential benefits from the development of new indications for EPs that are currently not being realized due to a lack of regulatory and pricing incentives in Europe. Incentives for orphan or paediatric drugs have proven to be effective in promoting R&D. Similarly, incentives to promote R&D in EPs should be developed, for the benefit of patients and healthcare systems.
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Affiliation(s)
- Gabrielle Nayroles
- Global Market Access and Pricing, IPSEN Pharma, Boulogne-Billancourt, France
| | - Sandrine Frybourg
- Pricing, Reimbursement and Market Access, Creativ-Ceutical, Paris, France
| | - Sylvie Gabriel
- Global Market Access and Pricing, IPSEN Pharma, Boulogne-Billancourt, France
| | - Åsa Kornfeld
- Pricing, Reimbursement and Market Access, Creativ-Ceutical, Paris, France
| | | | - Jaime Espín
- Andalusian School of Public Health, Granada, Spain
| | - Claudio Jommi
- Department of Pharmaceutical Sciences, University of Eastern Piedmont, Novara, Italy
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
| | | | | | | | - Jürgen Wasem
- Department of Economics, University Duisburg-Essen, Essen, Germany
| | - Mondher Toumi
- Department of Public Health, Aix-Marseille University, Marseille, France
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