BackgroundAs part of the efforts to curb obesity, a new focus seems to be put on taxing foods that are perceived as being associated with obesity (eg, sugar-sweetened beverages and foods high in fat, sugar, and salt content) as a policy instrument to promote healthier diets.ObjectiveTo assess the possible effects of such taxation policies by identifying and analyzing all studies which investigate the impact of price increases on consumption, caloric intake, or weight outcomes.MethodsElectronic data bases were searched with appropriate terms and their combinations. Thereafter, abstracts were reviewed and studies were selected based on predefined criteria. The characteristics of the selected studies and the results were extracted in a special form and consequently were reviewed and synthesized.ResultsPrice increase may lead to a reduction in consumption of the targeted products, but the subsequent effect on caloric intake may be much smaller. Only a limited number of the identified studies reported weight outcomes, most of which are either insignificant or very small in magnitude to make any improvement in public health.ConclusionThe effectiveness of a taxation policy to curb obesity is doubtful and available evidence in most studies is not very straightforward due to the multiple complexities in consumer behavior and the underling substitution effects. There is need to investigate in-depth the potential underlying mechanisms and the relationship between price-increase policies, obesity, and public health outcomes.
A391review of Medline and EMBASE databases was conducted for the period 2000 -2013. The search sought to identify papers on the topic of assessment and reimbursement policy for rare diseases. Health policy studies, commentaries, and review articles were included. Clinical or economic studies of specific drugs or diseases were excluded. Information was extracted on assessment and reimbursement challenges and author recommendations for addressing these issues. Results: The literature review identified 726 papers; 49 met the inclusion criteria. The most frequently identified issues included multiplicity of orphan indications (34/49), high per-patient cost (32/49), and the difficulty in undertaking robust clinical and economic evaluations given limited evidence (32/49). Several authors commented on limitations of current health technology appraisal processes. The issue of equity and societal preference for funding rare diseases was highlighted in almost half of the papers (22/49). Lack of availability of alternative treatments was also considered an important factor. Suggestions for improvements to the assessment and reimbursement process included: greater use of registries (22/49), adjustment to preference weights used in cost effectiveness analysis (19/49) and conditional reimbursement and risksharing-schemes (12/49). Some authors advocated alternative pathways for assessing rare disease treatments including a specific approach utilising multi-criteria decision analysis. ConClusions: The debate on payer policy in rare diseases has grown in the last 5 years as concerns have increased about patient access to new medicines. While there is some consistency in the literature, there is as yet little consensus on how policy should be changed to address these issues.
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