Country (reference)
Products procured
Therapeutic area Sector Study objective Method Study
period
specified To assess the immediate impact of the creation of the Mexican Commission for Price Negotiation on ARV prices and expenditures
Descriptive
analysis 2004–2009 1) price variation before and after the creation of the Commission; 2) Mexican ARV prices and international
Prices for ARVs dropped by an average of 38% after the first round of negotiations, indicating that the interinstitutional Commission was successful in price negotiations. When compared with other upper-middle-income countries, however, Mexico continues to pay an average of six times more for ARVs.
Brazil
(2) Not specified Not specified Not
specified To evaluate the impact of the Intermunicipal Health Consortium on budget and shortages of medicines in the Indaial municipality in southern Brazil
Descriptive
analysis 2007–2009 Price, expenditure and stock-outs in 2007 (without Consortium), 2008 (mixed) and 2009 (with Consortium)
Total expenditure decreased by 33% when comparing procurement by the Intermunicipal Health Consortium (2009) to municipal procurement (2007), and by 18% when compared to the average expenditure of the 2009 health prices database from the Ministry of Health.
Denmark (3)
Various Various Hospital To present the Danish experience with centralized procurement
Descriptive analysis
2008–2015 Expenditure at tender prices vs expenditure at retail prices
By investing in and combining a centralized structure (Amgros) and the establishment of the Danish Council for the Use of Expensive Hospital Medicines, which assesses the clinical costs and benefits of expensive medicines and helps guide the selection of medicines by Amgros and clinicians, the Danish Government saved approximately €314 million in 2015. Mexico
To discuss achievements and challenges in negotiating prices for patented by the new central body in Mexico
Descriptive analysis
2008–2011 reference to the preceding year
According to the annual reports by the Coordinating Commission for Negotiating the Price of Medicines and other Health Inputs, the accumulated direct savings (e.g. price reductions resulting from the negotiation) over 2008–2011 reached a total of US$ 355 million.
Greece
Not specified Hospital To present the procurement practices and policies set forth by the Health Procurement Committee and the first measurable outcomes, in terms of cost savings, resulting from these policies
In 2010 implementation of the Health Services Procurement Programme resulted in savings of approximately €180 million, i.e. the difference between estimated budget and actual contract prices. The Health Procurement Committee performed the first tender for hospital drugs in July 2011 using the e-procurement method, and specifically for four active substances on behalf of three hospitals with a total budget exceeding Euro 2 million. The e-auction process resulted in annual economic savings of 80%. On an even larger scale, the second e-tender for hospital drugs conducted in November 2011 involved 23 active substances on behalf of all Greek Hospitals with a total budget exceeding Euro 80 million. In this case the e-auction process resulted in substantially lower prices which are estimated at 57%.
Country (reference)
Products procured
Therapeutic area Sector Study objective Method Study
period
specified To assess the immediate impact of the creation of the Mexican Commission for Price Negotiation on ARV prices and expenditures
Descriptive
analysis 2004–2009 1) price variation before and after the creation of the Commission;
2) Mexican ARV prices and international
Prices for ARVs dropped by an average of 38% after the first round of negotiations, indicating that the interinstitutional Commission was successful in price negotiations. When compared with other upper-middle-income countries, however, Mexico continues to pay an average of six times more for ARVs.
Brazil
(2) Not specified Not specified Not
specified To evaluate the impact of the Intermunicipal Health Consortium on budget and shortages of medicines in the Indaial municipality in southern Brazil
Descriptive
analysis 2007–2009 Price, expenditure and stock-outs in 2007 (without Consortium), 2008 (mixed) and 2009 (with Consortium)
Total expenditure decreased by 33% when comparing procurement by the Intermunicipal Health Consortium (2009) to municipal procurement (2007), and by 18% when compared to the average expenditure of the 2009 health prices database from the Ministry of Health.
Denmark (3)
Various Various Hospital To present the Danish experience with centralized procurement
Descriptive analysis
2008–2015 Expenditure at tender prices vs expenditure at retail prices
By investing in and combining a centralized structure (Amgros) and the establishment of the Danish Council for the Use of Expensive Hospital Medicines, which assesses the clinical costs and benefits of expensive medicines and helps guide the selection of medicines by Amgros and clinicians, the Danish Government saved approximately €314 million in 2015.
Mexico
To discuss achievements and challenges in negotiating prices for patented by the new central body in Mexico
Descriptive analysis
2008–2011 reference to the preceding year
According to the annual reports by the Coordinating Commission for Negotiating the Price of Medicines and other Health Inputs, the accumulated direct savings (e.g. price reductions resulting from the negotiation) over 2008–2011 reached a total of US$ 355 million.
Greece
Not specified Hospital To present the procurement practices and policies set forth by the Health Procurement Committee and the first measurable outcomes, in terms of cost savings, resulting from these policies
In 2010 implementation of the Health Services Procurement Programme resulted in savings of approximately €180 million, i.e. the difference between estimated budget and actual contract prices. The Health Procurement Committee performed the first tender for hospital drugs in July 2011 using the e-procurement method, and specifically for four active substances on behalf of three hospitals with a total budget exceeding Euro 2 million. The e-auction process resulted in annual economic savings of 80%. On an even larger scale, the second e-tender for hospital drugs conducted in November 2011 involved 23 active substances on behalf of all Greek Hospitals with a total budget exceeding Euro 80 million. In this case the e-auction process resulted in substantially lower prices which are estimated at 57%.
Country (reference)
Products procured
Therapeutic area Sector Study objective Method Study
period
Comparison Impact on expenditure
n/a (6)
Not specified Tuberculosis (TB) Not specified
To review the contribution of the Global Drug Facility (GDF) in reducing the price of multidrug-resistant (MDR) TB treatment
Descriptive analysis
2011–2013 Cost of treating a patient for 24 months in different years
There was a significant reduction in the overall cost of treatment. Between 2011 and 2013 the cost of the longest (24-month) treatment course and most expensive regimen for treating MDR-TB in one patient decreased by up to 26%: from US$ 7890 to US$ 5822.
Italy (7)
On-patent Cardiovascular Not
specified
To model different price–volume scenarios for the procurement of evolocumab and alirocumab (PCSK9 inhibitors)
Simulations 2016 Different price-halving populations (PHPs)
In nine price–volume simulations (testing three values of PHP at 25 000, 50 000 or 100 000 patients), the total national expenditure varied from €204 million to €721 million. In the least expensive scenario (PHP = 25 000 patients), the expenditure ranged from €204 million to €338 million, while the average treatment cost per year was €3382. At more than 100 000 treated patients, the treatment cost fell to €626. On the other hand, the scenarios based on PHP = 50 000 and PHP
= 100 000 patients were very unlikely to be acceptable for national health systems.
To assess the financial benefit from tendering and to evaluate its operational framework
Descriptive analysis
2011 Tendered vs pharmacy procurement prices (wholesale)
A 60.6% reduction in expenditure was achieved with the tendering system. Generics demonstrated the greatest reduction in expenditure (94.8%); branded products reached 33.4% and the top 20 products achieved 29% expenditure reduction.
Various Hospital To investigate the effect of electronic tendering on the price paid by the public sector for pharmaceuticals and medical devices in Chile
Regression
analysis 2001–2006 Before and after the Chilecompra electronic platform was implemented
In 2006, US$ 65 million in drugs and US$ 37 million in medical devices were tendered over Chilecompra. Using only the direct effect of e-tendering on price the authors found savings of US$ 8.7 million.
Contd
Country (reference)
Products procured
Therapeutic area Sector Study objective Method Study
period
Comparison Impact on expenditure
n/a (6)
Not specified Tuberculosis (TB) Not specified
To review the contribution of the Global Drug Facility (GDF) in reducing the price of multidrug-resistant (MDR) TB treatment
Descriptive analysis
2011–2013 Cost of treating a patient for 24 months in different years
There was a significant reduction in the overall cost of treatment. Between 2011 and 2013 the cost of the longest (24-month) treatment course and most expensive regimen for treating MDR-TB in one patient decreased by up to 26%: from US$ 7890 to US$ 5822.
Italy (7)
On-patent Cardiovascular Not
specified
To model different price–volume scenarios for the procurement of evolocumab and alirocumab (PCSK9 inhibitors)
Simulations 2016 Different price-halving populations (PHPs)
In nine price–volume simulations (testing three values of PHP at 25 000, 50 000 or 100 000 patients), the total national expenditure varied from €204 million to €721 million. In the least expensive scenario (PHP = 25 000 patients), the expenditure ranged from €204 million to €338 million, while the average treatment cost per year was €3382. At more than 100 000 treated patients, the treatment cost fell to €626. On the other hand, the scenarios based on PHP = 50 000 and PHP
= 100 000 patients were very unlikely to be acceptable for national health systems.
To assess the financial benefit from tendering and to evaluate its operational framework
Descriptive analysis
2011 Tendered vs pharmacy procurement prices (wholesale)
A 60.6% reduction in expenditure was achieved with the tendering system. Generics demonstrated the greatest reduction in expenditure (94.8%); branded products reached 33.4% and the top 20 products achieved 29% expenditure reduction.
Various Hospital To investigate the effect of electronic tendering on the price paid by the public sector for pharmaceuticals and medical devices in Chile
Regression
analysis 2001–2006 Before and after the Chilecompra electronic platform was implemented
In 2006, US$ 65 million in drugs and US$ 37 million in medical devices were tendered over Chilecompra. Using only the direct effect of e-tendering on price the authors found savings of US$ 8.7 million.
Annex 8 references
1. Adesina A, Wirtz V, Dratler S. Reforming antiretroviral price negotiations and public procurement: the Mexican experience. Health Policy Plan. 2013;28:1–10.
2. Sehnem do Amaral S, Blatt C. Municipal consortia for medicine procurement: impact on the stock-out and budget. Rev Saúde Pública. 2011;45(3):1–3.
3. Bartels D. Centralizing procurement of medicines to save costs for Denmark. Eurohealth Observer. 2016;22(2).
4. Gómez-Dantés O, Wirtz V, Reich M, Terrazas P, Ortiz M. A new entity for the negotiation of public procurement prices for patented medicines in Mexico. Bull World Health Organ.
2012;90:788–92.
5. Kastanioti C, Kontodimopoulos N, Stasinopoulos D, Kapetaneas N, Polyzos N. Public procurement of health technologies in Greece in an era of economic crisis. Health Policy.
2013;109:7–13.
6. Lunte K, Cordier-Lassalleb T, Keraveca J. Reducing the price of treatment for multidrug-resistant tuberculosis through the Global Drug Facility. Bull World Health Organ. 2015;93:279–82.
7. Messori A. Evolocumab and alirocumab: exploring original procurement models to manage the reimbursement of these innovative treatments. Int J Clin Pharmacol Ther. 2016;Apr 27 [Epub ahead of print].
8. Petrou P, Talias M. Tendering for pharmaceuticals as a reimbursement tool in Cyprus. Health Policy Technol. 2014;3(3):167–75.
9. Raventós P, Zolezzi S. Electronic tendering of pharmaceuticals and medical devices in Chile. J Bus Res. 2015;68.