Lista de leitura

Jan/2017:

In this article we argue that the social value of health research should be conceptualized as a function of both the expected benefits of the research and the priority that the beneficiaries deserve. People deserve greater priority the worse off they are. This conception of social value can be applied for at least two important purposes: (1) in health research priority setting when research funders, policy-makers, or researchers decide between alternative research projects; and (2) in evaluating the ethics of proposed research proposals when research ethics committees (RECs) assess whether the social value of the research is sufficient to justify the risks and burdens to research participants and others. In assessing how far a proposed research project will advance the interests of people who are more disadvantaged, research priority setters and RECs should examine (at least) the diseases that the research targets and the type of research. Just as certain diseases impose a greater burden on people who are more disadvantaged, so certain types of intervention and forms of research are more likely to benefit people who are more disadvantaged. We outline which populations are likely to be representative of the global worst off and identify what types of health research, and which disease categories, are priorities for these populations.

Using publicly available data, we analysed funding for NID research in the European Union’s (EU’s) 7th Framework Programme for Research and Technological Development (FP7), which ran from 2007 to 2013. During FP7, the EU provided €169 million for 65 NID research projects, and thereby placed itself among the top global funders of NID research. Average annual FP7 investment in NID research exceeded €24 million, triple that committed by the EU before the launch of FP7. FP7 NID projects involved research teams from 331 different institutions in 72 countries on six continents, underlining the increasingly global nature of European research activities. NID research has remained a priority in the current EU Framework Programme for research and innovation, Horizon 2020, launched in 2014. This has most notably been reflected in the second programme of the European and Developing Countries Clinical Trials Partnership (EDCTP), which provides unprecedented opportunities to advance the clinical development of new medical interventions against NIDs. Europe is thus better positioned than ever before to play a major role in the global fight against NIDs.

Achieving the PCT-NTD targets for 2020 will yield significant economic benefits to affected individuals. Despite large uncertainty, these benefits far exceed the investment required by governments and their development partners within all reasonable scenarios. Given the concentration of the NTDs among the poorest households, these investments represent good value for money in efforts to share the world’s prosperity and reduce inequity.

We linked all company-verified antiretroviral (ARV) patent data (1,260 patents for 12 drugs) from a World Intellectual Property Organization patent study on the 2013 World Health Organization’s (WHO) Model List of Essential Medicines to all available matching procurement records in the WHO’s Global Price Reporting Mechanism. We then cross referenced these with lists of legal flexibilities which facilitate generic access where patents have been granted (e.g., supplier companies’ patent non-enforcement policies, and voluntary and compulsory licenses).

Voluntary pooled procurement significantly reduced the price of 600 mg generic Efavirenz between 2009 and 2013. Voluntary pooled procurement therefore offers a potentially effective strategy for the reduction in HIV drug prices and the improvement of technical efficiency in HIV programming. Further work is required to establish if these findings hold also for other drugs.

Considerando que a população inicialmente estimada no RFMG fosse atendida em sua totalidade no PFPB, haveria um custo incremental de R$ 139.324.050,19. A análise de Monte Carlo mostrou-se favorável ao RFMG. Foram realizadas 10 mil simulações resultando no valor médio de R$ 114.053.709,99 para RFMG e de R$ 254.106.120,65 para o FPB. O Brasil apresenta uma formulação avançada de políticas públicas na saúde. A Política Nacional de Medicamentos enfatiza a necessidade de fortalecimento da assistência farmacêutica para além da mera aquisição. O modelo público, coerente com princípios e diretrizes do SUS, apresenta-se com condições mais adequadas para garantir assistência integral e universal de qualidade. A avaliação econômica reforça essa afirmativa, pois encontrou maior eficiência na alternativa de aplicação dos recursos diretamente na rede pública.

Foram incluídos 866 ensaios clínicos, 88 identificados no ReBEC e 778 no ClinicalTrials.gov; 73 (8,5%) eram de fase I, 610 (70,5%) de fases II e III e 183 (21%) de fase IV. Foram identificados 38 ensaios (4%) enfocando as doenças relacionadas à pobreza. Quanto à carga de doenças, 734 (84,8%) ensaios abordaram as doenças não transmissíveis, que de fato representam a maior carga de doença no Brasil. A indústria farmacêutica foi a grande responsável pelo desenvolvimento de ensaios clínicos de medicamentos (55,3%). O financiamento privado predominou (57,1%); entretanto, considerando-se apenas os estudos com doenças da pobreza, 63,1% foram financiados por recursos públicos.

Conclusions: Competitive large-scale generic manufacture could allow supplies of treatment for 5–10 times more MDR-TB cases within current procurement budgets.

Results: Target prices were £411 per cycle for bortezomib, £9 per month for dasatinib, £852 per month for everolimus and £10 per month for gefitinib. Compared with current list prices in England, these target prices would represent reductions of 74–99.6%. Patent expiry dates were bortezomib 2014–22, dasatinib 2020–26, everolimus 2019–25 and gefitinib 2017. The total global eligible treatment population in 1 year is 769 736.

Conclusions: Our findings demonstrate that affordable drug treatment costs are possible for novel cancer drugs, suggesting that new therapeutic options can be made available to patients and doctors worldwide. Assessing treatment cost estimations alongside cost-effectiveness evaluations is an important area of future research.

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