is a professor at the Research Centre for Pharmaceutical Care and Pharmaco-economics. He is a health economist and leads the Centre's research into the economics of medicines, medical devices and related products. His research interests focus on issues surrounding competition and regulation of the pharmaceutical industry, and economic evaluation of medicines and medical devices. Sandra De Costergraduated from the Katholieke Universiteit Leuven as a pharmacist. She spent two years in the pharmaceutical industry, where she participated in the regulatory affairs of herbal medicines. She then joined the Research Centre for Pharmaceutical Care and Pharmaco-economics as a research fellow. Her research interests focus on pharmacotherapy. In addition to this, she works part-time as a community pharmacist.Abstract The size of generic medicines retail markets varies widely among European countries, owing to differences in the policy environment surrounding generic medicines. This study aims to provide a comparative analysis of policy tools that European countries have used to develop their generic medicines market and to formulate recommendations for sustaining generic medicines markets. The European experience indicates that there is no single approach towards developing a generic medicines market. Penetration of generic medicines is more successful in countries that permit (relatively) free medicine pricing. Reference-pricing systems do not aid generic medicine use if the price of originator medicines falls to the reference price level. Physician budgets stimulate generic medicine use if accompanied by rewards/sanctions for budget surpluses/deficits, respectively. Generic substitution aids generic medicine use if it is financially attractive to pharmacists to substitute generic for originator medicines. Patient co-payment seems to affect demand for generic medicines. This study shows that coordinated government policies are critically needed in many European countries. To sustain the development of a generic medicines market, countries need to supplement supply-side policies, such as pricing reductions, by demandside policies that create incentives for physicians, pharmacists and patients to use generic medicines.

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This study aims to estimate annual savings from increased generic substitution in the retail market of 11 European countries in 2004. Savings from generic substitution were calculated for the top ten active substances by public expenditure on originator medicines in each country. For each active substance, average price levels weighted by volume of sales of medicines belonging to the group of originator medicines and to the group of generic medicines were calculated. The price difference between originator and generic medicines was multiplied by the volume of originator medicines to be substituted. The analysis considered that, following generic substitution, 5 per cent of market volume for each active substance would be made up by originator medicines and 95 per cent by generic medicines. Increased generic substitution for the top ten active substances generated total potential savings of around S 3bn, with country savings ranging from S 11m in Poland to S 1bn in Germany. Increased generic substitution would be expected to reduce public expenditure on originator medicines containing these active substances by at least 20 per cent in each country. Countries that pursue the development of their domestic generic medicines market, therefore, can expect to gain substantial savings from increased generic substitution.

The aim of the study was to analyse the clinical and economic indicators of the treatment of acute exacerbations of chronic obstructive pulmonary disease (COPD). The study focused specifically on antimicrobial therapy and the use of fluoroquinolones in the management of exacerbations. Data on the consumption of antibiotics to treat exacerbations in ambulatory care were derived from IMS Health. Also, an observational, retrospective analysis was carried out of patients who entered the clinical pathway for COPD exacerbations in University Hospitals Leuven. IMS Health data showed that there is a trend towards the increasing use of broad-spectrum penicillins and fluoroquinolones, and decreasing use of tetracyclines in the treatment of COPD exacerbations in ambulatory care in Belgium in the first half of the 2000s. The observational analysis enrolled 267 patients who were hospitalised between October 2000 and October 2005 to manage 359 exacerbations according to the clinical pathway. Median length of stay per exacerbation amounted to 10 days. Mean quality of life associated with an exacerbation was 74 using the Chronic Respiratory Disease Questionnaire. Median costs of hospital treatment amounted to euro5514 (third-party payer reimbursement and patient co-payment) per exacerbation. Treatment costs were driven by hospital stay (75% of total costs), diagnostic and laboratory tests (20%) and medication (5%). Antibiotics played a role in the hospital management of 75% of exacerbations. Fluoroquinolones were used to treat more severe exacerbations. Treatment of acute exacerbations of COPD imposes a significant clinical and economic burden on patients, the healthcare system and the society.

Background Approximately 1000 protein encoding genes common for vertebrates are still unannotated in avian genomes. Are these genes evolutionary lost or are they not yet found for technical reasons? Using genome landscapes as a tool to visualize large-scale regional effects of genome evolution, we reexamined this question. Results On basis of gene annotation in non-avian vertebrate genomes, we established a list of 15,135 common vertebrate genes. Of these, 1026 were not found in any of eight examined bird genomes. Visualizing regional genome effects by our sliding window approach showed that the majority of these "missing" genes can be clustered to 14 regions of the human reference genome. In these clusters, an additional 1517 genes (often gene fragments) were underrepresented in bird genomes. The clusters of “missing” genes coincided with regions of very high GC content, particularly in avian genomes, making them “hidden” because of incomplete sequencing. Moreover, proteins encoded by genes in these sequencing refractory regions showed signs of accelerated protein evolution. As a proof of principle for this idea we experimentally characterized the mRNA and protein products of four "hidden" bird genes that are crucial for energy homeostasis in skeletal muscle: ALDOA, ENO3, PYGM and SLC2A4. Conclusions A least part of the “missing” genes in bird genomes can be attributed to an artifact caused by the difficulty to sequence regions with extreme GC% (“hidden” genes). Biologically, these “hidden” genes are of interest as they encode proteins that evolve more rapidly than the genome wide average. Finally we show that four of these “hidden” genes encode key proteins for energy metabolism in flight muscle.

Actual retail prices and reimbursement tariffs for a neck brace and a knee brace exceeded prices based on estimated costs. Therefore, there appears to be scope for reducing tariffs.

4622 Background: Patient adherence to oral therapy is a critical issue in cancer treatment. The aim of this study is to investigate the prevalence and severity of non-adherence to OAD in mRCC and to identify factors predictive of non-adherence. Methods: Prospective observational multicenter trial performed at 11 Belgian academic and non-academic centers. All pts with mRCC starting OADs (sunitinib, pazopanib, everolimus or sorafenib) are eligible for the study. Pts are contacted by phone at baseline and at 1, 3, 6 and 12 months. At each contact, pts are asked to complete questionnaires investigating 1) medication adherence (MMAS), 2) patient satisfaction with treatment (CTSQ) and with treatment education (PS-CaTE), 3) the extent of information desire (EID), 4) quality of life (FACT-G and FKSI) and 5) the role of the pharmacist (SWiP). Adherence is measured using an electronic medication event monitoring system (MEMS, Aardex). Results: Between 02/2011 and 11/2011, 49 pts (m: 33, f: 16) with a median age of 63 years (range 25 - 87) have participated in the IPSOC study. Twenty-nine pts (64%) were treated with an OAD in first-line, 15 pts (33%) in second-line. With a median follow-up of 131 days (range 2 - 313) 45 pts (92%) claimed to be fully adherent to their treatment (based on MMAS and CTSQ data). Four patients indicated to have missed at least one dose, of whom two indicated they occasionally forgot their medication and two others interrupted treatment because of side effects. Based on MEMS data, mean adherence, defined as the percentage of days with at least the prescribed number of dosage taken, was 98.91%. Conclusions: The IPSOC study, the first to examine adherence to OAD among mRCC pts, shows that mRCC pts are almost fully adherent to treatment recommendations. This seems to be in contrast to adherence data for other, long-lasting, anti-cancer treatments. Further investigations will focus on the question whether extensive counseling and participation in side-effect programs contribute to the high percentage of adherence in this study.

ObjectiveThis study aims to use a pharmacoepidemiological approach to study the drug use of patients during the year prior to diabetes diagnosis (i.e. pre-diabetic patients) and control patients. Drug use might reveal cardiovascular, metabolic and/or endocrinological changes and help to identify indicators for active monitoring of Type 2 diabetes mellitus.MethodsA retrospective case-control study compared drug use of patients with a future diagnosis of diabetes (experimental patients) with patients without a diabetes diagnosis (control patients) based on community pharmacy records. An experimental patient had used oral hypoglycaemic drugs during 2005 or 2006. Experimental and control patients were matched in terms of age, gender and quarter of index date. Drugs were selected based on possible co-morbidities of diabetes. Drug use was expressed as a binary variable, indicating whether or not a patient took specific drugs. Drug use was compared between experimental patients during the year prior to diagnosis and control patients using the chi-squared test.ResultsOur dataset covered 5,064 patients (1,688 experimental and 3,376 control patients). A higher probability of taking cardiovascular drugs was observed for specific subgroups of patients with pre-diabetes as compared to control patients: this trend was observed for men as well as for women, for various cardiovascular drug classes, and for different age groups (p<0.05), although it was not always statistically significant for the 29-38 age group. For each selected age and gender group, patients with pre-diabetes had a higher probability of taking a combination of a lipid-modifying agent and an antihypertensive drug than control patients (p<0.005).ConclusionsUsing community pharmacy data, this study demonstrated that age and a characteristic drug use pattern could contribute to detecting pre-diabetes. There is a potential role for community pharmacists to follow up drug indicators of patients with a view to refer high-risk people for screening by a physician.