A guest towards introducing a pharmacoeconomics framework in Cyprus
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As the growth of pharmaceutical expenditure exceeds the increase of productive capacity on a global scale, health agencies are under significant pressure by patients, physicians and social stakeholders, to provide timely and unobstructed access to innovative and safe medicines. At the same time, health agencies must safeguard the Research and Development projects of the industry, thus setting fair prices to medicines which will not hinder innovation. A comprehensive decision-making context should encompass all aforementioned needs and attributes of the stakeholders and extenuate their divergent and inconsonant interests, ultimately amalgamating them into a joint strategic framework. It is imperative that the standards of this framework are laid on high grade of evidence data, which, in return, will maximise the utility generated out of health resources. To this end, the economic evaluation of pharmaceuticals has emerged as a pivotal decision-making tool. Accordingly, the current study aims to develop a pharmacoecenomic model to evaluate cost-effectiveness of pharmaceuticals and also to elaborate on an innovative pricing model, which will integrate all attributes of the product, in the theoretical framework of a value based pricing scheme. Prior to this, and due to the lack of data of the Cyprus pharmaceutical market, current thesis will evaluate existing pricing and reimbursement schemes. The specific study critically assesses Health Technology Assessment in Cyprus and furthermore, the prevailing pricing and reimbursement tool of public health care sector, tendering. The next step of the thesis is the decomposition of public health care sales, spanning a period of seven years, which will identify cost-drivers of the Pharmaceutical Market. Based on these findings, a pharmacoeconomic evaluation was performed on a key cost-driver product. The last part of the thesis explores the potential of price setting based on the clinical and social value of the product. The findings of this study indicate that current pricing and reimbursement tool of public health care sector are potent, nevertheless they are context specific and context sensitive tools with several particularities. Foremost, they are not sensitive to the innovation status of the product. The decomposition study revealed that the oncology segment of the market is the powerhouse of pharmaceutical expenditure and as a result these findings underline that further research in this therapeutic area is incumbent. The pharmacoecenomic evaluation also highlighted, through the expected value of perfect information, the uncertainty that encompass the decision for reimbursement of the given pharmaceutical. The final part of the thesis defined the price, at vi which the product can be considered cost-effective, through identification of the health benefits that the product delivers, which exceed the health benefits displaced in the broader health system and society on the grounds of additional cost incurred. Cost–effectiveness analysis can contribute to rational decision making in pharmaceutical and the introduction of uncertainty tackling mechanisms, such as the expected value of perfect information, can reveal areas which could benefit by further research. Value based pricing, which has been described as the holy-grail of pharmacoeconomics, also delivered significant data. There are also several technical parameters that merit more research such as the introduction of willingness to pay thresholds. The overall findings of the study epitomise the necessity of implementing a pharmacoecenomic evaluation framework in Cyprus and the value that this can yield to the health policy level. The current study also highlights the complexity of the pharmaceutical market, the need to employ sensitive instruments and the imperative need to incorporate high grade of evidence data. Also, areas that merit additional research have been identified such as expected value of partial perfect information, ethical issues intertwining with willingness-to-pay thresholds and new approximations to quality of life measurement tools.