Objective A systematic review was conducted to summarize government strategies aimed at controlling pharmaceutical prices in developing countries and their effects on relevant outcomes, and to qualitatively analyse eligible studies of pricing policy and their impact on expenditure and medicine prices. Methods Several databases, grey literature and Google Scholar were systematically searched, and reference lists of relevant studies were screened for full‐text studies published in Arabic or English between January 2000 and March 2016. Studies describing government pharmaceutical pricing strategies in developing countries and their effect were considered eligible. Key findings Twenty‐one studies were included in the explorative synthesis: sixteen covered Asian countries, three covered African countries and three from Latin and South America. Identified policies covered disease‐specific and essential medicines with some countries extending it to all medicine classes. Markup regulation (n = 7) was the most commonly used, followed by external reference pricing (n = 6) and cost‐plus (n = 5), promotion of generics use (n = 3), while tax exemptions were the least used policy (n = 2). Six of the twenty‐one studies were included in the qualitative synthesis. Markup regulation was similarly predominant in this latter synthesis. Although the implemented policies showed a measure of success, medicine prices appeared to be influenced by poor legislative framework, lack of pre‐/post‐implementation activities and noncompliance by various stakeholders. Conclusion Various internationally recognized pharmaceutical pricing policies are implemented in developing countries; however, these policies are not optimally adopted. Policymakers should tailor the pharmaceutical pricing policy to the nation taking into consideration macro‐ and microeconomic factors.

Objectives This study aimed at reviewing and analysing the pharmaceutical pricing policies implemented in two middle-east countries. Methods Official documents related to national pharmaceutical pricing policies were reviewed, and meetings with key informants in the registration and pricing departments in the Qatari and Lebanese ministries of public health were conducted. Key findings As of April 2017, the laws currently in effect in Qatar and Lebanon are based on the latest versions of decrees enacted in 2011 and 2005 respectively. Both countries have implemented similar pharmaceutical pricing policies which apply only to the private sectors in both countries. Landing price in Lebanon is either free-on-board (FOB) or cost-insurance-freight (CIF) while it is only CIF in Qatar. External reference pricing and mark-up regulations were two of the common policies identified in both countries. For external reference pricing, the basket of countries considered and the price adopted were different. Mark-ups were applied with different schemes along the pharmaceutical supply chain in each country with Qatar imposing an overall higher mark-up margin. Moreover, Qatar utilized health technology assessment whenever such economic evaluation studies were available at the time of medicine registration. These pricing strategies applied to both public and private sectors in Lebanon, while they only applied to the private sector in Qatar. Conclusions The pharmaceutical pricing policies implemented in Qatar and Lebanon are reflective of both the advancements in the human capital and financial resources of the nations and are in line with the World Health Organization-recommended pricing policies for developing countries.

BackgroundCardiovascular diseases are the leading cause of death in Lebanon and Qatar. When lifestyle modifications prove insufficient, medication becomes a cornerstone in controlling such diseases and saving lives. Price, availability, and affordability hinder the equitable access to medicines. The study aimed to assess prices, availability, and affordability of essential cardiovascular disease medicines in relation to pricing strategies in Qatar and Lebanon.MethodsA cross-sectional survey using a variant of the World Health Organization and Health Action International (WHO/HAI) methodology as outlined in “Measuring medicine prices, availability, affordability and price components” (2008), second edition, was adopted. Prices and availability of 27 cardiovascular medicines were collected from public and private dispensing outlets. For international comparison, prices were adjusted to purchasing power parity. Data was analyzed across multiple sectors, within and across countries.ResultsA total of 15 public and private outlets were surveyed in each country. Prices were more uniform in Qatar than in Lebanon. In the public sector, medicines were free-of-charge in Lebanon and priced lower than the international reference prices in Qatar. The ratio of medicine unit price to international reference price in the private sectors surveyed are significantly higher than the acceptable threshold of 4. This ratio of originator brands and lowest priced generics in Qatar were up to two and five times those in Lebanon, respectively, even after adjusting for purchasing power parity. However, prices of lowest priced generics in the private sector were at least 35% cheaper in Qatar and 65% cheaper in Lebanon than their comparative originator brands. Medicines were more available in the private sector in Lebanon than in Qatar, but only the originator brand availability in the public sector in Qatar exceeded the WHO target of more than 80%. While affordable in the public sector in Qatar, four out of thirteen medicines exceeded the threshold in all private sectors covered. Hence, only the public sector in Qatar had a satisfying level of availability and affordability.ConclusionsExcept for the Qatari public sector, medicine prices, availability, and affordability are falling short from targets. Key policy decisions should be implemented to improve access to medicines.

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max 169%) after including future medical costs. On average, the ICERs increased with V8,600 per QALY. ICERs that were lower than the relevant willingness-to-pay threshold (71%) did not exceed the threshold when future medical costs were included. The methodology of including future medical costs was insufficiently described in the submitted reimbursement dossiers, which hampered comparison. Conclusions: Although the inclusion of future medical costs had a variable impact on the ICERs, the relevant willingness-to-pay thresholds were not exceeded. It is therefore unlikely that the inclusion of these costs in the base case analysis would have influenced former reimbursement recommendations of ZIN.

Costs were expressed as 2018 GBP. Statistical analysis included descriptive statistics (t-tests, chi-squared tests) assessing differences in baseline characteristics, and Wilcoxon rank sum to test for differences between mean LOS. RESULTS: 46 patients (>18 years) across both audit periods were eligible for analysis, with no statistically significant differences in baseline characteristics observed between the two cohorts. Mean LOS was 8.19 days (SD: 6.59) in the warfarin cohort (n¼ 15) and 2.23 days (SD: 2.64) in the apixaban cohort (n¼31), a difference of -5.96 days (p0.001). Mean per-patient cost for overall healthcare resource utilisation was £3,506.99 (LOS ¼ £2,783.50 [79.4%], anticoagulation¼ £1.22 [0.03%], INR¼ £93.33 [2.7%], INR-related staff contacts¼ £611.07[17.4%], enoxaparin admin-istrations¼£17.87 [0.5%]) in the warfarin cohort, and £840.13 (LOS ¼ £757.50 [90.2%], anticoagulation¼ £82.63 [9.8%]) in the apixaban cohort, resulting in a 76% reduction in medical expenditure compared to warfarin. CONCLUSIONS: This study suggests that prescribing choice should not be determined by drug acquisition cost alone. The utilisation of apixaban in hospitalised, newly-diagnosed NVAF patients led to a shorter LOS, the avoidance of INR testing and administration of enoxaparin.