Climate co-benefits of VOC control policies in China based on a cross-scale approach.

Volatile organic compounds (VOC) contributing to smog formation, have been an important indicator of atmospheric governance during China's "14th Five-Year Plan". VOC would be possibly incorporated into the scope of environmental protection tax, but previous studies have seldom explored impacts of VOC control policies at national and regional levels. Here, we design a national uniform VOC control policy, as well as two regionally differentiated policies based on regional disparities in PM2.5 concentrations and energy intensity by using a cross-scale dynamic computable general equilibrium (CGE) model. Our analysis is to assess the impacts of these policies on VOC, CO2, sulfur dioxide (SO2), nitrogen oxides (NOX), and PM2.5 emissions, air quality and environmental equity, and to estimate health benefits, policy costs and net benefits. We find that national and regionally differentiated VOC control policies generally lead to VOC emission reductions and generate co-benefits on emission reductions in CO2, SO2, NOX and PM2.5 at national and provincial levels. However, regional emission leakage exists due to differences in the provincial costs of VOC mitigation. The regionally differentiated VOC pricing policies are found to be more effective to enhance environmental equity than the uniform policy. In particular, the regionally differentiated VOC control policy based on provincial energy efficiency is found to be superior to other policies in terms of improve air quality. Furthermore, the human health benefits associated with VOC pricing policies would partially offset policy costs at both the national and regional levels. Our results suggest that policymakers would pay attention to developing regions with low energy efficiency which have the great emission reduction potential. Advanced producing technology and further end-of-pipe control measures to reduce non-combustion PM2.5 emissions are needed. VOC policy designed based on provincial energy efficiency provides great insights for environmental policy making to accomplish 2035 goal of building a Beautiful China.

Streamlined data-gathering techniques to estimate the price and affordability of healthy and unhealthy diets under different pricing scenarios.

OBJECTIVE: To determine the reliability of streamlined data-gathering techniques for examining the price and affordability of a healthy (recommended) and unhealthy (current) diet. We additionally estimated the price and affordability of diets across socio-economic areas and quantified the influence of different pricing scenarios. DESIGN: Following the Healthy Diets Australian Standardised Affordability and Pricing (ASAP) protocol, we compared a cross-sectional sample of food and beverage pricing data collected using online data and phone calls (lower-resource streamlined techniques) with data collected in-store from the same retailers. SETTING: Food and beverage prices were collected from major supermarkets, fast food and alcohol retailers in eight conveniently sampled areas in Victoria, Australia (n 72 stores), stratified by area-level deprivation and remoteness. PARTICIPANTS: This study did not involve human participants. RESULTS: The biweekly price of a healthy diet was on average 21 % cheaper ($596) than an unhealthy diet ($721) for a four-person family using the streamlined techniques, which was comparable with estimates using in-store data (healthy: $594, unhealthy: $731). The diet price differential did not vary considerably across geographical areas (range: 18-23 %). Both diets were estimated to be unaffordable for families living on indicative low disposable household incomes and below the poverty line. The inclusion of generic brands notably reduced the prices of healthy and unhealthy diets (≥20 %), rendering both affordable against indicative low disposable household incomes. Inclusion of discounted prices marginally reduced diet prices (3 %). CONCLUSIONS: Streamlined data-gathering techniques are a reliable method for regular, flexible and widespread monitoring of the price and affordability of population diets in areas where supermarkets have an online presence.

Modeling residential water demand: An approach based on household demand systems.

Most estimations of residential water demand are based on single-equation models that rely on assumptions that are most often not compatible with the fundamental principles of consumer theory. In this paper, we relax these assumptions by using a more flexible system of demand estimation, the Quadratic Almost Ideal Demand System (QUAIDS) (Banks et al., 1997) and reveal the existence in our sample of substitution and complementary patterns as well as non-linearities in Engel curves for water consumption. Water demand would not be, therefore, linear in income and separable from other goods consumed within the household. In this context the QUAIDS functional specification is expected to be more consistent with observed consumer behavior. Our results seem to confirm this expectation; when compared to the linear, log-linear and double-log models commonly used in water demand estimation, QUAIDS seems to produce a better overall fit and a better fit to the asymmetric shape of the real distribution of water consumption. This has important implications in terms of public policy, as it allows to explore how water policies interact with other goods consumed within the household (e.g. water-energy nexus or efficient household appliances). Furthermore, differential responses to pricing policies and taxes across the income distribution can be considered, thus contributing to avoid undesired redistributive effects and water poverty.

Guest Commentary: Fat and other taxes, lessons for the implementation of preventive policies.

Fat, sugar or sweetened beverage taxes are part of an overall public health nutrition approach to healthy eating. They are not approaches that on their own are likely to bring about change. Policy evidence from existing food tax implementation suggest that taxes need to be paralleled by subsidies and other interventions to encourage healthy eating. Such dual methods help not only contribute to nutrition outcomes but also ensure political support for food taxes. Politicians and policy makers are suspicious of taxes, using subsidies and revenue monies from taxes to support healthy eating is more likely to encourage both political and public support. Building support for policies is never just a matter of academic evidence. Public health advocates need to show more ambition by developing skills in implementing pricing policies to support healthy eating. Key opponents to taxes are the food industry who use a range of arguments to prevent taxation being implemented. Public health advocates are weak in tackling the issues of corporate power and providing evidence to maintain policy and political support. The public health movement needs to continue to develop the political will among politicians and the public for taxes on food. A new way of looking at policy formation is required and this includes addressing the power of corporate interests and the role of professionals in shaping or combating these influences.

A critical review of methodologies used in pharmaceutical pricing policy analyses.

Robust evidence from health policy research has the potential to inform policy-making, but studies have suggested that methodological shortcomings are abundant. We aimed to identify common methodological weaknesses in pharmaceutical pricing policy analyses. A systematic review (SR) of studies examining pharmaceutical pricing policies served as basis for the present analysis. We selected all studies that were included in the SR (n = 56), and those that were excluded from the SR due to ineligible study designs only (n = 101). Risk of bias was assessed and specific study design issues were recorded to identify recurrent methodological issues. Sixty-one percent of studies with a study design eligible for the SR presented with a high risk of bias in at least one domain. Potential interference of co-interventions was a source of possible bias in 53% of interrupted time series studies. Failing to consider potential confounders was the primary cause for potential bias in difference-in-differences, regression, and panel data analyses. In 101 studies with a study design not eligible for the SR, 32% were uncontrolled before-after studies and 23% were studies without pre-intervention data. Some of the methodological issues encountered may be resolved during the design of a study. Awareness among researchers on methodological issues will help improve the rigor of health policy research in general.

Is minimum unit pricing for alcohol having the intended effects on alcohol consumption in Scotland?

BACKGROUND AND AIMS: The Scottish Government introduced minimum unit pricing (MUP) for alcohol on 1 May 2018. This means retailers in Scotland cannot sell alcohol to consumers for less than £0.50 per unit (1 UK unit = 8 g ethanol). The Government intended the policy to increase the price of cheap alcohol, cut alcohol consumption overall and particularly among those drinking at hazardous or harmful levels, and ultimately reduce alcohol-related harm. This paper aims to summarise and assess the evidence to date evaluating the impact of MUP on alcohol consumption and related behaviours in Scotland. ARGUMENT: Evidence from analyses of population-level sales data suggest, all else being equal, MUP reduced the volume of alcohol sold in Scotland by ~ 3.0% to 3.5%, with the largest reductions affecting cider and spirits sales. Analyses of two time series datasets on household-level alcohol purchasing and individual-level alcohol consumption suggest reductions in purchasing and consumption among those drinking at hazardous and harmful levels, but offer conflicting results for those drinking at the most harmful levels. These subgroup analyses are methodologically robust, but the underlying datasets have important limitations as they rely on non-random sampling strategies. Further studies identified no clear evidence of reduced alcohol consumption among those with alcohol dependence or those presenting to emergency departments and sexual health clinics, some evidence of increased financial strain among people with dependence and no evidence of wider negative outcomes arising from changes in alcohol consumption behaviours. CONCLUSIONS: Minimum unit pricing for alcohol in Scotland has led to reduced consumption, including among heavier drinkers. However, there is uncertainty regarding its impact on those at greatest risk and some limited evidence of negative outcomes, specifically financial strain, among people with alcohol dependence.

Comparing taxes on alcoholic beverages in the Region of the Americas.

BACKGROUND AND AIMS: Excise taxes represent one of the most cost-effective policies to reduce the harmful use of alcohol. Existing information about their design is limited and no standardized metric has been used to compare tax levels in the Region of the Americas. This study aimed to compare alcohol excise tax policies throughout the Americas, compare tax levels and consider opportunities to improve the impact of excise taxes on alcohol consumption and health. DESIGN AND SETTING: Descriptive analysis using a method developed by the Pan American Health Organization and adapted from the World Health Organization's tobacco tax monitoring. Data were collected by surveying ministries of finance and reviewing tax legislation in effect as of November 2020 in the Region of the Americas. MEASUREMENTS: Tax policy design indicators, taxes as a percentage of the retail price of the most-sold brand of beer, wine and spirits, including a weighted average indicator across beverage types, and tax levels per standard drink (10 g ethanol) in international dollars at purchasing power parity. FINDINGS: Thirty-three countries in the Americas (94%) apply excise taxes on alcoholic beverages, with Argentina and Uruguay not applying them to wine. There is significant heterogeneity in excise tax design across countries and beverage types. Only a third of amount-specific excise taxes are regularly adjusted to avoid erosion. Regional median excise taxes represent the highest share of the price for spirits (21.4%) and the lowest for wine (11.0%). The regional median consumption-weighted average excise tax share across all beverage types is 12.0%. Excise tax shares are generally higher in Latin America than in the Caribbean and Canada. Excise tax levels per standard drink are generally lower for spirits than for other beverages. CONCLUSIONS: Alcohol excise tax policies vary significantly across the Americas, often reflecting national consumption patterns. To maximize their public health impact, tax rates could be increased and tax designs improved, particularly to ensure higher tax burdens on high-strength drinks.

Implementation of medicines pricing policies in sub-Saharan Africa: systematic review.

BACKGROUND: High medicine prices contribute to increasing cost of healthcare worldwide. Many patients with limited resources in sub-Saharan Africa (SSA) are confronted with out-of-pocket charges, constraining their access to medicines. Different medicine pricing policies are implemented to improve affordability and availability; however, evidence on the experiences of implementations of these policies in SSA settings appears limited. Therefore, to bridge this knowledge gap, we reviewed published evidence and answered the question: what are the key determinants of implementation of medicines pricing policies in SSA countries? METHODS: We identified policies and examined implementation processes, key actors involved, contextual influences on and impact of these policies. We searched five databases and grey literature; screening was done in two stages following clear inclusion criteria. A structured template guided the data extraction, and data analysis followed thematic narrative synthesis. The review followed best practices and reported using PRISMA guidelines. RESULTS: Of the 5595 studies identified, 31 met the inclusion criteria. The results showed thirteen pricing policies were implemented across SSA between 2003 and 2020. These were in four domains: targeted public subsides, regulatory frameworks and direct price control, generic medicine policies and purchasing policies. Main actors involved were government, wholesalers, manufacturers, retailers, professional bodies, community members and private and public health facilities. Key contextual barriers to implementation were limited awareness about policies, lack of regulatory capacity and lack of price transparency in external reference pricing process. Key facilitators were favourable policy environment on essential medicines, strong political will and international support. Evidence on effectiveness of these policies on reducing prices of, and improving access to, medicines was mixed. Reductions in prices were reported occasionally, and implementation of medicine pricing policy sometimes led to improved availability and affordability to essential medicines. CONCLUSIONS: Implementation of medicine pricing policies in SSA shows some mixed evidence of improved availability and affordability to essential medicines. It is important to understand country-specific experiences, diversity of policy actors and contextual barriers and facilitators to policy implementation. Our study suggests three policy implications, for SSA and potentially other low-resource settings: avoiding a 'one-size-fits-all' approach, engaging both private and public sector policy actors in policy implementation and continuously monitoring implementation and effects of policies. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020178166.

Pricing Policies of Green Dual-Channel Supply Chain with Fairness Concerns and Altruistic Preferences Based on Consumers' Environmental Awareness and Channel Preference.

Taking into consideration fairness concerns and altruistic preferences of manufacturers, this paper aims to propose a green dual-channel supply chain that incorporates consumers' environmental awareness (CEA) and channel preference. The purpose of this work is to explore and further compare the optimal outcomes in a green dual-channel supply chain in three scenarios, which are the fairness-neutrality scenario (Model N), the manufacturer is concerned with fairness scenario (Model F), and the manufacturer has altruistic preference (Model A), respectively. The game-theoretical models with different fairness preferences, comparative, and numerical analyses are used to put forward the impacts of consumers' channel preference and CEA on pricing, profits, and utilities, and to identify the differences in decisional outcomes between the three models. The results indicate that CEA always contributes to developing the green market while adversely affecting common products. Moreover, consumers' channel preferences might enable the manufacturer and retailer to enhance profitability under certain conditions. The findings also reveal that manufacturer's fairness concerns can possibly increase the demand for green products but impair the overall performance of the supply chain in general. Moreover, while the manufacturer's altruistic preference benefits the retailer's profits, it has a detrimental effect on the performance of the green supply chain. The practical implications of this research come to promote green consumption and increasing consumer awareness of environmental protection are effective ways to develop a green supply chain. It is also important to note that in order to maintain the durability and stability of the sup-ply chain, the manufacturer must maintain a moderate level of fairness preference behaviors so that downstream retailers will remain enthusiastic about establishing long-term relationships.

How value-based policy interventions influence price negotiations for new medicines: An experimental approach and initial evidence.

BACKGROUND: Various forms of value-based pricing policies for new medicines have recently been introduced in OECD countries. While these initiatives are expected to have a positive impact on societal outcomes such as availability, affordability and value for money, scientific evidence on this impact is scarce due to confidential agreements. OBJECTIVE: We aimed to assess the impact of value-based policy interventions in price negotiations on patient benefit in an experimental setting. METHODS: An online experiment was conducted (n = 269). Participants were randomly assigned into the active role of either a buyer or seller in two intervention groups (cost-benefit, risk-sharing) and one control group. Decisions had real monetary consequences on other participants and through donations to a patient association. RESULTS: Patient access, benefit and value for money were higher in the cost-benefit group than in the risk-sharing group. An available alternative to the agreement led to higher price offers. This effect was weaker in the cost-benefit group. CONCLUSIONS: Outcomes of price negotiations on patient benefit depend on the alternatives available for failed or delayed negotiations. A shared but voluntary valuation framework might increase patient access, benefit, and value for money. The cost containment effect of risk-sharing agreements may be offset by the negative impact on overall patient benefit. Further development of the approach could provide support for policy design of pharmaceutical pricing regulations.

Medicines for Europe - 16th Legal Affairs Conference (June 29-July 1, 2022 - Barcelona, Spain).

Medicines for Europe held its 2022 annual conference in Sitges, Spain, from June 29 to July 1. Many topics were discussed including future-proofing healthcare systems in the E.U., methods to build a sustainable European ecosystem to incentivize the development of value-added medicines (VAMs), how to reshape national market policies and build a strong European co-operation to prevent shortages. In addition, attendants discussed key challenges and barriers that need to be addressed to ensure the E.U. remains a leader and an innovator in medicines manufacturing, as well as national strategies and practices influencing the sustainability of the biosimilar medicines market and patient access to biological medicines.

Addressing the medicines access challenge through balance, evidence, collaboration and transparency: key take-away lessons of the 4th PPRI Conference.

The 4th PPRI Conference, held in Vienna in October 2019, addressed issues related to equitable and affordable access to medicines. A multi-stakeholder audience from around the globe discussed solutions and best practice models for current challenges such as high-priced medicines, limitations of current pricing and reimbursement policies and tight budgets for health technologies. A multi-faceted approach (so-called balance, evidence, collaboration and transparency/BECT strategy) was also discussed. This includes an improved balance of different interests and policy areas, generation of relevant evidence, collaboration between countries and stakeholders, and transparency, and was considered as the most promising pathway for the future.

The Ethics of Taxing Sugar-Sweetened Beverages to Improve Public Health.

The World Health Organization highlights fiscal policies as priority interventions for the promotion of healthy eating in its Action Plan for the Prevention and Control of Non-communicable Diseases. The taxation of sugar sweetened beverages (SSBs) in particular is noted to be an effective measure, and SSBs taxes have already been implemented in several countries worldwide. However, although the evidence base suggests that this will be effective in helping to combat rising obesity rates, opponents of SSBs taxation argue that it is illiberal and paternalistic, and therefore should be avoided. Bioethical analysis may play an essential role in clarifying whether policymakers should adopt SSBs taxes as part of wider obesity strategy. In this article we argue that no single ethical theory can account for the complexities inherent in obesity prevention strategy, especially the liberal theories relied upon by opponents of SSBs taxation. We contend that a pluralist approach to the ethics of SSBs taxation must be adopted as the only suitable way of accounting for the multiple overlapping, and sometimes, conflicting factors that are relevant to determining the moral acceptability of such an intervention.

Optimal price regulations in international pharmaceutical markets with generic competition.

In a two-country (home and foreign) model in which the home producer of a branded pharmaceutical product faces generic competition in each market, we analyze home's optimal policy choices regarding two major types of price regulations: external reference pricing (ERP) and direct price controls. Home's nationally optimal ERP policy lowers domestic price while maintaining the firm's export incentive. This ERP policy results in a negative international price spillover that the foreign country can (partly) offset via a local price control. Generic competition in either market reduces home's welfare gain from instituting an ERP policy. Weaker competition abroad or a greater weight on firm profits relative to consumer surplus in home's welfare function makes it more likely that home prefers an ERP policy to a price control. While international integration of national generic markets can improve welfare, such is not the case if it causes home to relax its ERP policy.

Systematic reviews of ten pharmaceutical pricing policies - a research protocol.

BACKGROUND: High prices of pharmaceutical products are an increasing challenge in high- and low-income countries. Governments in many countries have implemented pricing policies to ensure affordability of medicines to patients and healthcare systems. The World Health Organization published in 2015 the Guideline on Country Pharmaceutical Pricing Policies, which was based on a series of evidence reviews in the preceding years.As part of the ongoing update of this guideline, we present a protocol for 10 systematic literature reviews on pharmaceutical pricing policies to be covered by the updated guideline. METHODS: The systematic literature reviews will be undertaken according to the principles embodied in the Cochrane Handbook and Centre for Reviews and Dissemination. The interventions studied are pharmaceutical pricing policies implemented by public institutions or a group of purchasing organizations/individuals (e.g. health services). Studies reporting price, volume, availability and/or affordability as the primary outcomes will be eligible for inclusion. Studies in any country or jurisdiction, in any language and in any setting published in 2004 or later are eligible. Eligible study designs are randomized and non-randomized trials, and observational studies including cohort studies, panel data analyses, comparative time series design (including interrupted time-series and repeated measures studies), and controlled before-after studies. A list of 21 databases of peer-reviewed and grey literature will be searched, along with supplementary searches of relevant national and international organizational and governmental websites. Risk of bias will be assessed according to the Cochrane Effective Practice and Organisation of Care (EPOC) guidelines. A summary table according to the EPOC Worksheets for preparing a Summary of Findings table (SoF) using GRADE will be provided. DISCUSSION: The results of the review will be used as part of the update of the WHO Guideline on Country Pharmaceutical Pricing Policies. The current protocol may serve as an example for performing systematic literature reviews to inform policy makers.

Comparing alcohol taxation throughout the European Union.

BACKGROUND AND AIMS: The World Health Organization recommends increasing alcohol taxes as a 'best-buy' approach to reducing alcohol consumption and improving population health. Alcohol may be taxed based on sales value, product volume or alcohol content; however, duty structures and rates vary, both among countries and between beverage types. From a public health perspective, the best duty structure links taxation level to alcohol content, keeps pace with inflation and avoids substantial disparities between different beverage types. This data note compares current alcohol duty structures and levels throughout the 28 European Union (EU) Member States and how these vary by alcohol content, and also considers implications for public health. DESIGN AND SETTING: Descriptive analysis using administrative data, European Union, July 2018. MEASUREMENTS: Beverage-specific alcohol duty rates per UK alcohol unit (8 g ethanol) in pounds sterling at a range of different alcoholic strengths. FINDINGS: Only 50% of Member States levy any duty on wine and several levy duty on spirits and beer at or close to the EU minimum level. There is at least a 10-fold difference in the effective duty rate per unit between the highest- and lowest-duty countries for each beverage type. Duty rates for beer and spirits stay constant with strength in the majority of countries, while rates for wine and cider generally fall as strength increases. Duty rates are generally higher for spirits than other beverage types and are generally lowest in eastern Europe and highest in Finland, Sweden, Ireland and the United Kingdom. CONCLUSIONS: Different European Union countries enact very different alcohol taxation policies, despite a partially restrictive legal framework. There is only limited evidence that alcohol duties are designed to minimize public health harms by ensuring that drinks containing more alcohol are taxed at higher rates. Instead, tax rates appear to reflect national alcohol production and consumption patterns.

Pharmaceutical Pricing Policies and Procedures in Saudi Arabia: A Narrative Review.

From inception, the health care system in Saudi Arabia has ensured the availability of health care facilities to its people. This article discusses the pharmaceutical pricing policies and the impact of health drug prices on the public in the Kingdom of Saudi Arabia. A review of government and Saudi Food and Drug Authority (SFDA) policy documents, guidelines, and articles published in PubMed and other indexed journals (N = 10) was performed to identify the relevant literature. Results showed that the government appears poised and focused on the availability of better health care facilities to the Saudi population. The pharmaceutical market in Saudi Arabia commands a large portion of the pharmaceuticals market share in the entire Middle East region. The government, through the SFDA, sets the prices of pharmaceutical products. There are occasional price variations, which are induced by a number of factors. However, because the Saudis enjoy free health care coupled with the recent introduction of a compulsory health insurance policy, the impact of price variation is not felt. In addition, the Saudis prefer using branded medicines. The SFDA plays a major role in price regulation by setting up rules for pharmaceutical product pricing. However, there appears to be little or no impact of pharmaceutical price variation in Saudi Arabia because of better earning power among the population and free health care access to public health facilities.

Institutionalizing health technology assessment for priority setting and health policy in Latin America: from regional endeavors to national experiences.

In this paper, we provide a short summary of recent trends and key issues regarding the current status of health technology assessment (HTA) in Latin America. Initially, we describe worldwide and region-wide initiatives that foster the institutionalization of HTA for decision making and health policy in our region. Then, we describe some countries in the region that are worth mentioning for their application of HTA at a national level. The target audiences are those researchers and decision makers interested in following HTA in our region.

¿Cuál es el impacto de introducir competencia en el mercado farmacéutico sobre el precio de los medicamentos?: síntesis rápida de evidencia / What is the impact of introducing competition in the pharmaceutical market on drug prices?: rapid evidence synthesis

ANTECEDENTES Y OBJETIVO La decisión de suscribir el acuerdo internacional Trans Pacific Partnership (TPP) promovido por EEUU, involucra el trabajo conjunto de diversos sectores del Estado. En ese sentido, este acuerdo tendría ciertas implicancias para el sector salud y, específicamente, para el mercado de fármacos en Chile. El TPP traería consigo cambios en la protección de información no divulgada, nuevos indicaciones clínicas y usos descubiertos, lo que impactaría fuertemente en el mercado de productos de síntesis biológica. En este contexto, el Departamento de Políticas Farmacéuticas solicita esta síntesis de evidencia con el objetivo de conocer si la introducción de competencia en el mercado de medicamentos generaría una reducción en el precio que los usuarios pagarían por estos productos. METODOLOGÍA Se formuló una estrategia de búsqueda para ser utilizada en las bases de datos PubMed, Cochrane Library, PDQ y Health System Evidence el objetivo de identificar revisiones sistemáticas del tema. Al no encontrar, se seleccionaron estudios primarios realizados en los últimos 5 años que abordaran la pregunta definida. No se incluyeron artículos que no abordaran directamente la intervención definida, tales como intervenciones para regular precios (precio de referencia, precio mínimo, reembolso máximo), drogas falsas, estudios que no incluyeran el precio o el gasto como resultado. RESULTADOS El resumen no utiliza revisiones sistemáticas -Los estudios considerados en esta síntesis rápida muestran que el ingreso de competencia al mercado de medicamentos reduce el precio promedio de venta. -El efecto se debe a la entrada de nuevos productos, el aumento de la participación de mercado de los competidores (en ventas) y el número de competidores en un mercado particular. -Dada su naturaleza más compleja, los medicamentos biosimilares necesitan establecer mecanismos costosos de bioequivalencia, lo que constituiría barreras de ingreso al mercado. -Producto de una escasa competencia en el mercado, se podrían generar pseudogenéricos, los cuales generarían un efecto paradójico (alza en los precios), al capturar gran participación de mercado o realizar altas inversiones en publicidad.