OBJECTIVE: Managed entry agreements and especially financial-based agreements are commonly used in European countries for innovative cancer pharmaceuticals. These agreements facilitate access to innovative treatments while mitigating financial risks for payers. This study focuses on the confidential price agreement made by the Dutch government for the reimbursement of pembrolizumab, the implications of broadening indications on cost-effectiveness, and the viability or desirability of said agreement.
METHODS: We selected 5 indications in which pembrolizumab was deemed effective and developed portioned survival models for each indication. Survival and progression-free survival data from the published trials were utilized to recreate individual patient data, and we extrapolated-using parametric models-to a time horizon of 30 years. Inputs for both quality of life and costs were derived from the available literature and were indexed.
RESULTS: The incremental cost-effectiveness ratios ranged between €35 313 and €322 349 per quality-adjusted life-year, depending on the indication. Only 1 indication fell under the €80 000 (or €100 000) cost-effectiveness threshold. When applying the average reported discount on intramural pharmaceuticals in The Netherlands, incremental cost-effectiveness ratios ranged between €20 881 and €252 934 per quality-adjusted life-year gained, and the €80 000 (or €100 000) threshold was met in 3 indications out of 5.
CONCLUSIONS: Our results show that pembrolizumab could be cost-effective in some indications, depending on the confidential price agreement established. However, the possibility of reimbursing not cost-effective care when the price is anchored in 1 indication remains possible. Indication-based pricing could help align value and price for innovative pharmaceuticals that are subject to indication broadening.

BACKGROUND: Open-system electronic cigarette (EC) product features, such as battery capacity, maximum output wattage, and so forth, are major components that drive product costs and may influence use patterns. Moreover, continued innovation and monitoring of product features and prices will provide critical information for designing appropriate taxation policies and product regulations.
OBJECTIVE: This study will examine how product features are associated with the prices of devices sold in web-based vape shops.
METHODS: We draw samples from 5 popular, US-based, web-based vape shops from April to August 2022 to examine starter kits, device-only products, and e-liquid container-only products. We implemented a linear regression model with a store-fixed effect to examine the association between device attributes and prices.
RESULTS: EC starter kits or devices vary significantly by type, with mod prices being much higher than pod and vape pen prices. The prices of mod starter kits were even lower than those of mod devices, suggesting that mod starter kits are discounted in web-based vape shops. The price of mod kits, mod device-only products, and pod kits increased as the battery capacity and output wattage increased. For vape pens, the price was positively associated with the volume size of the e-liquid container. On the other hand, the price of pod kits was positively associated with the number of containers.
CONCLUSIONS: A unit-based specific tax, therefore, will impose a higher tax burden on lower-priced devices such as vape pens or pod systems and a lower tax burden on mod devices. A volume- or capacity-based specific tax on devices will impose a higher tax burden on vape pens with a larger container size. Meanwhile, ad valorem taxes pegged to wholesale or retail prices would apply evenly across device types, meaning those with advanced features such as higher battery capacities and output wattage would face higher rates. Therefore, policy makers could manipulate tax rates by device type to discourage the use of certain device products.

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In this paper, we explore dynamic market share and public healthcare costs of trastuzumab\'s evergreening (subcutaneous) variant during introduction of trastuzumab\'s competitive biosimilar variants in the Netherlands. We used a time series design to assess dynamic market share of trastuzumab\'s evergreening variant after introducing trastuzumab\'s biosimilar variants, focusing on the number of treatments and patients. The public healthcare costs of this evergreening strategy were estimated using administrative claims data. Our results show that the original trastuzumab was completely replaced by the subcutaneous and biosimilar variants. The uptake of the subcutaneous form peaked at 50% market share but after the introduction of biosimilars progressively reduced to a market share of 20%, resulting in a more competitive market structure. The public healthcare costs for trastuzumab significantly decreased after the introduction of the biosimilars. After the introduction of the biosimilars, a substantial price drop is visible, with the subcutaneous version, still under patent, also falling sharply in price but less strongly than the iv/biosimilar version. As the costs are publicly funded, we recommend a more explicit societal debate to consider if the potential benefits of subcutaneous Herceptin® (and other similar medicines) are worth the additional costs, and at which price it should be reimbursed as the part of the benefit package.

Government policy guidance in Victoria, Australia, encourages schools to provide affordable, healthy foods in canteens. This study analysed the healthiness and price of items available in canteens in Victorian primary schools and associations with school characteristics.
Dietitians classified menu items (main, snack and beverage) using the red, amber and green traffic light system defined in the Victorian government\'s School Canteens and Other School Food Services Policy. This system also included a black category for confectionary and high sugar content soft drinks which should not be supplied. Descriptive statistics and regressions were used to analyse differences in the healthiness and price of main meals, snacks and beverages offered, according to school remoteness, sector (government and Catholic/independent) size, and socio-economic position.
State of Victoria, Australia.
A convenience sample of canteen menus drawn from three previous obesity prevention studies in forty-eight primary schools between 2016 and 2019.
On average, school canteen menus were 21 % \'green\' (most healthy - everyday), 53 % \'amber\' (select carefully), 25 % \'red\' (occasional) and 2 % \'black\' (banned) items, demonstrating low adherence with government guidelines. \'Black\' items were more common in schools in regional population centres. \'Red\' main meal items were cheaper than \'green\'% (mean difference -$0·48 (95 % CI -0·85, -0·10)) and \'amber\' -$0·91 (-1·27, -0·57)) main meal items. In about 50 % of schools, the mean price of \'red\' main meal, beverages and snack items were cheaper than \'green\' items, or no \'green\' alternative items were offered.
In this sample of Victorian canteen menus, there was no evidence of associations of healthiness and pricing by school characteristics except for regional centres having the highest proportion of \'black\' (banned) items compared with all other remoteness categories examined. There was low adherence with state canteen menu guidelines. Many schools offered a high proportion of \'red\' food options and \'black\' (banned) options, particularly in regional centres. Unhealthier options were cheaper than healthy options. More needs to be done to bring Victorian primary school canteen menus in line with guidelines.

BACKGROUND: In Germany, oral emergency contraception (EC) with the active ingredients levonorgestrel (LNG) and ulipristal acetate (UPA) is available as over-the-counter (OTC) medicine only from community pharmacies (CPs). Because of the window of effect, which is limited to only a few days, CPs have a great responsibility to provide rapid and unimpeded access, while also ensuring \"adequate\" counseling. The aim was-for the first time in Europe and thus also in Germany for the methodology used in this study-to investigate immediate availability, pricing, and aspects of counseling.
METHODS: Covert mystery calls were conducted in a random sample of CPs stratified by districts in the German capital Berlin. Each of the 263 CPs included was called once at random by one of two trained female student mystery callers. They simulated a product-based scenario for the UPA original ellaOne®, citing a contraceptive failure one day ago as the reason.
RESULTS: Of 257 successfully called CPs, UPA preparations were immediately available in 98.4% (253/257) and LNG preparations in 86.8% (184/212) of CPs. Prices for UPA preparations varied from €15.95 to €42.95 (∆ 169%; median €35.00 [interquartile range (IQR) €5.91]) and for LNG preparations from €10.60 to €32.49 (Δ 207%; median €22.00 [IQR €5.76]). Information about the correct different window of effect of UPA and LNG preparations was provided in 69.8% (127/182) of CPs. UPA preparations were recommended in 63.1% (111/176) and LNG preparations in 17.2% (30/174) of CPs. Information was provided on how to take them as soon as possible in 30.8% (44/143) of CPs and on how to use them after vomiting in 46.0% (64/139).
CONCLUSIONS: Berlin CPs support access through high immediate availability, especially to UPA preparations. However, access is hampered by high absolute price ranges of both UPA and LNG preparations, which could ideally be minimized by a comparison app. It is positive that CPs promote the benefits of UPA preparations by recommending them noticeably more often than LNG preparations. However, there are deficiencies in giving advice, so there is a need to raise awareness among pharmacy staff to ensure \"adequate\" counseling in advance over the phone.

BACKGROUND: There is a lack of comprehensive evidence assessing variability and volatility in contraceptive prices. Improved understanding of contraceptive pricing, both between and within public and private service delivery points situated within complex, mixed health systems, may improve understanding of contraceptive access from the perspective of the consumer.
OBJECTIVE: To describe variability and volatility in contraceptive method prices within localized urban and semiurban markets in Nigeria.
METHODS: We used product audit data from a complete census and longitudinal cohort of family planning vendors within 4 urban and semiurban study sites in Nigeria. Differences in outlet-level minimum prices by outlet type were assessed using generalized estimating equations. We presented descriptive summaries of within-outlet changes in minimum price over time.
RESULTS: Among 672 family planning vendors, outlet-level minimum prices were significantly higher in private facilities/outlets than in public facilities. The outlet-level minimum price was $9.4 (95% confidence interval, $5.7-$13.2) higher for implants in private vs public facilities. We observed high availability of free contraceptive products in the public sector (79%-100%), moderate levels for specific contraceptive product types among community health workers and private facilities (28%-62% for male condoms), and low prevalence among private nonfacility outlets (0%-3%). Variability in contraceptive prices was high within private facilities and nonfacility outlets: standard deviations in the distribution of long-acting reversible contraceptive products ranged from $9.7 for implants to $13.1 for intrauterine devices in the private sector. Changes in minimum prices by contraceptive method type were common within the same outlets over time in the private sector.
CONCLUSIONS: We observed high variability between and within contraceptive vendors in selected Nigerian family planning markets. Further research assessing the impact of price variability is critical for understanding contraceptive access and decision-making from the consumer\'s perspective.

The increasing rate of manufacturers and consequently the production of the products gave rise to an increase in used products. The growth in old goods, as well as their negative environmental and social consequences, prompted supply chain operators to focus more on reverse logistics for collecting and reusing these items. However, there are a few key issues that should be handled in this manner, covering how to implement an effective collecting plan. What categories of used items should be collected? And how should they be handled for the aim of reusing them? To address these questions, the pricing issues are investigated in a CLSC with a manufacturer and two retailers. As an effective collection strategy, the first retailer, along with selling new products, benefits from the product exchange program (PEP). In this program, the retailer, by offering two types of discounts on a new product\'s price, is able to collect two types of products, including those without and with useful lifetime left as the first- and second-category products, respectively. In terms of used products management, the first-category products are sent to the manufacturer for recycling, and the second-category ones are sold as second-hand products by the first retailer. Besides, the first retailer exercises a full refund return policy, where the returned defective products, after being remanufactured by the manufacturer, are sold to customers by the second retailer in the secondary market. With respect to buy back price of first-category products from the first retailer, two scenarios are considered: 1) the manufacturer pays as much as the difference between the original retail price and discounted retail price in order to encourage the retailer to offer exercise the PEP for returned used items, or 2) by considering the discount on wholesale price, the manufacturer pays as much as the difference between the original wholesale price and discounted wholesale price. In this study, a real-world case study is considered based on an Iranian automotive industry to understand the issue better and obtain practical results. The findings show that the second scenario is more profitable due to lower selling prices and greater demand rates. It is proved that the PEP along with providing environmental benefits can improve supply chain financial profit even for the first or the second-category products.

BACKGROUND: To combat the global challenge of cancer, priority has been placed on the research and development of new cancer medicines (NCMs). NCMs are often approved for marketing in accelerated processes. Despite significant advances in treating cancer, the overall added value and high prices of NCMs has been questioned. While market authorisations for NCMs are granted at the EU level, the assessment of added value, price negotiations and purchase or reimbursement decisions are made by member states. This article explores the practices in Finland for assessing and deciding on purchasing or reimbursing NCMs.
METHODS: Semi-structured interviews were conducted with 26 civil servants, hospital employees, scientists, and representatives of cancer NGOs and of the pharmaceutical industry in 2019 and 2020. The transcribed interviews were coded inductively using Atlas.ti software and analysed thematically under 3 major themes and 11 sub-themes.
RESULTS: The clinical value of NCMs is considered to be high, especially regarding NCMs for certain types of cancer. Proper patient selection is important but difficult and not all NCMs can be considered as adding value. The prices are considered to often be very high, leading to concerns about the sustainability and equity of health systems. Equity concerns among cancer patients are raised concerning differences in the availability of NCMs between hospital districts and cost differences for patients between those receiving outpatient and inpatient treatment. The systems and processes in Finland for deciding on the introduction of NCMs are fragmentary, involving separate approaches for outpatient care and hospital medicines by under-resourced evaluation bodies. The scientific evidence available is often limited for evidence-based decisions on introduction. Individual hospital districts sometimes introduce NCMs without assessment by national bodies. This can hamper the proper assessment of some NCMs before their uptake and lead to unequal access to NCMs by hospitals. There is an increasing lack of transparency about pricing, due to the rapid increase of market entry agreements. Lack of transparency on information on prices poses a challenge for authorities responsible for equitable access to cost-effective care within the available resources.
CONCLUSIONS: Robust reform of the national introductory systems is needed. Internationally, efforts are needed to increase price transparency, to revise incentives within the system of market approval and to accumulate and assess evidence of comparable value and cost-effectiveness after the market approval of NCMs.

To prevent unwanted pregnancies, oral emergency contraception (EC) with the active ingredients levonorgestrel (LNG) and ulipristal acetate (UPA) is recommended by the guidelines of the German Federal Chamber of Pharmacists (BAK). In this respect, community pharmacies (CPs) in Germany have a major responsibility for information gathering, selecting the appropriate medicine, availability and pricing, among other things. Therefore, it would be appropriate to conduct a study with the aim of investigating information gathering, a possible recommendation as well as availability and pricing for oral EC in German CPs. A representative nationwide observational study based on the simulated patient methodology (SPM) in the form of covert mystery calls will be conducted in a random sample of German CPs stratified according to the 16 federal states. Each selected CP will be randomly called once successfully by one of six both female and male trained mystery callers (MCs). The MCs will simulate a product-based scenario using the request for oral EC. For quality assurance of the data collection, a second observer accompanying the MC is planned. After all mystery calls have been made, each CP will receive written, pharmacy-specific performance feedback. The only national SPM study on oral EC to date has identified deficits in the provision of self-medication consultations with the help of visits in the CPs studied. International studies suggest that UPA in particular is not always available. Significant price differences could be found analogous to another German study for a different indication.