The perverse impact of external reference pricing (ERP): a comparison of orphan drugs affordability in 12 European countries. A call for policy change

Objective: The study compared the relative cost differences of similar orphan drugs among high and low GDP countries in Europe: Bulgaria, France, Germany, Greece, Hungary, Italy, Norway, Poland, Romania, Spain, Sweden, UK. Methods: Annual treatment costs per patient were calculated. Relative costs were computed by dividing the costs by each economic parameter: nominal GDP per capita, GDP in PPP per capita, % GDP contributed by the government, government budget per inhabitant, % GDP spent on healthcare, % GDP spent on pharmaceuticals, and average annual salary. An international comparison of the relative costs was done using UK as the reference country and results were analysed descriptively. Results: 120 orphan drugs were included. The median annual costs of orphan drugs in all countries varied minimally (cost ratios: 0.87 to 1.08). When the costs were adjusted using GDP per capita, the EU-5 and Nordic countries maintained minimal difference in median cost. However, the lower GDP countries showed three to six times higher relative costs. The same pattern was evident when costs were adjusted using the other economic parameters. Conclusion: When the country's ability to pay is taken into consideration, lower GDP countries pay relatively higher costs for similarly available orphan drugs in Europe.

[Epidemic of nosocomial infection by rotavirus in a neonatology service]

The goal of work is to establish a clinical descriptive analysis of the epidemic of nosocomial rotavirus occurred in the Neonatal Unit of the Hospital's Child Rabat for a winter period. We systematically collected all the patients of the service right from the first case of rotavirus nosocomial infection. Patients with a stay of less than 48 hours of hospitalization were excluded. We have established operating sheets for all positive cases, with the term, birth weight, postnatal age and weight during the sampling, clinical symptoms, treatment, and the evolution. Out of the 36 cases analyzed (where 26 preterm and 10 term neonates), 12 samples were positive for rotavirus, so one third of patients. The patients with positive samples were in 75% symptomatic cases. The clinical signs were represented in term newborns with stool weight with stagnant fluid in 2 cases and weight loss in one case and in premature infants with mucous stools with abdominal distension in 2/3 of cases, and fluid and stool dehydration in 1/3 of cases. A very low rate of breastfeeding (17%) was noted among all newborns service in this epidemic. We performed the isolation of positive patients, with a strengthening of hygiene measures. In addition, infants were started on symptomatic treatment with careful clinical monitoring. Evolution was complicated by necrotizing enterocolitis in 3 cases of preterm infants.