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Introduction and Utilization of High Priced HCV Medicines across Europe; Implications for the Future

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Introduction and Utilization of High Priced HCV Medicines across Europe; Implications for the Future

Auteurs : Winnie De Bruijn [Pays-Bas] ; Cristina Ibá Ez [Espagne] ; Pia Frisk [Suède] ; Hanne Bak Pedersen [Danemark] ; Ali Alkan [Turquie] ; Patricia Vella Bonanno [Malte] ; Ljiljana S. Brki I [Croatie] ; Anna Bucsics [Autriche] ; Guillaume Dedet [France] ; Jaran Eriksen [Suède] ; Joseph O. Fadare [Nigeria] ; Jurij Fürst [Slovénie] ; Gisselle Gallego [Australie, Suède] ; Isabella P. God I [Brésil] ; Augusto A. Guerra Júnior [Brésil] ; Hakk Gürsöz [Turquie] ; Saira Jan [États-Unis] ; Jan Jones [Royaume-Uni] ; Roberta Joppi [Italie] ; Saim Kerman [Turquie] ; Ott Laius [Estonie] ; Newman Madzikwa [Zimbabwe] ; Einar Magnússon [Islande] ; Mojca Maticic [Slovénie] ; Vanda Markovic-Pekovic [Bosnie-Herzégovine] ; Amos Massele [Botswana] ; Olayinka Ogunleye [Nigeria] ; Aisling O'Leary [Irlande (pays)] ; Jutta Piessnegger [Autriche] ; Catherine Sermet [France] ; Steven Simoens [Belgique] ; Celda Tiroyakgosi [Botswana] ; Ilse Truter [Afrique du Sud] ; Magnus Thyberg [Suède] ; Kristina Tomekova [Slovaquie] ; Magdalena Wladysiuk [Pologne] ; Sotiris Vandoros [Royaume-Uni] ; Elif H. Vural [Turquie] ; Corinne Zara [Espagne] ; Brian Godman [Suède, Royaume-Uni]

Source :

Frontiers in Pharmacology [ 1663-9812 ] ; 2016.

RBID : PMC:4964878

Abstract

Background: Infection with the Hepatitis C Virus (HCV) is a widespread transmittable disease with a diagnosed prevalence of 2.0%. Fortunately, it is now curable in most patients. Sales of medicines to treat HCV infection grew 2.7% per year between 2004 and 2011, enhanced by the launch of the protease inhibitors (PIs) boceprevir (BCV) and telaprevir (TVR) in addition to ribavirin and pegylated interferon (pegIFN). Costs will continue to rise with new treatments including sofosbuvir, which now include interferon free regimens.

Objective: Assess the uptake of BCV and TVR across Europe from a health authority perspective to offer future guidance on dealing with new high cost medicines.

Methods: Cross-sectional descriptive study of medicines to treat HCV (pegIFN, ribavirin, BCV and TVR) among European countries from 2008 to 2013. Utilization measured in defined daily doses (DDDs)/1000 patients/quarter (DIQs) and expenditure in Euros/DDD. Health authority activities to influence treatments categorized using the 4E methodology (Education, Engineering, Economics and Enforcement).

Results: Similar uptake of BCV and TVR among European countries and regions, ranging from 0.5 DIQ in Denmark, Netherlands and Slovenia to 1.5 DIQ in Tayside and Catalonia in 2013. However, different utilization of the new PIs vs. ribavirin indicates differences in dual vs. triple therapy, which is down to factors including physician preference and genotypes. Reimbursed prices for BCV and TVR were comparable across countries.

Conclusion: There was reasonable consistency in the utilization of BCV and TVR among European countries in comparison with other high priced medicines. This may reflect the social demand to limit the transmission of HCV. However, the situation is changing with new curative medicines for HCV genotype 1 (GT1) with potentially an appreciable budget impact. These concerns have resulted in different prices across countries, with their impact on budgets and patient outcomes monitored in the future to provide additional guidance.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4964878

DOI: 10.3389/fphar.2016.00197
PubMed: 27516740
PubMed Central: 4964878

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<author><name sortKey="Tomekova, Kristina" sort="Tomekova, Kristina" uniqKey="Tomekova K" first="Kristina" last="Tomekova">Kristina Tomekova</name>
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<author><name sortKey="Wladysiuk, Magdalena" sort="Wladysiuk, Magdalena" uniqKey="Wladysiuk M" first="Magdalena" last="Wladysiuk">Magdalena Wladysiuk</name>
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</author>
<author><name sortKey="Godman, Brian" sort="Godman, Brian" uniqKey="Godman B" first="Brian" last="Godman">Brian Godman</name>
<affiliation wicri:level="1"><nlm:aff id="aff10"><institution>Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge</institution>
<country>Stockholm, Sweden</country>
</nlm:aff>
<country xml:lang="fr">Suède</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff40"><institution>Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde</institution>
<country>Glasgow, UK</country>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
</titleStmt>
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<idno type="pmid">27516740</idno>
<idno type="pmc">4964878</idno>
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<idno type="doi">10.3389/fphar.2016.00197</idno>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Introduction and Utilization of High Priced HCV Medicines across Europe; Implications for the Future</title>
<author><name sortKey="De Bruijn, Winnie" sort="De Bruijn, Winnie" uniqKey="De Bruijn W" first="Winnie" last="De Bruijn">Winnie De Bruijn</name>
<affiliation wicri:level="1"><nlm:aff id="aff1"><institution>Department of Pharmaceutical Sciences, Utrecht University</institution>
<country>Utrecht, Netherlands</country>
</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Iba Ez, Cristina" sort="Iba Ez, Cristina" uniqKey="Iba Ez C" first="Cristina" last="Ibá Ez">Cristina Ibá Ez</name>
<affiliation wicri:level="1"><nlm:aff id="aff2"><institution>Catalan Health Service - Servei Català de la Salut</institution>
<country>Barcelona, Spain</country>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Frisk, Pia" sort="Frisk, Pia" uniqKey="Frisk P" first="Pia" last="Frisk">Pia Frisk</name>
<affiliation wicri:level="1"><nlm:aff id="aff3"><institution>Public Health Services Committee, Stockholm County Council</institution>
<country>Stockholm, Sweden</country>
</nlm:aff>
<country xml:lang="fr">Suède</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Bak Pedersen, Hanne" sort="Bak Pedersen, Hanne" uniqKey="Bak Pedersen H" first="Hanne" last="Bak Pedersen">Hanne Bak Pedersen</name>
<affiliation wicri:level="1"><nlm:aff id="aff4"><institution>Health Technologies and Pharmaceuticals, Division of Health Systems and Public Health, WHO Regional Office for Europe</institution>
<country>Copenhagen, Denmark</country>
</nlm:aff>
<country xml:lang="fr">Danemark</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Alkan, Ali" sort="Alkan, Ali" uniqKey="Alkan A" first="Ali" last="Alkan">Ali Alkan</name>
<affiliation wicri:level="1"><nlm:aff id="aff5"><institution>Turkish Medicines and Medical Devices Agency, Ministry of Health</institution>
<country>Ankara, Turkey</country>
</nlm:aff>
<country xml:lang="fr">Turquie</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Vella Bonanno, Patricia" sort="Vella Bonanno, Patricia" uniqKey="Vella Bonanno P" first="Patricia" last="Vella Bonanno">Patricia Vella Bonanno</name>
<affiliation wicri:level="1"><nlm:aff id="aff6"><institution>Independent Pharmaceutical Consultant</institution>
<country>Mellieha, Malta</country>
</nlm:aff>
<country xml:lang="fr">Malte</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Brki I, Ljiljana S" sort="Brki I, Ljiljana S" uniqKey="Brki I L" first="Ljiljana S." last="Brki I">Ljiljana S. Brki I</name>
<affiliation wicri:level="1"><nlm:aff id="aff7"><institution>Croatian Health Insurance Fund</institution>
<country>Zagreb, Croatia</country>
</nlm:aff>
<country xml:lang="fr">Croatie</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Bucsics, Anna" sort="Bucsics, Anna" uniqKey="Bucsics A" first="Anna" last="Bucsics">Anna Bucsics</name>
<affiliation wicri:level="1"><nlm:aff id="aff8"><institution>Department of Finance, University of Vienna</institution>
<country>Vienna, Austria</country>
</nlm:aff>
<country xml:lang="fr">Autriche</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Dedet, Guillaume" sort="Dedet, Guillaume" uniqKey="Dedet G" first="Guillaume" last="Dedet">Guillaume Dedet</name>
<affiliation wicri:level="1"><nlm:aff id="aff9"><institution>Ministry of Health</institution>
<country>Paris, France</country>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Eriksen, Jaran" sort="Eriksen, Jaran" uniqKey="Eriksen J" first="Jaran" last="Eriksen">Jaran Eriksen</name>
<affiliation wicri:level="1"><nlm:aff id="aff10"><institution>Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge</institution>
<country>Stockholm, Sweden</country>
</nlm:aff>
<country xml:lang="fr">Suède</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Fadare, Joseph O" sort="Fadare, Joseph O" uniqKey="Fadare J" first="Joseph O." last="Fadare">Joseph O. Fadare</name>
<affiliation wicri:level="1"><nlm:aff id="aff11"><institution>Department of Pharmacology, Ekiti State University</institution>
<country>Ado-Ekiti, Nigeria</country>
</nlm:aff>
<country xml:lang="fr">Nigeria</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Furst, Jurij" sort="Furst, Jurij" uniqKey="Furst J" first="Jurij" last="Fürst">Jurij Fürst</name>
<affiliation wicri:level="1"><nlm:aff id="aff12"><institution>Health Insurance Institute</institution>
<country>Ljubljana, Slovenia</country>
</nlm:aff>
<country xml:lang="fr">Slovénie</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Gallego, Gisselle" sort="Gallego, Gisselle" uniqKey="Gallego G" first="Gisselle" last="Gallego">Gisselle Gallego</name>
<affiliation wicri:level="1"><nlm:aff id="aff13"><institution>School of Medicine, The University of Notre Dame Australia</institution>
<country>Darlinghurst, NSW, Australia</country>
</nlm:aff>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff14"><institution>Department of Pharmacology and Clinical Neuroscience, Umea University</institution>
<country>Umea, Sweden</country>
</nlm:aff>
<country xml:lang="fr">Suède</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="God I, Isabella P" sort="God I, Isabella P" uniqKey="God I I" first="Isabella P." last="God I">Isabella P. God I</name>
<affiliation wicri:level="1"><nlm:aff id="aff15"><institution>School of Pharmacy, Graduate Program in Medicines and Pharmaceutical Assistance, Federal University of Minas Gerais</institution>
<country>Belo Horizonte, Brazil</country>
</nlm:aff>
<country xml:lang="fr">Brésil</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff16"><institution>Department of Social Pharmacy, SUS Collaborating Centre – Health Technology Assessment and Excellence in Health, College of Pharmacy, Federal University of Minas Gerais</institution>
<country>Belo Horizonte, Brazil</country>
</nlm:aff>
<country xml:lang="fr">Brésil</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Guerra Junior, Augusto A" sort="Guerra Junior, Augusto A" uniqKey="Guerra Junior A" first="Augusto A." last="Guerra Júnior">Augusto A. Guerra Júnior</name>
<affiliation wicri:level="1"><nlm:aff id="aff15"><institution>School of Pharmacy, Graduate Program in Medicines and Pharmaceutical Assistance, Federal University of Minas Gerais</institution>
<country>Belo Horizonte, Brazil</country>
</nlm:aff>
<country xml:lang="fr">Brésil</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff16"><institution>Department of Social Pharmacy, SUS Collaborating Centre – Health Technology Assessment and Excellence in Health, College of Pharmacy, Federal University of Minas Gerais</institution>
<country>Belo Horizonte, Brazil</country>
</nlm:aff>
<country xml:lang="fr">Brésil</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Gursoz, Hakk" sort="Gursoz, Hakk" uniqKey="Gursoz H" first="Hakk" last="Gürsöz">Hakk Gürsöz</name>
<affiliation wicri:level="1"><nlm:aff id="aff5"><institution>Turkish Medicines and Medical Devices Agency, Ministry of Health</institution>
<country>Ankara, Turkey</country>
</nlm:aff>
<country xml:lang="fr">Turquie</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Jan, Saira" sort="Jan, Saira" uniqKey="Jan S" first="Saira" last="Jan">Saira Jan</name>
<affiliation wicri:level="1"><nlm:aff id="aff17"><institution>Clinical Pharmacy, Rutgers State University of New Jersey</institution>
<country>Piscataway, NJ, USA</country>
</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff18"><institution>Horizon Blue Cross Blue Shield of New Jersey</institution>
<country>Newark, NJ, USA</country>
</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Jones, Jan" sort="Jones, Jan" uniqKey="Jones J" first="Jan" last="Jones">Jan Jones</name>
<affiliation wicri:level="1"><nlm:aff id="aff19"><institution>Scottish Medicines Consortium</institution>
<country>Glasgow, UK</country>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Joppi, Roberta" sort="Joppi, Roberta" uniqKey="Joppi R" first="Roberta" last="Joppi">Roberta Joppi</name>
<affiliation wicri:level="1"><nlm:aff id="aff20"><institution>Pharmaceutical Drug Department, Azienda Sanitaria Locale of Verona</institution>
<country>Verona, Italy</country>
</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Kerman, Saim" sort="Kerman, Saim" uniqKey="Kerman S" first="Saim" last="Kerman">Saim Kerman</name>
<affiliation wicri:level="1"><nlm:aff id="aff5"><institution>Turkish Medicines and Medical Devices Agency, Ministry of Health</institution>
<country>Ankara, Turkey</country>
</nlm:aff>
<country xml:lang="fr">Turquie</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Laius, Ott" sort="Laius, Ott" uniqKey="Laius O" first="Ott" last="Laius">Ott Laius</name>
<affiliation wicri:level="1"><nlm:aff id="aff21"><institution>State Agency of Medicines</institution>
<country>Tartu, Estonia</country>
</nlm:aff>
<country xml:lang="fr">Estonie</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Madzikwa, Newman" sort="Madzikwa, Newman" uniqKey="Madzikwa N" first="Newman" last="Madzikwa">Newman Madzikwa</name>
<affiliation wicri:level="1"><nlm:aff id="aff22"><institution>Ministry of Health and Child Care</institution>
<country>Harrare, Zimbabwe</country>
</nlm:aff>
<country xml:lang="fr">Zimbabwe</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Magnusson, Einar" sort="Magnusson, Einar" uniqKey="Magnusson E" first="Einar" last="Magnússon">Einar Magnússon</name>
<affiliation wicri:level="1"><nlm:aff id="aff23"><institution>Department of Health Services, Ministry of Health</institution>
<country>Reykjavík, Iceland</country>
</nlm:aff>
<country xml:lang="fr">Islande</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Maticic, Mojca" sort="Maticic, Mojca" uniqKey="Maticic M" first="Mojca" last="Maticic">Mojca Maticic</name>
<affiliation wicri:level="1"><nlm:aff id="aff24"><institution>Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana</institution>
<country>Ljubljana, Slovenia</country>
</nlm:aff>
<country xml:lang="fr">Slovénie</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Markovic Pekovic, Vanda" sort="Markovic Pekovic, Vanda" uniqKey="Markovic Pekovic V" first="Vanda" last="Markovic-Pekovic">Vanda Markovic-Pekovic</name>
<affiliation wicri:level="1"><nlm:aff id="aff25"><institution>Faculty of Medicine, University of Banja Luka</institution>
<country>Banja Luka, Bosnia and Herzegovina</country>
</nlm:aff>
<country xml:lang="fr">Bosnie-Herzégovine</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff26"><institution>Ministry of Health and Social Welfare</institution>
<country>Banja Luka, Bosnia and Herzegovina</country>
</nlm:aff>
<country xml:lang="fr">Bosnie-Herzégovine</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Massele, Amos" sort="Massele, Amos" uniqKey="Massele A" first="Amos" last="Massele">Amos Massele</name>
<affiliation wicri:level="1"><nlm:aff id="aff27"><institution>Department of Clinical Pharmacology, School of Medicine, University of Botswana</institution>
<country>Gaborone, Botswana</country>
</nlm:aff>
<country xml:lang="fr">Botswana</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Ogunleye, Olayinka" sort="Ogunleye, Olayinka" uniqKey="Ogunleye O" first="Olayinka" last="Ogunleye">Olayinka Ogunleye</name>
<affiliation wicri:level="1"><nlm:aff id="aff28"><institution>Clinical Pharmacology Unit, Department of Medicine, Lagos State University Teaching Hospital</institution>
<country>Lagos, Nigeria</country>
</nlm:aff>
<country xml:lang="fr">Nigeria</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff29"><institution>Department of Pharmacology and Therapeutics, Lagos State University College of Medicine</institution>
<country>Lagos, Nigeria</country>
</nlm:aff>
<country xml:lang="fr">Nigeria</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="O Leary, Aisling" sort="O Leary, Aisling" uniqKey="O Leary A" first="Aisling" last="O'Leary">Aisling O'Leary</name>
<affiliation wicri:level="1"><nlm:aff id="aff30"><institution>National Centre for Pharmacoeconomics</institution>
<country>Dublin, Ireland</country>
</nlm:aff>
<country xml:lang="fr">Irlande (pays)</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Piessnegger, Jutta" sort="Piessnegger, Jutta" uniqKey="Piessnegger J" first="Jutta" last="Piessnegger">Jutta Piessnegger</name>
<affiliation wicri:level="1"><nlm:aff id="aff31"><institution>Hauptverband der Österreichischen Sozialversicherungsträger</institution>
<country>Wien, Austria</country>
</nlm:aff>
<country xml:lang="fr">Autriche</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Sermet, Catherine" sort="Sermet, Catherine" uniqKey="Sermet C" first="Catherine" last="Sermet">Catherine Sermet</name>
<affiliation wicri:level="1"><nlm:aff id="aff32"><institution>IRDES</institution>
<country>Paris, France</country>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Simoens, Steven" sort="Simoens, Steven" uniqKey="Simoens S" first="Steven" last="Simoens">Steven Simoens</name>
<affiliation wicri:level="1"><nlm:aff id="aff33"><institution>Department of Pharmaceutical and Pharmacological Sciences, KU Leuven</institution>
<country>Leuven, Belgium</country>
</nlm:aff>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Tiroyakgosi, Celda" sort="Tiroyakgosi, Celda" uniqKey="Tiroyakgosi C" first="Celda" last="Tiroyakgosi">Celda Tiroyakgosi</name>
<affiliation wicri:level="1"><nlm:aff id="aff34"><institution>Ministry of Health, Nelson Mandela Drive</institution>
<country>Gaborone, Botswana</country>
</nlm:aff>
<country xml:lang="fr">Botswana</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Truter, Ilse" sort="Truter, Ilse" uniqKey="Truter I" first="Ilse" last="Truter">Ilse Truter</name>
<affiliation wicri:level="1"><nlm:aff id="aff35"><institution>Drug Utilisation Research Unit, Faculty of Health Sciences, Nelson Mandela Metropolitan University</institution>
<country>Port Elizabeth, South Africa</country>
</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Thyberg, Magnus" sort="Thyberg, Magnus" uniqKey="Thyberg M" first="Magnus" last="Thyberg">Magnus Thyberg</name>
<affiliation wicri:level="1"><nlm:aff id="aff36"><institution>Stockholms Läns Landsting, Hälso-och Sjukvårdsförvaltningen</institution>
<country>Stockholm, Sweden</country>
</nlm:aff>
<country xml:lang="fr">Suède</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Tomekova, Kristina" sort="Tomekova, Kristina" uniqKey="Tomekova K" first="Kristina" last="Tomekova">Kristina Tomekova</name>
<affiliation wicri:level="1"><nlm:aff id="aff37"><institution>Faculty of Management, Comenius University</institution>
<country>Bratislava, Slovakia</country>
</nlm:aff>
<country xml:lang="fr">Slovaquie</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Wladysiuk, Magdalena" sort="Wladysiuk, Magdalena" uniqKey="Wladysiuk M" first="Magdalena" last="Wladysiuk">Magdalena Wladysiuk</name>
<affiliation wicri:level="1"><nlm:aff id="aff38"><institution>HTA Consulting</institution>
<country>Cracow, Poland</country>
</nlm:aff>
<country xml:lang="fr">Pologne</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Vandoros, Sotiris" sort="Vandoros, Sotiris" uniqKey="Vandoros S" first="Sotiris" last="Vandoros">Sotiris Vandoros</name>
<affiliation wicri:level="1"><nlm:aff id="aff39"><institution>School of Management and Business, King's College London</institution>
<country>London, UK</country>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Vural, Elif H" sort="Vural, Elif H" uniqKey="Vural E" first="Elif H." last="Vural">Elif H. Vural</name>
<affiliation wicri:level="1"><nlm:aff id="aff5"><institution>Turkish Medicines and Medical Devices Agency, Ministry of Health</institution>
<country>Ankara, Turkey</country>
</nlm:aff>
<country xml:lang="fr">Turquie</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Zara, Corinne" sort="Zara, Corinne" uniqKey="Zara C" first="Corinne" last="Zara">Corinne Zara</name>
<affiliation wicri:level="1"><nlm:aff id="aff2"><institution>Catalan Health Service - Servei Català de la Salut</institution>
<country>Barcelona, Spain</country>
</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Godman, Brian" sort="Godman, Brian" uniqKey="Godman B" first="Brian" last="Godman">Brian Godman</name>
<affiliation wicri:level="1"><nlm:aff id="aff10"><institution>Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge</institution>
<country>Stockholm, Sweden</country>
</nlm:aff>
<country xml:lang="fr">Suède</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff40"><institution>Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde</institution>
<country>Glasgow, UK</country>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>, Santa Cruz</wicri:regionArea>
</affiliation>
</author>
</analytic>
<series><title level="j">Frontiers in Pharmacology</title>
<idno type="eISSN">1663-9812</idno>
<imprint><date when="2016">2016</date>
</imprint>
</series>
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<front><div type="abstract" xml:lang="en"><p><bold>Background:</bold>
 Infection with the Hepatitis C Virus (HCV) is a widespread transmittable disease with a diagnosed prevalence of 2.0%. Fortunately, it is now curable in most patients. Sales of medicines to treat HCV infection grew 2.7% per year between 2004 and 2011, enhanced by the launch of the protease inhibitors (PIs) boceprevir (BCV) and telaprevir (TVR) in addition to ribavirin and pegylated interferon (pegIFN). Costs will continue to rise with new treatments including sofosbuvir, which now include interferon free regimens.</p>
<p><bold>Objective:</bold>
 Assess the uptake of BCV and TVR across Europe from a health authority perspective to offer future guidance on dealing with new high cost medicines.</p>
<p><bold>Methods:</bold>
 Cross-sectional descriptive study of medicines to treat HCV (pegIFN, ribavirin, BCV and TVR) among European countries from 2008 to 2013. Utilization measured in defined daily doses (DDDs)/1000 patients/quarter (DIQs) and expenditure in Euros/DDD. Health authority activities to influence treatments categorized using the 4E methodology (Education, Engineering, Economics and Enforcement).</p>
<p><bold>Results:</bold>
 Similar uptake of BCV and TVR among European countries and regions, ranging from 0.5 DIQ in Denmark, Netherlands and Slovenia to 1.5 DIQ in Tayside and Catalonia in 2013. However, different utilization of the new PIs vs. ribavirin indicates differences in dual vs. triple therapy, which is down to factors including physician preference and genotypes. Reimbursed prices for BCV and TVR were comparable across countries.</p>
<p><bold>Conclusion:</bold>
 There was reasonable consistency in the utilization of BCV and TVR among European countries in comparison with other high priced medicines. This may reflect the social demand to limit the transmission of HCV. However, the situation is changing with new curative medicines for HCV genotype 1 (GT1) with potentially an appreciable budget impact. These concerns have resulted in different prices across countries, with their impact on budgets and patient outcomes monitored in the future to provide additional guidance.</p>
</div>
</front>
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</TEI>
<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
  <front><journal-meta><journal-id journal-id-type="nlm-ta">Front Pharmacol</journal-id>
<journal-id journal-id-type="iso-abbrev">Front Pharmacol</journal-id>
<journal-id journal-id-type="publisher-id">Front. Pharmacol.</journal-id>
<journal-title-group><journal-title>Frontiers in Pharmacology</journal-title>
</journal-title-group>
<issn pub-type="epub">1663-9812</issn>
<publisher><publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">27516740</article-id>
<article-id pub-id-type="pmc">4964878</article-id>
<article-id pub-id-type="doi">10.3389/fphar.2016.00197</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Pharmacology</subject>
<subj-group><subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group><article-title>Introduction and Utilization of High Priced HCV Medicines across Europe; Implications for the Future</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>de Bruijn</surname>
<given-names>Winnie</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
<uri xlink:type="simple" xlink:href="http://loop.frontiersin.org/people/351480/overview"></uri>
</contrib>
<contrib contrib-type="author"><name><surname>Ibáñez</surname>
<given-names>Cristina</given-names>
</name>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
<uri xlink:type="simple" xlink:href="http://loop.frontiersin.org/people/347701/overview"></uri>
</contrib>
<contrib contrib-type="author"><name><surname>Frisk</surname>
<given-names>Pia</given-names>
</name>
<xref ref-type="aff" rid="aff3"><sup>3</sup>
</xref>
<uri xlink:type="simple" xlink:href="http://loop.frontiersin.org/people/351466/overview"></uri>
</contrib>
<contrib contrib-type="author"><name><surname>Bak Pedersen</surname>
<given-names>Hanne</given-names>
</name>
<xref ref-type="aff" rid="aff4"><sup>4</sup>
</xref>
<uri xlink:type="simple" xlink:href="http://loop.frontiersin.org/people/139264/overview"></uri>
</contrib>
<contrib contrib-type="author"><name><surname>Alkan</surname>
<given-names>Ali</given-names>
</name>
<xref ref-type="aff" rid="aff5"><sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Vella Bonanno</surname>
<given-names>Patricia</given-names>
</name>
<xref ref-type="aff" rid="aff6"><sup>6</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Brkičić</surname>
<given-names>Ljiljana S.</given-names>
</name>
<xref ref-type="aff" rid="aff7"><sup>7</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bucsics</surname>
<given-names>Anna</given-names>
</name>
<xref ref-type="aff" rid="aff8"><sup>8</sup>
</xref>
<uri xlink:type="simple" xlink:href="http://loop.frontiersin.org/people/66208/overview"></uri>
</contrib>
<contrib contrib-type="author"><name><surname>Dedet</surname>
<given-names>Guillaume</given-names>
</name>
<xref ref-type="aff" rid="aff9"><sup>9</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Eriksen</surname>
<given-names>Jaran</given-names>
</name>
<xref ref-type="aff" rid="aff10"><sup>10</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Fadare</surname>
<given-names>Joseph O.</given-names>
</name>
<xref ref-type="aff" rid="aff11"><sup>11</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Fürst</surname>
<given-names>Jurij</given-names>
</name>
<xref ref-type="aff" rid="aff12"><sup>12</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gallego</surname>
<given-names>Gisselle</given-names>
</name>
<xref ref-type="aff" rid="aff13"><sup>13</sup>
</xref>
<xref ref-type="aff" rid="aff14"><sup>14</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Godói</surname>
<given-names>Isabella P.</given-names>
</name>
<xref ref-type="aff" rid="aff15"><sup>15</sup>
</xref>
<xref ref-type="aff" rid="aff16"><sup>16</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Guerra Júnior</surname>
<given-names>Augusto A.</given-names>
</name>
<xref ref-type="aff" rid="aff15"><sup>15</sup>
</xref>
<xref ref-type="aff" rid="aff16"><sup>16</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gürsöz</surname>
<given-names>Hakkı</given-names>
</name>
<xref ref-type="aff" rid="aff5"><sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Jan</surname>
<given-names>Saira</given-names>
</name>
<xref ref-type="aff" rid="aff17"><sup>17</sup>
</xref>
<xref ref-type="aff" rid="aff18"><sup>18</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Jones</surname>
<given-names>Jan</given-names>
</name>
<xref ref-type="aff" rid="aff19"><sup>19</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Joppi</surname>
<given-names>Roberta</given-names>
</name>
<xref ref-type="aff" rid="aff20"><sup>20</sup>
</xref>
<uri xlink:type="simple" xlink:href="http://loop.frontiersin.org/people/158660/overview"></uri>
</contrib>
<contrib contrib-type="author"><name><surname>Kerman</surname>
<given-names>Saim</given-names>
</name>
<xref ref-type="aff" rid="aff5"><sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Laius</surname>
<given-names>Ott</given-names>
</name>
<xref ref-type="aff" rid="aff21"><sup>21</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Madzikwa</surname>
<given-names>Newman</given-names>
</name>
<xref ref-type="aff" rid="aff22"><sup>22</sup>
</xref>
<uri xlink:type="simple" xlink:href="http://loop.frontiersin.org/people/345832/overview"></uri>
</contrib>
<contrib contrib-type="author"><name><surname>Magnússon</surname>
<given-names>Einar</given-names>
</name>
<xref ref-type="aff" rid="aff23"><sup>23</sup>
</xref>
<uri xlink:type="simple" xlink:href="http://loop.frontiersin.org/people/359044/overview"></uri>
</contrib>
<contrib contrib-type="author"><name><surname>Maticic</surname>
<given-names>Mojca</given-names>
</name>
<xref ref-type="aff" rid="aff24"><sup>24</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Markovic-Pekovic</surname>
<given-names>Vanda</given-names>
</name>
<xref ref-type="aff" rid="aff25"><sup>25</sup>
</xref>
<xref ref-type="aff" rid="aff26"><sup>26</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Massele</surname>
<given-names>Amos</given-names>
</name>
<xref ref-type="aff" rid="aff27"><sup>27</sup>
</xref>
<uri xlink:type="simple" xlink:href="http://loop.frontiersin.org/people/351418/overview"></uri>
</contrib>
<contrib contrib-type="author"><name><surname>Ogunleye</surname>
<given-names>Olayinka</given-names>
</name>
<xref ref-type="aff" rid="aff28"><sup>28</sup>
</xref>
<xref ref-type="aff" rid="aff29"><sup>29</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>O'Leary</surname>
<given-names>Aisling</given-names>
</name>
<xref ref-type="aff" rid="aff30"><sup>30</sup>
</xref>
<uri xlink:type="simple" xlink:href="http://loop.frontiersin.org/people/351392/overview"></uri>
</contrib>
<contrib contrib-type="author"><name><surname>Piessnegger</surname>
<given-names>Jutta</given-names>
</name>
<xref ref-type="aff" rid="aff31"><sup>31</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sermet</surname>
<given-names>Catherine</given-names>
</name>
<xref ref-type="aff" rid="aff32"><sup>32</sup>
</xref>
<uri xlink:type="simple" xlink:href="http://loop.frontiersin.org/people/91670/overview"></uri>
</contrib>
<contrib contrib-type="author"><name><surname>Simoens</surname>
<given-names>Steven</given-names>
</name>
<xref ref-type="aff" rid="aff33"><sup>33</sup>
</xref>
<uri xlink:type="simple" xlink:href="http://loop.frontiersin.org/people/14301/overview"></uri>
</contrib>
<contrib contrib-type="author"><name><surname>Tiroyakgosi</surname>
<given-names>Celda</given-names>
</name>
<xref ref-type="aff" rid="aff34"><sup>34</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Truter</surname>
<given-names>Ilse</given-names>
</name>
<xref ref-type="aff" rid="aff35"><sup>35</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Thyberg</surname>
<given-names>Magnus</given-names>
</name>
<xref ref-type="aff" rid="aff36"><sup>36</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Tomekova</surname>
<given-names>Kristina</given-names>
</name>
<xref ref-type="aff" rid="aff37"><sup>37</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Wladysiuk</surname>
<given-names>Magdalena</given-names>
</name>
<xref ref-type="aff" rid="aff38"><sup>38</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Vandoros</surname>
<given-names>Sotiris</given-names>
</name>
<xref ref-type="aff" rid="aff39"><sup>39</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Vural</surname>
<given-names>Elif H.</given-names>
</name>
<xref ref-type="aff" rid="aff5"><sup>5</sup>
</xref>
<uri xlink:type="simple" xlink:href="http://loop.frontiersin.org/people/354548/overview"></uri>
</contrib>
<contrib contrib-type="author"><name><surname>Zara</surname>
<given-names>Corinne</given-names>
</name>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
<uri xlink:type="simple" xlink:href="http://loop.frontiersin.org/people/90535/overview"></uri>
</contrib>
<contrib contrib-type="author"><name><surname>Godman</surname>
<given-names>Brian</given-names>
</name>
<xref ref-type="aff" rid="aff10"><sup>10</sup>
</xref>
<xref ref-type="aff" rid="aff40"><sup>40</sup>
</xref>
<xref ref-type="author-notes" rid="fn001"><sup>*</sup>
</xref>
<uri xlink:type="simple" xlink:href="http://loop.frontiersin.org/people/14310/overview"></uri>
</contrib>
</contrib-group>
<aff id="aff1"><sup>1</sup>
<institution>Department of Pharmaceutical Sciences, Utrecht University</institution>
<country>Utrecht, Netherlands</country>
</aff>
<aff id="aff2"><sup>2</sup>
<institution>Catalan Health Service - Servei Català de la Salut</institution>
<country>Barcelona, Spain</country>
</aff>
<aff id="aff3"><sup>3</sup>
<institution>Public Health Services Committee, Stockholm County Council</institution>
<country>Stockholm, Sweden</country>
</aff>
<aff id="aff4"><sup>4</sup>
<institution>Health Technologies and Pharmaceuticals, Division of Health Systems and Public Health, WHO Regional Office for Europe</institution>
<country>Copenhagen, Denmark</country>
</aff>
<aff id="aff5"><sup>5</sup>
<institution>Turkish Medicines and Medical Devices Agency, Ministry of Health</institution>
<country>Ankara, Turkey</country>
</aff>
<aff id="aff6"><sup>6</sup>
<institution>Independent Pharmaceutical Consultant</institution>
<country>Mellieha, Malta</country>
</aff>
<aff id="aff7"><sup>7</sup>
<institution>Croatian Health Insurance Fund</institution>
<country>Zagreb, Croatia</country>
</aff>
<aff id="aff8"><sup>8</sup>
<institution>Department of Finance, University of Vienna</institution>
<country>Vienna, Austria</country>
</aff>
<aff id="aff9"><sup>9</sup>
<institution>Ministry of Health</institution>
<country>Paris, France</country>
</aff>
<aff id="aff10"><sup>10</sup>
<institution>Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge</institution>
<country>Stockholm, Sweden</country>
</aff>
<aff id="aff11"><sup>11</sup>
<institution>Department of Pharmacology, Ekiti State University</institution>
<country>Ado-Ekiti, Nigeria</country>
</aff>
<aff id="aff12"><sup>12</sup>
<institution>Health Insurance Institute</institution>
<country>Ljubljana, Slovenia</country>
</aff>
<aff id="aff13"><sup>13</sup>
<institution>School of Medicine, The University of Notre Dame Australia</institution>
<country>Darlinghurst, NSW, Australia</country>
</aff>
<aff id="aff14"><sup>14</sup>
<institution>Department of Pharmacology and Clinical Neuroscience, Umea University</institution>
<country>Umea, Sweden</country>
</aff>
<aff id="aff15"><sup>15</sup>
<institution>School of Pharmacy, Graduate Program in Medicines and Pharmaceutical Assistance, Federal University of Minas Gerais</institution>
<country>Belo Horizonte, Brazil</country>
</aff>
<aff id="aff16"><sup>16</sup>
<institution>Department of Social Pharmacy, SUS Collaborating Centre – Health Technology Assessment and Excellence in Health, College of Pharmacy, Federal University of Minas Gerais</institution>
<country>Belo Horizonte, Brazil</country>
</aff>
<aff id="aff17"><sup>17</sup>
<institution>Clinical Pharmacy, Rutgers State University of New Jersey</institution>
<country>Piscataway, NJ, USA</country>
</aff>
<aff id="aff18"><sup>18</sup>
<institution>Horizon Blue Cross Blue Shield of New Jersey</institution>
<country>Newark, NJ, USA</country>
</aff>
<aff id="aff19"><sup>19</sup>
<institution>Scottish Medicines Consortium</institution>
<country>Glasgow, UK</country>
</aff>
<aff id="aff20"><sup>20</sup>
<institution>Pharmaceutical Drug Department, Azienda Sanitaria Locale of Verona</institution>
<country>Verona, Italy</country>
</aff>
<aff id="aff21"><sup>21</sup>
<institution>State Agency of Medicines</institution>
<country>Tartu, Estonia</country>
</aff>
<aff id="aff22"><sup>22</sup>
<institution>Ministry of Health and Child Care</institution>
<country>Harrare, Zimbabwe</country>
</aff>
<aff id="aff23"><sup>23</sup>
<institution>Department of Health Services, Ministry of Health</institution>
<country>Reykjavík, Iceland</country>
</aff>
<aff id="aff24"><sup>24</sup>
<institution>Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana</institution>
<country>Ljubljana, Slovenia</country>
</aff>
<aff id="aff25"><sup>25</sup>
<institution>Faculty of Medicine, University of Banja Luka</institution>
<country>Banja Luka, Bosnia and Herzegovina</country>
</aff>
<aff id="aff26"><sup>26</sup>
<institution>Ministry of Health and Social Welfare</institution>
<country>Banja Luka, Bosnia and Herzegovina</country>
</aff>
<aff id="aff27"><sup>27</sup>
<institution>Department of Clinical Pharmacology, School of Medicine, University of Botswana</institution>
<country>Gaborone, Botswana</country>
</aff>
<aff id="aff28"><sup>28</sup>
<institution>Clinical Pharmacology Unit, Department of Medicine, Lagos State University Teaching Hospital</institution>
<country>Lagos, Nigeria</country>
</aff>
<aff id="aff29"><sup>29</sup>
<institution>Department of Pharmacology and Therapeutics, Lagos State University College of Medicine</institution>
<country>Lagos, Nigeria</country>
</aff>
<aff id="aff30"><sup>30</sup>
<institution>National Centre for Pharmacoeconomics</institution>
<country>Dublin, Ireland</country>
</aff>
<aff id="aff31"><sup>31</sup>
<institution>Hauptverband der Österreichischen Sozialversicherungsträger</institution>
<country>Wien, Austria</country>
</aff>
<aff id="aff32"><sup>32</sup>
<institution>IRDES</institution>
<country>Paris, France</country>
</aff>
<aff id="aff33"><sup>33</sup>
<institution>Department of Pharmaceutical and Pharmacological Sciences, KU Leuven</institution>
<country>Leuven, Belgium</country>
</aff>
<aff id="aff34"><sup>34</sup>
<institution>Ministry of Health, Nelson Mandela Drive</institution>
<country>Gaborone, Botswana</country>
</aff>
<aff id="aff35"><sup>35</sup>
<institution>Drug Utilisation Research Unit, Faculty of Health Sciences, Nelson Mandela Metropolitan University</institution>
<country>Port Elizabeth, South Africa</country>
</aff>
<aff id="aff36"><sup>36</sup>
<institution>Stockholms Läns Landsting, Hälso-och Sjukvårdsförvaltningen</institution>
<country>Stockholm, Sweden</country>
</aff>
<aff id="aff37"><sup>37</sup>
<institution>Faculty of Management, Comenius University</institution>
<country>Bratislava, Slovakia</country>
</aff>
<aff id="aff38"><sup>38</sup>
<institution>HTA Consulting</institution>
<country>Cracow, Poland</country>
</aff>
<aff id="aff39"><sup>39</sup>
<institution>School of Management and Business, King's College London</institution>
<country>London, UK</country>
</aff>
<aff id="aff40"><sup>40</sup>
<institution>Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde</institution>
<country>Glasgow, UK</country>
</aff>
<author-notes><fn fn-type="edited-by"><p>Edited by: Dominique J. Dubois, Université Libre de Bruxelles, Belgium</p>
</fn>
<fn fn-type="edited-by"><p>Reviewed by: Domenico Criscuolo, Genovax, Italy; Michael Hans Thiede, Health Economics and Policy, Germany</p>
</fn>
<corresp id="fn001">*Correspondence: Brian Godman <email xlink:type="simple">brian.godman@ki.se</email>
</corresp>
<fn fn-type="other" id="fn002"><p>This article was submitted to Pharmaceutical Medicine and Outcomes Research, a section of the journal Frontiers in Pharmacology</p>
</fn>
</author-notes>
<pub-date pub-type="epub"><day>22</day>
<month>7</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="collection"><year>2016</year>
</pub-date>
<volume>7</volume>
<elocation-id>197</elocation-id>
<history><date date-type="received"><day>29</day>
<month>4</month>
<year>2016</year>
</date>
<date date-type="accepted"><day>21</day>
<month>6</month>
<year>2016</year>
</date>
</history>
<permissions><copyright-statement>Copyright © 2016 de Bruijn, Ibáñez, Frisk, Bak Pedersen, Alkan, Vella Bonanno, Brkičić, Bucsics, Dedet, Eriksen, Fadare, Fürst, Gallego, Godói, Guerra Júnior, Gürsöz, Jan, Jones, Joppi, Kerman, Laius, Madzikwa, Magnússon, Maticic, Markovic-Pekovic, Massele, Ogunleye, O'Leary, Piessnegger, Sermet, Simoens, Tiroyakgosi, Truter, Thyberg, Tomekova, Wladysiuk, Vandoros, Vural, Zara and Godman.</copyright-statement>
<copyright-year>2016</copyright-year>
<copyright-holder>de Bruijn, Ibáñez, Frisk, Bak Pedersen, Alkan, Vella Bonanno, Brkičić, Bucsics, Dedet, Eriksen, Fadare, Fürst, Gallego, Godói, Guerra Júnior, Gürsöz, Jan, Jones, Joppi, Kerman, Laius, Madzikwa, Magnússon, Maticic, Markovic-Pekovic, Massele, Ogunleye, O'Leary, Piessnegger, Sermet, Simoens, Tiroyakgosi, Truter, Thyberg, Tomekova, Wladysiuk, Vandoros, Vural, Zara and Godman</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</license-p>
</license>
</permissions>
<abstract><p><bold>Background:</bold>
 Infection with the Hepatitis C Virus (HCV) is a widespread transmittable disease with a diagnosed prevalence of 2.0%. Fortunately, it is now curable in most patients. Sales of medicines to treat HCV infection grew 2.7% per year between 2004 and 2011, enhanced by the launch of the protease inhibitors (PIs) boceprevir (BCV) and telaprevir (TVR) in addition to ribavirin and pegylated interferon (pegIFN). Costs will continue to rise with new treatments including sofosbuvir, which now include interferon free regimens.</p>
<p><bold>Objective:</bold>
 Assess the uptake of BCV and TVR across Europe from a health authority perspective to offer future guidance on dealing with new high cost medicines.</p>
<p><bold>Methods:</bold>
 Cross-sectional descriptive study of medicines to treat HCV (pegIFN, ribavirin, BCV and TVR) among European countries from 2008 to 2013. Utilization measured in defined daily doses (DDDs)/1000 patients/quarter (DIQs) and expenditure in Euros/DDD. Health authority activities to influence treatments categorized using the 4E methodology (Education, Engineering, Economics and Enforcement).</p>
<p><bold>Results:</bold>
 Similar uptake of BCV and TVR among European countries and regions, ranging from 0.5 DIQ in Denmark, Netherlands and Slovenia to 1.5 DIQ in Tayside and Catalonia in 2013. However, different utilization of the new PIs vs. ribavirin indicates differences in dual vs. triple therapy, which is down to factors including physician preference and genotypes. Reimbursed prices for BCV and TVR were comparable across countries.</p>
<p><bold>Conclusion:</bold>
 There was reasonable consistency in the utilization of BCV and TVR among European countries in comparison with other high priced medicines. This may reflect the social demand to limit the transmission of HCV. However, the situation is changing with new curative medicines for HCV genotype 1 (GT1) with potentially an appreciable budget impact. These concerns have resulted in different prices across countries, with their impact on budgets and patient outcomes monitored in the future to provide additional guidance.</p>
</abstract>
<kwd-group><kwd>boceprevir</kwd>
<kwd>cross national drug utilization study</kwd>
<kwd>demand-side measures</kwd>
<kwd>Hepatitis C</kwd>
<kwd>introduction new medicines</kwd>
<kwd>sofosbuvir</kwd>
<kwd>telaprevir</kwd>
</kwd-group>
<counts><fig-count count="4"></fig-count>
<table-count count="8"></table-count>
<equation-count count="0"></equation-count>
<ref-count count="97"></ref-count>
<page-count count="18"></page-count>
<word-count count="13691"></word-count>
</counts>
</article-meta>
</front>
</pmc>
</record>

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Introduction and Utilization of High Priced HCV Medicines across Europe; Implications for the Future

Introduction and Utilization of High Priced HCV Medicines across Europe; Implications for the Future

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