Journal Description
Journal of Market Access & Health Policy
Journal of Market Access & Health Policy
(JMAHP) is an international, peer-reviewed, open access journal that covers all different subdisciplines of ‘market access’ from economic, technical, scientific, sociological, psychological and policy perspectives. The journal is owned by the Market Access Society, and is published quarterly online by MDPI (since Volume 12, Issue 1 - 2024).
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, PubMed, PMC, and other databases.
- Rapid Publication: first decisions in 16 days; acceptance to publication in 5.8 days (median values for MDPI journals in the second half of 2023).
- Recognition of Reviewers: APC discount vouchers, optional signed peer review, and reviewer names published annually in the journal.
subject
Imprint Information
Open Access
ISSN: 2001-6689
Latest Articles
Welcome to the Journal of Market Access and Health Policy under MDPI Wings
J. Mark. Access Health Policy 2024, 12(1), 2-4; https://doi.org/10.3390/jmahp12010002 - 01 Jan 2024
Abstract
The Journal of Market Access and Health Policy (JMAHP) is the first peer-reviewed open access journal that focuses on the concept of ‘market access’ from economic, technical, scientific, sociological, anthropological, psychological, and policy perspectives [...]
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Open AccessEditorial
Publisher’s Note: A New Chapter for the Journal of Market Access and Health Policy (JMAHP)—Continued Publication by MDPI
J. Mark. Access Health Policy 2024, 12(1), 1; https://doi.org/10.3390/jmahp12010001 - 01 Jan 2024
Abstract
The Journal of Market Access and Health Policy (JMAHP) is an open access peer-reviewed publication focused on Market Access and its sub-dimensions [...]
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Open AccessEssay
Discounting Health Gain: A Different View
by
and Olivier Ethgen
J. Mark. Access Health Policy 2023, 11(1), 2275350; https://doi.org/10.1080/20016689.2023.2275350 - 02 Nov 2023
Abstract
ABSTRACT
At least since the Age of Enlightenment, good health has been a tenet for society. Healthy societies could learn better, work harder, improve their wealth, and live longer. Today societies focus on life expectancy, as we value long and healthy lives. As
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ABSTRACT
At least since the Age of Enlightenment, good health has been a tenet for society. Healthy societies could learn better, work harder, improve their wealth, and live longer. Today societies focus on life expectancy, as we value long and healthy lives. As illustrated by the provision of COVID-19 vaccines first for the elderly, societies value life-saving actions. Paradoxically, health economic assessments conventionally devalue long-lasting health through the practice of discounting health benefits along with costs. However, health, with its intrinsic and instrumental characteristics, is not synonymous with money cash, a tradeable asset that devalues with time. If improving healthy life expectancy is a societal ambition, it seems counter-intuitive to value future health less as a result of an artificial mathematical construct when evaluating economically new medical interventions. In this paper, we investigate the application of discounting health in healthcare and consider paradoxical findings, especially in relation to disease prevention with vaccination. We argue that there is no economically sustainable argument to discount health gains, except for the benefit of the payer with a goal of spending less on life-saving products. If that is the objective for discounting health, there are other means to achieve the same goal in a more transparent and simpler way. From the long-term perspective of healthcare development, not discounting health gains would encourage research that values long-term effects. This in turn has the potential to benefit the investor, the payer, and the patient/consumer, improving the situation from multiple perspectives.
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Open AccessArticle
Observational Study on the Therapeutic Management and Economic Burden of Adult Patients with Moderate to Severe Plaque Psoriasis in France—The POP Study
by
A. P. Villani, N. Quiles Tsimaratos, A. Crochard, A. Gherardi, A. Panes, A. Schmidt, and I. Borget
J. Mark. Access Health Policy 2023, 11(1), 2270293; https://doi.org/10.1080/20016689.2023.2270293 - 01 Nov 2023
Abstract
ABSTRACT
Background: Data on the therapeutic management and healthcare cost of moderate to severe psoriasis in France are scarce. Objective: To assess the therapeutic management and economic burden of patients with moderate to severe psoriasis. Setting: This is a retrospective observational
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ABSTRACT
Background: Data on the therapeutic management and healthcare cost of moderate to severe psoriasis in France are scarce. Objective: To assess the therapeutic management and economic burden of patients with moderate to severe psoriasis. Setting: This is a retrospective observational study on the Generalist Beneficiaries Sample of the National Health Data System. Patients and outcome measures: Adults with moderate to severe psoriasis (with a topical vitamin D derivative followed by systemic treatment or hospitalization for psoriasis) were included and followed-up from 1 January 2009 to 31 December 2018. Patients were matched to controls without psoriasis. Patients’ characteristics and healthcare cost from the National Health Insurance’s (NHI) perspective were described. Results: Overall, 1,848 and 5,544 adults were included in the psoriatic and control cohorts, respectively. The most frequent treatments were methotrexate (18.5% to 21.4% of patients by year), phototherapy (29.9% in 2010 down to 6.2% in 2018), and acitretin (25.9% in 2010 down to 8.6% in 2018). Overall, 19% of patients used biotherapies. The mean healthcare costs reimbursed by NHI was €5,365/psoriatic patient (including €2,685 potentially attributable to psoriasis), which was twice as high as in controls. In both cohorts, healthcare costs increased over time. Conclusion: Moderate to severe psoriasis healthcare costs are high. ![]()
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Open AccessArticle
Inappropriate Dosing of Direct Oral Anticoagulants: Findings from a Clinical Vignette Study and Physician Survey
by
Ahmet Fuat, Emmanuel Ako, David Hargroves, Douglas Holden, Amrit Caleyachetty, Matthew Carter, James Harris, Carol Roberts, Nnanyelu Nzeakor, Burcu Vardar and
J. Mark. Access Health Policy 2023, 11(1), 2267327; https://doi.org/10.1080/20016689.2023.2267327 - 29 Oct 2023
Abstract
ABSTRACT
Objective: Direct oral anticoagulants (DOACs) are first-line therapy for stroke prevention for 1.4 million atrial fibrillation (AF) patients in the UK. However, the rates of DOAC dosing below evidence-based recommendations are estimated between 9% and 22%. This study explores specific patient and
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ABSTRACT
Objective: Direct oral anticoagulants (DOACs) are first-line therapy for stroke prevention for 1.4 million atrial fibrillation (AF) patients in the UK. However, the rates of DOAC dosing below evidence-based recommendations are estimated between 9% and 22%. This study explores specific patient and physician factors associated with prescribing inappropriate DOAC underdoses. Methods: DOAC-prescribing physicians within the UK completed both a clinical vignette survey, which contained 12 hypothetical patient profiles designed to replicate DOAC prescribing scenarios, and a physician survey to capture sociodemographic, clinical experience, and prescriber-related beliefs and motivations related to DOAC prescribing. Eight patient factors based on a literature search and an expert consultation process were varied within the vignettes. Associations between the prescribers’ dosing choices and patient factors were explored via multilevel logistic regression. The analysis is focused on the most frequently selected DOACs, apixaban and rivaroxaban, both of which have different dosing guidelines. Results: In all, 336 prescribers (69% male; 233/336) completed the survey, mostly general physicians (GPs) (45%) or cardiology specialists (36%) with a mean of 17.9 years’ experience. Most prescribers (73%; 244/336) inappropriately underdosed at least once; rates between GPs and specialists were nearly identical. Patient factors most strongly associated with apixaban inappropriate underdosing included a history of major bleeding and falls. For rivaroxaban, these were major bleeding and severe frailty. Only 32% (106/335) of prescribers reported DOAC dosing guidelines as the sole influence on their prescribing behaviour. Among prescribers who did not inappropriately underdose, greater prescribing confidence was aligned to increased perception of inappropriate underdose risk. Conclusions: Overall, patient factors such as major bleeding and severe frailty were found to be associated with inappropriate underdosing of apixaban and rivaroxaban. Furthermore, prescribers who were more confident in DOAC prescribing, and were more worried about the risk of stroke, were significantly less likely to inappropriately underdose. These findings suggest that all prescribers, regardless of speciality, may benefit from education and training to raise awareness of the risks associated with inappropriate DOAC underdosing.
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Open AccessArticle
Women and Children’s Real-World Economic and Drug Indicators from 2015 to 2019
J. Mark. Access Health Policy 2023, 11(1), 2270297; https://doi.org/10.1080/20016689.2023.2270297 - 26 Oct 2023
Abstract
ABSTRACT
Objectives: To obtain real-world data on rational drug use, pharmacoeconomic regarding women’s and children’s health and the benefits of Hainan free trade port (HFTP) health policies, we retrospectively investigated drug indicators, prescribing trend, and economic data. Method: We retrospectively gathered the data
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ABSTRACT
Objectives: To obtain real-world data on rational drug use, pharmacoeconomic regarding women’s and children’s health and the benefits of Hainan free trade port (HFTP) health policies, we retrospectively investigated drug indicators, prescribing trend, and economic data. Method: We retrospectively gathered the data from the database of the hospital information system and the quality indicators of pharmacy; we compared the monthly indicators from 2015 to 2019. Results: In 2017, the HFTP maternal mortality ratio (MMR) was 24.46. In 2019, the HFTP infant mortality rate (‰) was 4.15, and the under-five mortality rate (‰) was 6.19. A total of 1,922,798 prescriptions included in the analysis, the defined daily dose of 2015–2019 ranged from 46.59 to 32.34. In 2019, the proportions of antibiotics prescribed in outpatient, emergency, and inpatient care were 14.19%, 16.68%, and 46.26%, respectively. The injection prescription percentage ranged from 13.08% to 8.08%. The proportion of medicine income to total hospital income of 2015–2019 ranged from 26.66% to 25.31%. Conclusion: According to the analysis of women’s and children’s real-world drug data, economic investment and strict quality control of antimicrobial stewardship programs can lead to the rational use of drugs.
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Open AccessArticle
Ivabradine in Patients with Heart Failure: A Systematic Literature Review
J. Mark. Access Health Policy 2023, 11(1), 2262073; https://doi.org/10.1080/20016689.2023.2262073 - 04 Oct 2023
Abstract
ABSTRACT
Background: Heart failure is a chronic disease linked with significant morbidity and mortality, and uncontrolled resting heart rate is a risk factor for adverse outcomes. This systematic literature review aimed to assess the efficacy, safety, and patient-reported outcomes (PROs) of ivabradine in
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ABSTRACT
Background: Heart failure is a chronic disease linked with significant morbidity and mortality, and uncontrolled resting heart rate is a risk factor for adverse outcomes. This systematic literature review aimed to assess the efficacy, safety, and patient-reported outcomes (PROs) of ivabradine in patients with heart failure (HF) with reduced ejection fraction (HFrEF) in randomized controlled trials (RCTs) and observational studies. Methods: We searched electronic databases from their inception to July 2021 to include studies that reported on efficacy, safety, or PROs of ivabradine in patients with HFrEF. Results: Of 1947 records screened, 51 RCTs and 6 observational studies were identified. Ivabradine on top of background therapy demonstrated a significant reduction in composite outcomes including hospitalization for HF or cardiovascular death. In addition, observational studies suggested that ivabradine was associated with a significant reduction in mortality. Across all studies, ivabradine use on top of background therapy was associated with greater reductions in heart rate, improved EF, and improved health-related quality of life (QoL) and comparable risk of total adverse events compared to those treated with background therapy alone. Conclusions: Ivabradine on top of background therapy is beneficial for heart rate, hospitalization risk for HF, mortality, EF, and patients’ QoL. Moreover, these benefits were achieved with no significant increase in the overall risk of total adverse events.
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Open AccessArticle
Patient Perceptions of Copay Card Utilization and Policies
J. Mark. Access Health Policy 2023, 11(1), 2254586; https://doi.org/10.1080/20016689.2023.2254586 - 07 Sep 2023
Abstract
ABSTRACT
Background: Copay cards are intended to mitigate patient out-of-pocket (OOP) expenses. This qualitative, exploratory focus group study aimed to capture patient perceptions of copay cards and copay adjustment programs (CAPs; insurers’ accumulator and maximizer policies), which redirect the copay card utilization benefits
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ABSTRACT
Background: Copay cards are intended to mitigate patient out-of-pocket (OOP) expenses. This qualitative, exploratory focus group study aimed to capture patient perceptions of copay cards and copay adjustment programs (CAPs; insurers’ accumulator and maximizer policies), which redirect the copay card utilization benefits intended for patients’ OOP expenses. Methods: Patients with chronic conditions were recruited through Janssen’s Patient Engagement Research Council program. They completed a survey and attended a live virtual session to provide feedback on copay cards. Results: Among 33 participants (median age, 49 years [range, 24–78]), the most frequent conditions were cardiovascular-metabolic disease and inflammatory bowel disease. Patients associated copay cards with lessening financial burden, improving general and mental health, and enabling medication adherence. An impact on medication adherence was identified by 10 (63%) White and nine (100%) Black respondents. Some patients were unaware of CAPs despite having encountered them; they recommended greater copay card education and transparency about CAPs. Conclusion: Patients relied on copay cards to help afford their prescribed medication OOP expenses and maintain medication adherence. Use of CAPs may increase patient OOP expenses. Patients would benefit from awareness programs and industry – healthcare provider partnerships that facilitate and ensure access to copay cards.
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Open AccessArticle
Budget and Health Impact of Switching Eligible Patients with Atrial Fibrillation to Lower- Dose Dabigatran
J. Mark. Access Health Policy 2023, 11(1), 2247719; https://doi.org/10.1080/20016689.2023.2247719 - 04 Sep 2023
Abstract
ABSTRACT
Objectives: To assess the comparative budget and health impact of lower-dose dabigatran versus reduced doses of apixaban and rivaroxaban in atrial fibrillation (AF) patients eligible for a lower-/reduced-dose due to individual patient characteristics in the Netherlands. Methods: A budget impact model was
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ABSTRACT
Objectives: To assess the comparative budget and health impact of lower-dose dabigatran versus reduced doses of apixaban and rivaroxaban in atrial fibrillation (AF) patients eligible for a lower-/reduced-dose due to individual patient characteristics in the Netherlands. Methods: A budget impact model was developed in accordance with ISPOR guidelines. A 3-year-time horizon was considered, and analyses were conducted from a Dutch healthcare payer’s perspective. The model applies published data to local AF-epidemiology, allowing calculations to estimate clinical events (strokes and haemorrhages) and costs. The analyses were based on real-world outcomes from patients with AF receiving a first direct oral anticoagulant (DOAC) prescription for low-dose dabigatran (110 mg) and a reduced dose of apixaban (2.5 mg) or rivaroxaban (15 mg). Two situations of switching treatments from one to another DOAC were modelled: switching from apixaban to dabigatran and from rivaroxaban to dabigatran. Base case results were given as savings per 100 patient-year, per total Dutch population, and events avoided. A univariate sensitivity analysis was conducted to explore the uncertainty around epidemiological and event costs input data. Scenario analyses were performed to estimate the effect of different market shares and potential price reductions due to future patent expiry for the total real-world population from the Netherlands. Results: The 3-years outcomes of switching patients eligible for a lower-/reduced-dose due to individual patient characteristics from apixaban or rivaroxaban to dabigatran resulted in cost savings estimated at €157 or €72 thousand per 100 patient-years, respectively, or €146 million per total Dutch population. Looking into the clinical events, dabigatran reflected the lowest number of mortalities, ischemic strokes, major bleeding, non-major bleeding, and haemorrhagic stroke compared to apixaban and rivaroxaban. The sensitivity analysis consistently reflected cost savings, with the ischeamic stroke events having the biggest impact. Accounting for the Dutch situation, both scenarios showed total savings ranging from €45 to €229 million over 3 years. Conclusions: Switching eligible AF-patients from reduced-dose apixaban or rivaroxaban to lower-dose dabigatran has the potential to reduce healthcare payer’s budget expenditures and provide health gains. Cost savings can potentially be further enhanced by market share adjustments and further price reductions.
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Open AccessArticle
Systematic Literature Reviews over the Years
J. Mark. Access Health Policy 2023, 11(1), 2244305; https://doi.org/10.1080/20016689.2023.2244305 - 21 Aug 2023
Abstract
ABSTRACT
Purpose: Nowadays, systematic literature reviews (SLRs) and meta-analyses are often placed at the top of the study hierarchy of evidence. The main objective of this paper is to evaluate the trends in SLRs of randomized controlled trials (RCTs) throughout the years. Methods:
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ABSTRACT
Purpose: Nowadays, systematic literature reviews (SLRs) and meta-analyses are often placed at the top of the study hierarchy of evidence. The main objective of this paper is to evaluate the trends in SLRs of randomized controlled trials (RCTs) throughout the years. Methods: Medline database was searched, using a highly focused search strategy. Each paper was coded according to a specific ICD-10 code; the number of RCTs included in each evaluated SLR was also retrieved. All SLRs analyzing RCTs were included. Protocols, commentaries, or errata were excluded. No restrictions were applied. Results: A total of 7,465 titles and abstracts were analyzed, from which 6,892 were included for further analyses. There was a gradual increase in the number of annual published SLRs, with a significant increase in published articles during the last several years. Overall, the most frequently analyzed areas were diseases of the circulatory system (n = 750) and endocrine, nutritional, and metabolic diseases (n = 734). The majority of SLRs included between 11 and 50 RCTs each. Conclusions: The recognition of SLRs’ usefulness is growing at an increasing speed, which is reflected by the growing number of published studies. The most frequently evaluated diseases are in alignment with leading causes of death and disability worldwide.
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Open AccessReview
Pharmaceutical Pricing and Reimbursement Policies in Algeria, Morocco, and Tunisia: Comparative Analysis
J. Mark. Access Health Policy 2023, 11(1), 2244304; https://doi.org/10.1080/20016689.2023.2244304 - 20 Aug 2023
Abstract
Objectives: In this paper, we outline and compare pharmaceutical pricing and reimbursement policies for in-patent prescription medicines in three Maghreb countries, Algeria, Morocco, and Tunisia, and explore possible improvements in their pricing and reimbursement systems. Methods: The evidence informing this study comes from
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Objectives: In this paper, we outline and compare pharmaceutical pricing and reimbursement policies for in-patent prescription medicines in three Maghreb countries, Algeria, Morocco, and Tunisia, and explore possible improvements in their pricing and reimbursement systems. Methods: The evidence informing this study comes from both an extensive literature review and a primary data collection from experts in the three studied countries. Key findings: Twenty-six local experts where interviewed Intervieweesincluded ministry officials, representatives of national regulatory authorities, health insurance organizations, pharmaceutical procurement departments and agencies, academics, private pharmaceutical-sector actors, and associations. Results show that External Reference Pricing (ERP) is the dominant pricing method for in-patent medicines in the studied countries. Value-based pricing through Health Technology Assessment (HTA) is a new concept, recently used in Tunisia to help the reimbursement decision of some in-patent medicines but not yet used in the pricing of innovative medicines in the studied countries. Reimbursement decision is mainly based on negotiations set on Internal Reference Pricing (IRP). Conclusion: Whereas each country has its specific regulations, there are many similarities in the pricing and reimbursement policies of in-patent medicines in Algeria, Morocco, and Tunisia. The ERP was found to be the dominant method to inform pricing and reimbursement decisions of in-patent medicines. Countries in the region can focus on the development of explicit value assessment systems and minimize their dependence on ERP over the longer-term. In this context, HTA will rely on local assessment of the evidence.
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Open AccessMeeting Report
Rule of Prevention: A Potential Framework to Evaluate Preventive Interventions for Rare Diseases
by
Eddie Gibson, Daniel A. Ollendorf, Steven Simoens, David E Bloom, Federico Martinón-Torres, David Salisbury, Johan Louis Severens, Mondher Toumi, Daniel Molnar, , Woo-Yun Sohn and Najida Begum
J. Mark. Access Health Policy 2023, 11(1), 2239557; https://doi.org/10.1080/20016689.2023.2239557 - 10 Aug 2023
Abstract
Background: The benefits of preventive interventions lack comprehensive evaluation in standard health technology assessments (HTA), particularly for rare and transmissible diseases. Objective: To identify possible considerations for future HTA using analogies between the treatment and prevention of rare diseases. Study design: An Expert
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Background: The benefits of preventive interventions lack comprehensive evaluation in standard health technology assessments (HTA), particularly for rare and transmissible diseases. Objective: To identify possible considerations for future HTA using analogies between the treatment and prevention of rare diseases. Study design: An Expert panel meeting assessed whether one HTA assessment framework can be applied to assess both rare disease treatments and preventive interventions. Experts also evaluated the range of value elements currently included in HTAs and their applicability to rare, transmissible, and/or preventable diseases. Results: A broad range of value should be considered when assessing rare, transmissible disease prevention. Although standard HTA can be applied to transmissible diseases, the risk of local outbreaks and the need for large-scale prevention programs suggest a modified assessment framework, capable of incorporating prevention-specific value elements in HTAs. A ‘Rule of Prevention’ framework was proposed to allow broader value considerations anchored to severity, equity, and prevention benefits in decision-making for preventive interventions for rare transmissible diseases. Conclusion: The proposed prevention framework introduces an explicit initial approach to consistently assess rare transmissible diseases, and to incorporate the broader value of preventive interventions compared with treatment.
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Open AccessArticle
Economic Analysis of Allogeneic Hematopoietic Stem Cell Transplantation in the Bone Marrow Transplant Center of Tunisia
by
, Chema Drira, Mohamed Zied Sboui, Ikram Fazaa, Mohamed Ali Soussi, Senda Hammami, Tarek Ben Othman and Myriam Razgallah Khrouf
J. Mark. Access Health Policy 2023, 11(1), 2236851; https://doi.org/10.1080/20016689.2023.2236851 - 09 Aug 2023
Abstract
Introduction: New procedures and diagnostic tests in hematopoietic stem cell transplantation (HSCT) are associated with a significant increase in costs. The last cost estimate of allogeneic HSCT done in Tunisia was in 1996 and concerned only direct medical costs. Therefore, an updated cost
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Introduction: New procedures and diagnostic tests in hematopoietic stem cell transplantation (HSCT) are associated with a significant increase in costs. The last cost estimate of allogeneic HSCT done in Tunisia was in 1996 and concerned only direct medical costs. Therefore, an updated cost analysis is needed. Objective: Analysis of direct costs during the first-year post-allogeneic HSCT in two groups of patients: Bone Marrow Transplant (Allo-BMT) and Peripheral Blood Stem Cell Transplant (Allo-PBSCT) and identification of factors leading to interindividual variations in costs in order to compare these costs with the budget allocated by the payer (CNAM). Methods: Pharmacoeconomic retrospective study, concerning patients who underwent allogeneic HSCT in 2013. Clinical and unit cost data were obtained from medical and administration records. Results: This study showed that the average direct cost of allogeneic HSCT in the population during the first year reached 56 638€. The average cost of Allo-BMT was 63 612€, and Allo-PBSCT was 45 966€ (p > 0.05). The initial hospitalization counted for 88% of total direct cost with an average cost of 41 441€ in Allo-BMT and 24 672€ in Allo-PBSCT (p < 0.05). Direct medical costs represented more than 70% of total direct costs, drugs, and laboratory tests occupied the largest share. Antifungals, antitumors, and antiviral drugs were the most expensive pharmaceutical classes with a mean cost, respectively, of 4 526€; 3 737€ and 3 268€. Some clinical criteria were significantly related to total direct costs like length of aplasia (p < 0.01) and GVHD (p < 0.05). However, the type of blood disease, its risk, length of mucositis, and the treatment protocol have no effect on the costs for all allogeneic patients. Conclusion: Our results showed that the costs of Allo HSCT have exceeded by far the budget allocated by the CNAM to the center, since the 90s to this day. That’s why the total reimbursement mechanism should be revised.
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Open AccessReview
Rapid Literature Review: Definition and Methodology
by
, Mondher Toumi, Karolina Świerk, Clement Francois, Małgorzata Biernikiewicz, Emilie Clay and Laurent Boyer
J. Mark. Access Health Policy 2023, 11(1), 2241234; https://doi.org/10.1080/20016689.2023.2241234 - 28 Jul 2023
Cited by 2
Abstract
ABSTRACT
Introduction: A rapid literature review (RLR) is an alternative to systematic literature review (SLR) that can speed up the analysis of newly published data. The objective was to identify and summarize available information regarding different approaches to defining RLR and the methodology
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ABSTRACT
Introduction: A rapid literature review (RLR) is an alternative to systematic literature review (SLR) that can speed up the analysis of newly published data. The objective was to identify and summarize available information regarding different approaches to defining RLR and the methodology applied to the conduct of such reviews. Methods: The Medline and EMBASE databases, as well as the grey literature, were searched using the set of keywords and their combination related to the targeted and rapid review, as well as design, approach, and methodology. Of the 3,898 records retrieved, 12 articles were included. Results: Specific definition of RLRs has only been developed in 2021. In terms of methodology, the RLR should be completed within shorter timeframes using simplified procedures in comparison to SLRs, while maintaining a similar level of transparency and minimizing bias. Inherent components of the RLR process should be a clear research question, search protocol, simplified process of study selection, data extraction, and quality assurance. Conclusions: There is a lack of consensus on the formal definition of the RLR and the best approaches to perform it. The evidence-based supporting methods are evolving, and more work is needed to define the most robust approaches.
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Open AccessReview
A Systematic Review of the Characteristics of Data Assessment Tools to Measure Medical Doctors’ Work-Related Quality of Life
J. Mark. Access Health Policy 2023, 11(1), 2234139; https://doi.org/10.1080/20016689.2023.2234139 - 24 Jul 2023
Abstract
ABSTRACT
Purpose: Remarkable progress in healthcare technology has recently been made alongside changes in concepts related to drugs and medical devices. It is speculated that this progress benefits not only patients but also healthcare professionals, such as medical doctors. We performed a systematic
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ABSTRACT
Purpose: Remarkable progress in healthcare technology has recently been made alongside changes in concepts related to drugs and medical devices. It is speculated that this progress benefits not only patients but also healthcare professionals, such as medical doctors. We performed a systematic review of the characteristics of current data assessment tools to measure medical doctors’ work-related quality of life (QOL). Methods: A literature search was conducted through PubMed and Ichushi-Web in 2020. The related search terms used were ‘medical doctor,’ ‘quality of work life,’ and ‘questionnaire/interview.’ Two reviewers independently screened the studies, and the characteristics of the QOL assessment tools used in the identified studies were qualitatively reviewed and summarized. Results: In total, 5,443 and 760 articles were retrieved from PubMed and Ichushi-Web, respectively, of which 82 studies were included in this review. Sixty-five (79%) studies used structured questionnaires, and 17 (21%) studies used semistructured questionnaires. In terms of the study purpose, the identified studies mainly included four: mental health, the work or labor situation, satisfaction, and QOL. Components used to measure work-related QOL included satisfaction, burnout, QOL, the work environment, stress, mental health, work-life balance, and others. None of the studies used an originally developed QOL questionnaire to assess the work-related benefits of medical doctors. Conclusion: This systematic review found that there is a lack of studies directly assessing the work-related QOL of medical doctors and a lack of effective data collection tools to assess all work-related QOL components.
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Open AccessArticle
The Impact of Amortization of Gene Therapies Funding on the Results and Conclusions of CEMs and BIMs
J. Mark. Access Health Policy 2023, 11(1), 2232648; https://doi.org/10.1080/20016689.2023.2232648 - 10 Jul 2023
Abstract
ABSTRACT
Background: Gene replacement therapy (GRT) is a treatment method used to combat or prevent various diseases. Its high one-off cost constitutes a major obstacle for successful market access. This paper aims to assess and discuss the applicability of amortization in models,
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ABSTRACT
Background: Gene replacement therapy (GRT) is a treatment method used to combat or prevent various diseases. Its high one-off cost constitutes a major obstacle for successful market access. This paper aims to assess and discuss the applicability of amortization in models, such as cost-effectiveness models (CEMs) and budget impact models (BIMs) informing HTA recommendations and reimbursement decisions. Methods and findings: A hypothetical CEA and BIA were considered. The objective was to compare the GRT with and without amortization. A straight-line amortization model was used. The CEM and BIM were considered and assessed based on two set of scenarios: considering different amortization duration or different discounting rate. The impact of amortization against the total cost of gene therapy was assessed for all the scenarios. The cost difference between GRT with and without amortization in relation to its total cost was -$58,855, thus amortization does not have a significant impact on the results and conclusions of the cost-effectiveness analysis. For BIM in the base case, amortization had no impact on the results. Conclusion: Amortization has negligible impact on the results of CEM and total BIM and no impact on the conclusions from the model. One exception is the budget impact in case of an amortization period longer than the time horizon of BIM, where a half of the GRT price is moved beyond the model time horizon. Amortization has a distinguishing effect from an accounting perspective, but it does not have any implication for payers.
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Open AccessReply
Reply to: Comment on Increased Reliance on Physician Assistants: An Access-Quality Tradeoff?
J. Mark. Access Health Policy 2023, 11(1), 2232192; https://doi.org/10.1080/20016689.2023.2232192 - 05 Jul 2023
Abstract
We thank Cawley, Hooker, and Nicholson [...]
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Open AccessArticle
Budget Impact Analysis for Avatrombopag in the Treatment of Chronic Primary Immune Thrombocytopenia in Adult Patients Refractory to Other Treatments
by
Andrea Aiello, , Mariangela Prada, Cristina Teruzzi, Nicoletta Martone, Stefano Capri, Giuseppe Carli and Sergio Siragusa
J. Mark. Access Health Policy 2023, 11(1), 2230663; https://doi.org/10.1080/20016689.2023.2230663 - 30 Jun 2023
Abstract
ABSTRACT
Introduction: Primary immune thrombocytopenia is a rare autoimmune disease characterised by a decreased platelet count resulting in an increased risk of bleeding events and even life-threatening haemorrhages. Thrombopoietin receptor agonists (TPO-RAs) are the standard of care second-line therapy for adult patients
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ABSTRACT
Introduction: Primary immune thrombocytopenia is a rare autoimmune disease characterised by a decreased platelet count resulting in an increased risk of bleeding events and even life-threatening haemorrhages. Thrombopoietin receptor agonists (TPO-RAs) are the standard of care second-line therapy for adult patients with chronic immune thrombocytopenia. The first TPO-RAs approved and reimbursed in Italy, eltrombopag and romiplostim, while effective, pose some issues in terms of safety (e.g., hepatotoxicity) or general management (e.g., dietary restrictions). Avatrombopag, an effective and well-tolerated TPO-RA, was recently granted reimbursement. Methods: A 3-year (2023–2025) budget impact analysis (BIA) was conducted to estimate its impact on the Italian National Health Service (NHS). Two scenarios were compared, of which one represents the current situation, without avatrombopag, and the other provides for an increasing market share of avatrombopag (up to 26.6%). Results: BIA shows that the increase in the use of avatrombopag correlates with savings for NHS: in the first year, saving would be €1,300,564, increasing to €2,774,210 in the third year, for a total of €6,083,231 over the 3-year period. The sensitivity analysis confirmed these savings in the scenario with avatrombopag. Conclusions: Based on this BIA, the introduction and reimbursement of avatrombopag is an efficient and advantageous choice for the Italian NHS.
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Open AccessEditorial
Transformative Potential of Artificial Intelligence in Global Health Policy
J. Mark. Access Health Policy 2023, 11(1), 2230660; https://doi.org/10.1080/20016689.2023.2230660 - 30 Jun 2023
Cited by 1
Abstract
ChatGPT is an extraordinary example of how far artificial intelligence has come regarding conversational interfaces [...]
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Open AccessArticle
Access to Innovative Drugs and the National Reimbursement Drug List in China: Changing Dynamics and Future Trends in Pricing and Reimbursement
by
, Liam Wilson, Jianwei Xuan, Ruichen Guo, Petar Atanasov, Linda Zheng, Clement François and Philippe Laramée
J. Mark. Access Health Policy 2023, 11(1), 2218633; https://doi.org/10.1080/20016689.2023.2218633 - 13 Jun 2023
Cited by 2
Abstract
ABSTRACT
Background and objectives: Multiple reforms aimed at improving the Chinese population’s health have been introduced in recent years, including several designed to improve access to innovative drugs. We sought to review current factors affecting access to innovative drugs in China and
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ABSTRACT
Background and objectives: Multiple reforms aimed at improving the Chinese population’s health have been introduced in recent years, including several designed to improve access to innovative drugs. We sought to review current factors affecting access to innovative drugs in China and to anticipate future trends. Methods: Targeted reviews of published literature and statistics on the Chinese healthcare system, medical insurance and reimbursement processes were conducted, as well as interviews with five Chinese experts involved in the reimbursement of innovative drugs. Results: Drug reimbursement in China is becoming increasingly centralized due to the removal of provincial pathways, the establishment of the National Healthcare Security Administration and the implementation of the National Reimbursement Drug List (NRDL), which is now the main route for drug reimbursement in China. There is also an increasing number of other channels via which patients may access innovative treatments, including various types of commercial insurance and special access. Health technology assessment (HTA) and health economic evidence are becoming pivotal elements of the NRDL decision-making process. Alongside the optimization of HTA decision making, innovative risk-sharing agreements are anticipated to be increasingly leveraged in the future to optimize access to highly specialized technologies and encourage innovation while safeguarding limited healthcare funds. Conclusions: Drug public reimbursement in China continues to align more closely with approaches widely used in Europe in terms of HTA, health economics and pricing. Centralization of decision-making processes for public reimbursement of innovative drugs allows consistency in assessment and access, which optimizes the improvement of the Chinese population’s health.
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