Economic analysis of drug policies on antibiotics and risk-sharing contracts stars

Abstract

This thesis, entitled Economic analysis of drug policies: antibiotics and risk-sharing contracts, is part of the research line in Health Economics of the Doctoral Programme in Business Economics of the University of La Rioja. The development of this thesis has been carried out within the Research Group in Health Economics of the Faculty of Business Sciences during the academic period 2017-2022. It is a thesis by compendium of five articles. Four publications analyze the economic impact of various economic and health policies on the prescription of antibiotics and another publication analyzes the perceptions of health professionals on the use of joint venture contracts for the introduction of gene therapies in the health system: Rojas García P, Antoñanzas Villar F. Risk Sharing Contracts in the national health care system: Perceptions of health care professionals. Revista Española de Salud Pública. 2018; 92: e201807041. Impact factor JCR (2018): 0,635 (Q4) Rojas García P, Antoñanzas Villar F. Assessment of the quality of antibiotics prescription in a regional health system. Revista Clínica Española. 2021; 221: 497-508. https://doi.org/10.1016/j.rce.2020.04.015. Impact factor JCR (2019): 1,304 (Q3) Rojas García P, Antoñanzas Villar F. Effects of economic and health policies on the consumption of antibiotics in a Spanish region. Expert Review of Pharmacoeconomics & Outcomes Research. 2019. doi: 10.1080/14737167.2019.1647105. Impact factor JCR (2019): 2,032 (Q2) Rojas García P, Antoñanzas Villar F. Policies to Reduce Antibiotic Consumption: The Impact in the Basque Country. Antibiotics. 2020; 9, 423: doi:10.3390/antibiotics9070423. Impact factor JCR (2019): 3,893 (Q1) Rojas García P, Antoñanzas Villar F. Analysis of the prescription of antibiotics during the implementation of COVID-19 personal protection measures in a regional health system. ClinicoEconomics and Outcomes Research. 2021; 13 (927-36) Impact factor SJR (2020): 0,59 (Q1) Likely, drugs constitute the most regulated economic good subject to an uncountable number of policies addressing every step of their development: trials in animals and humans, patent protection of the molecule, production plants, international approval (e.g. Food and Drug Administration -USA-, European Medicines Agency -EU-), package and handling, marketing authorisation by national authorities, price decision and public funding, prescription and administration, international trade, regional, national and international surveillance systems for safety purposes, health outcomes analysis, etc. These policies have important economic consequences in the chain of participants in addition to other health and equity implications. This thesis has focused the attention towards the analysis of two sets of policies: the new type of agreements that pursue to guarantee the health outcomes of the drug linking its payment by the public health system to the benefits obtained by patients, and those regulations that have consequences in the prescription of antibiotics. The reasons behind this selection are mostly derived from the importance of these agreements to facilitate the prescription of new advanced therapies, whose unitary costs are over one million euros, with high uncertainties about the durability of their health outcomes (namely, gene and cell therapies), and also due to the growing consciousness and acknowledgement that infectious diseases have big impacts in society´s welfare. Furthermore, the practical reason that the research group of health economics was conducting two projects on these two topics also contributed to their selection.