Worldwide, health care decision makers are challenged to set priorities in an environment in which the demand for health care services outweighs the allocated resources. Effective pharmaceutical pricing and reimbursement systems, based on health technology assessment (HTA) that encompasses economic evaluations, are essential to an efficient sustainable health care system. The Egyptian Ministry of Health and Population was encouraged to establish a pharmacoeconomic unit, as an initial step, for the support of pricing and reimbursement decisions. We anticipate that standardization of reporting would lead to a progressive improvement in the quality of submissions over time and provide the Egyptian health care system with health economic evidence often unavailable in the past. Therefore, recommendations for pharmacoeconomic evaluations provide an essential tool for the support of a transparent and uniform process in the evaluation of the clinical benefit and costs of drugs that do not rely on the use of low acquisition cost as the primary basis for selection. These recommendations will help inform health care decisions in improving health care systems and achieving better health for the Egyptian population.

The Ebola virus has spread across several Western Africa countries, adding a significant financial burden to their health systems and economies. In this article the experience with Ebola is reviewed, and economic challenges and policy recommendations are discussed to help curb the impact of other diseases in the future. The West African Ebola virus disease epidemic started in resource-constrained settings and caused thousands of fatalities during the last epidemic. Nevertheless, given population mobility, international travel, and an increasingly globalized economy, it has the potential to re-occur and evolve into a global pandemic. Struggling health systems in West African countries hinder the ability to reduce the causes and effects of the Ebola epidemic. The lessons learned include the need for strengthening health systems, mainly primary care systems, expedited access to treatments and vaccines to treat the Ebola virus disease, guidance on safety, efficacy, and regulatory standards for such treatments, and ensuring that research and development efforts are directed toward existing needs. Other lessons include adopting policies that allow for better flow of relief, averting the adverse impact of strong quarantine policy that includes exaggerating the aversion behavior by alarming trade and business partners providing financial support to strengthen growth in the affected fragile economies by the Ebola outbreak. Curbing the impact of future Ebola epidemics, or comparable diseases, requires increased long-term investments in health system strengthening, better collaboration between different international organizations, more funding for research and development efforts aimed at developing vaccines and treatments, and tools to detect, treat, and prevent future epidemics.

In 2009, Greece entered into one of the most serious economic downturns in its modern history. In May 2010, the country was put under the supervision of Troika (EU, ECB and IMF). Retail pharmaceutical market with size c. a. € 6.5 bn in retail prices for 2009 (public pharmaceutical expenditure € 5.2 bn), was one of the main targets for change through the implementation of new policies and drastic spending cuts. The purpose of this study was to measure the impact that these new policies for pharmaceutical spending had and how this was attributed to the levers of price, market volume and product mix. MethOds: An economic model was used, based on IMS Hellas' and Hellenic Statistical Authority data, to measure the contribution that (a) price; (b) market volume; and (c) product mix had on the reduction in the size of the retail market for pharmaceuticals in the period 2009-2014. The detailed approach decomposes the market change, as measured in values, into those attributed to (a) price (assuming market volume and product mix are constant); (b) market volume (assuming prices and product mix are unchanged); (c) product mix. Results: The analysis indicated that, the major contributor in the reduction of the pharmaceutical market size was the price of medicines. It has been estimated that 87% of the reduction (> € 1.2 bn) is coming from price. Volume contributed an additional c. a. 38% (> € 0.5 bn) in the reduction of the size but, at the same time, it was partially offset from substitution with pricier medicines. cOnclusiOns: Price was the major driver for the reduction in the size of the retail pharmaceutical market during the period of crisis. Volume had an impact as well but it was partially offset by switch towards more expensive medicines.

Our analysis revealed the importance of population size and EPR implementation on drug price levels; however, EPR results in higher pharmaceutical prices in lower-income countries compared to non-pharmaceutical services.

Figure 1: Chart of the article selection process Figure 2: Chart of the number of included articles arranged by years Costs considered Method of economic evaluation* Study design* Type of studied intervention* Type of data Funding source Modeling Direct costs only Direct and indirect costs CEA CBA CUA CMA Randomized controlled trial Prospective cohort Retrospective database Modeling

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