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1.
Expert Rev Pharmacoecon Outcomes Res ; 19(6): 619-626, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31721598

RESUMO

Introduction: In recent decades, medical devices (MDs) have increasingly become an integral part of patient care. However, when it comes to designing and appraising economic models, researchers typically follow pharmaceutical templates (e.g. CHEERS) to assess their economic viability. This study evaluates the generalizability of four device-specific criteria, as recommended by the recent MedtechHTA project, of learning curve, incremental innovation, dynamic pricing, and organizational impact with a broader group of MDs including diagnostics and implantables. The purpose was to determine the applicability of these criteria to a broader range of MDs.Areas Covered: We determined the extent to which these criteria could be applied to each device type and attempted to identify common themes. We performed a literature search using PubMed and Google of a range of devices to understand the clinical significance, operation, and economic viability.Expert Opinion: Our findings suggest that the four characteristics are not applicable to all device types. Prior evaluation of a device's intrinsic properties (such as longevity and device location) and its FDA risk classification could help to indicate the applicability of the criteria. Documenting this process when assessing the additional four criteria on the CHEERS checklist would improve the transparency of future economic evaluations.


Assuntos
Equipamentos e Provisões/economia , Modelos Econômicos , Avaliação da Tecnologia Biomédica/métodos , Lista de Checagem , Análise Custo-Benefício/métodos , Humanos , Avaliação da Tecnologia Biomédica/economia
2.
Med Biol Eng Comput ; 57(10): 2215-2230, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31399897

RESUMO

Maintenance is a crucial subject in medical equipment life cycle management. Evidence-based maintenance consists of the continuous performance monitoring of equipment, starting from the evidence-the current state in terms of failure history-and improvement of its effectiveness by making the required changes. This process is very important for optimizing the use and allocation of the available resources by clinical engineering departments. Medical equipment maintenance is composed of two basic activities: scheduled maintenance and corrective maintenance. Both are needed for the management of the entire set of medical equipment in a hospital. Because the classification of maintenance service work orders reveals specific issues related to frequent problems and failures, specific codes have been applied to classify the corrective and scheduled maintenance work orders at Careggi University Hospital (Florence, Italy). In this study, a novel set of key performance indicators is also proposed for evaluating medical equipment maintenance performance. The purpose of this research is to combine these two evidence-based methods to assess every aspect of the maintenance process and provide an objective and standardized approach that will support and enhance clinical engineering activities. Starting from the evidence (i.e. failures), the results show that the combination of these two methods can provide a periodical cross-analysis of maintenance performance that indicates the most appropriate procedures. Graphical abstract The left side shows a block diagram of the process needed to calculate the proposed set of KPIs, starting from technological, organizational and financial data. On the upper right it is shown an example of scheduled maintenance analysis for a specific class of equipment (legend in the article body). The bottom right part shows how the KPIs can be implemented in a business intelligence dashboard.


Assuntos
Equipamentos e Provisões , Engenharia Biomédica , Equipamentos e Provisões/economia , Manutenção , Telemetria
4.
Aten. prim. (Barc., Ed. impr.) ; 51(6): 359-366, jun.-jul. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185716

RESUMO

Objetivo: Describir el uso de dispositivos sanitarios de las personas con cronicidad avanzada, cuantificando y caracterizando el coste de dicho consumo para sugerir mejoras en los modelos de atención. Diseño: Estudio observacional, analítico y prospectivo durante 3 años de una cohorte de personas con cronicidad avanzada. Emplazamiento: Tres equipos de atención primaria (EAP) de Osona, Cataluña. Participantes: Un total de 224 personas identificadas como enfermos avanzados mediante una estrategia poblacional sistemática. Mediciones principales: Edad, sexo, tipo de domicilio, trayectoria final de vida; uso, tipo y coste de los recursos en atención primaria, urgencias, por equipos de paliativos o de hospitalización (en agudos o atención intermedia). Resultados: Se realizaron una media de 1,1 ingresos al año (estancia media = 6 días), el 74% en hospitales de atención intermedia. El 93,4% del tiempo los pacientes vivieron en la comunidad, realizando un contacto semanal con el EAP (45,1% en domicilio). El coste medio diario fue 19,4euros, siendo los principales capítulos la hospitalización de atención intermedia (36,5%), la actividad EAP (29,4%) y los ingresos en agudos (28,6%). Los determinantes de menor coste serían la trayectoria fragilidad/demencia (p < 0,001), vivir en una residencia (p < 0,001) y el sobreenvejecimiento (p < 0,001). Hay ciertas diferencias en el comportamiento de los EAP en el coste global y en recursos comunitarios (p < 0,05). Conclusiones: Los consumos en hospitalización intermedia y atención primaria son más relevantes que las estancias en centros de agudos. Los contextos residencial y domiciliario son importantes para atender con efectividad y eficiencia, especialmente cuando los EAP se preparan para ello


Objective: To describe the use of health resources of people with advanced chronicity, quantifying and characterizing its cost to suggest improvements in health care models. Design: Observational, analytical and prospective study during 3 years of a cohort of people with advanced chronicity. Location: Three primary care teams (EAP) of Osona, Cataluña. Participants: 224 people identified as advanced patients through a systematic population strategy. Main measurements: Age, sex, type of home, end-of-life trajectory; use, type and cost of resources in primary care, emergencies, palliative teams or hospitalization (in acute or intermediate care). Results: Patients made an average of 1.1 admissions per year (average stay = 6 days), 74% in intermediate care hospitals. They lived in the community 93.4% of time, carrying out 1 weekly contact with the EAP (45.1% home care). The average daily cost was 19.4 euros, the main chapters were intermediate care hospitalizations (36.5%), EAP activity (29.4%) and admissions in acute hospitals (28.6%). Factors determining a potential lower cost are frailty/dementia as trajectory (p < 0.001), living in a nursing-home facility (p < 0.001) and over-aging (p < 0.001). There are certain differences in the behavior of the EAP related to the global cost and to community resources (p < 0.05). Conclusions: Consumption in intermediate hospitalization and primary care is more relevant than stays in acute care centers. Nursing-homes and home-care strategies are important to attend effectively and efficiently, especially when primary care teams get ready for it


Assuntos
Humanos , Doença Crônica/economia , Equipamentos e Provisões/economia , Estudos de Coortes , Modelos de Assistência à Saúde , Atenção Primária à Saúde/economia , Recursos em Saúde/economia , Estudos Prospectivos , Análise de Variância , Planejamento em Saúde/economia , Recursos em Saúde/estatística & dados numéricos
5.
J Wound Care ; 28(6): 324-330, 2019 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-31166856

RESUMO

OBJECTIVE: To estimate the cost of wound care to the Irish health-care system. METHODS: A bottom-up, prevalence-based analysis was undertaken using a decision analytic model to estimate costs. Health-care resource activity was identified from a recently published study from the UK and was valued using unit cost data for Ireland. RESULTS: The base case analysis estimated the total annual healthcare cost of wound care to be €629,064,198 (95% Confidence interval (CI): €452,673,358 to €844,087,124), accounting for 5% (95% CI: 3% to 6%) of total public health expenditure in Ireland in 2013. The average cost per patient was €3,941 (95% CI: €2,836 to €5,287). However, this study is subject to many limitations and plausible changes in the model's inputs showed that the total annual health-care cost of wound care could range from €281,438,970 to €844,316,912. CONCLUSION: Caring for wounds places a substantial burden on the Irish health-care system. In light of growing pressures to finance an already resource-constrained health-care system, these results provide useful information for those charged with future wound care service design and provision in Ireland and elsewhere.


Assuntos
Custos de Cuidados de Saúde , Gastos em Saúde , Ferimentos e Lesões/economia , Assistência Ambulatorial/economia , Enfermagem em Saúde Comunitária/economia , Custos e Análise de Custo , Técnicas de Apoio para a Decisão , Equipamentos e Provisões/economia , Hospitalização/economia , Visita Domiciliar/economia , Humanos , Irlanda/epidemiologia , Prevalência , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia
7.
Eur J Health Econ ; 20(Suppl 1): 133-140, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31098886

RESUMO

BACKGROUND: The recent update of the European Union's (EU) regulation on public procurement has created new opportunity for progress in the purchasing of medical devices by shifting towards focus on value from one purely on price. Patient-reported outcome measures (PROMs) may serve as additional tools for manufacturers to demonstrate value beyond traditional metrics of safety and performance and to differentiate their products in a market of increasing competition. The aim of our study was to investigate the extent to which PROMs are included in registered device studies in the EU and interpret the results in the context of the purchasing of medical devices. METHODS: Twelve device groups were searched in clinical trial registries to determine the frequency distribution of PROMs in related studies. RESULTS: Results indicate that clinical studies of the selected device categories are done predominately in the western EU nations and are increasingly including PROMs. In the United Kingdom 121 (65%) study, out of 186 included PROMs, and in Germany, 92 (52%) out of 178 between 1998 and 2018. Few device studies were done in the Central and Eastern European region, and out of 76 studies 27 (35%) included PROMs. Since there is no requirement to include PROMs in device studies for regulatory purposes, it seems probable that their increasing use is driven by competitive market pressures. CONCLUSION: The trend of increasing use of PROMs might be driven by the demand of purchasers to demonstrate value of devices, but is manifested at different levels in various regions of the EU.


Assuntos
Ensaios Clínicos como Assunto/métodos , Equipamentos e Provisões/economia , Medidas de Resultados Relatados pelo Paciente , Aquisição Baseada em Valor/tendências , Europa (Continente) , Humanos
8.
Paediatr Int Child Health ; 39(3): 184-192, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30957682

RESUMO

Background: The bubble continuous positive airway pressure (bCPAP) technique is widely applied in neonatal respiratory support. Commercial bCPAP brands are expensive in Nigeria and this has driven Nigerian paediatricians to use potentially risky improvised devices (IbCPAP). Aim: This study aimed to design, produce and trial an appropriate low-cost bCPAP machine which is functionally effective and safe. Methods: Questionnaires were distributed to assess the need for a new bCPAP design for use in Nigeria, leading to the development of a new system (politeCPAP) which was functionally and clinically validated in three Nigerian hospitals. Six months of clinical data on the new device of sufficient comparative quality were generated from one of the hospitals and compared with control data on the IbCPAP. The hospitals (n = 3) submitted data on 71 patients on IbCPAP or politeCPAP; 14 were disqualified on the basis of the elimination criteria. The infants were classified into two birthweight categories: <1000 g (extremely low birthweight, ELBW, n = 15) and 1000 g (n = 42). Results: Six ELBW neonates on politeCPAP survived; there were no ELBW survivors in the IbCPAP group (n = 9). The IbCPAP device delivered an average 90% O2-gas ratio (FiO2) whereas the politeCPAP required only 47%. Many heavier neonates in the IbCPAP group survived (23 of 26); however, supplementary warming was required for all of them whereas none of the politeCPAP infants required warming. The politeCPAP costs around US$2000 whereas standard commercial CPAP brands in Nigeria range from US$5000 to US$18,000. High oxygen requirement and iatrogenic hypothermia were serious adverse features of IbCPAP. Conclusions: The study has narrowed the gap between relatively low-cost, risky devices (e.g. IbCPAP) and high-cost commercial machines. The politeCPAP is a feasible alternative to the IbCPAP in cost-constrained settings. Abbreviations: bCPAP: bubble continuous positive airway pressure; CPAP: continuous positive airway pressure; ELBW: extremely low birthweight; FiO2: ratio of oxygen content in gas flow (%); IbCPAP: improvised bubble continuous positive airway pressure device; LBW: low birthweight; NNU: neonatal unit; PEEP: positive end expiratory pressure; politeCPAP: the newly developed commercial bCPAP machine; RDS: respiratory distress syndrome; SpO2, oxygen saturation level (%).


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/instrumentação , Pressão Positiva Contínua nas Vias Aéreas/métodos , Equipamentos e Provisões/economia , Síndrome do Desconforto Respiratório do Adulto/terapia , Pressão Positiva Contínua nas Vias Aéreas/economia , Custos de Cuidados de Saúde , Humanos , Lactente , Recém-Nascido , Nigéria , Resultado do Tratamento
9.
Brachytherapy ; 18(4): 445-452, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30992185

RESUMO

PURPOSE: The purpose of this study was to quantify the cost of resources required to deliver adjuvant radiation therapy (RT) for high- to intermediate-risk endometrial cancer using time-driven activity-based costing (TDABC). METHODS AND MATERIALS: Comparisons were made for three and five fractions of vaginal cuff brachytherapy (VCB), 28 fractions of intensity-modulated radiation therapy (IMRT), and combined modality RT (25-fraction IMRT followed by 2-fraction VCB). Process maps were developed representing each phase of care. Salary and equipment costs were obtained to derive capacity cost rates, which were multiplied by process times and summed to calculate total costs. Costs were compared with 2018 Medicare physician fee schedule reimbursement. RESULTS: Full cycle costs for 5-fraction VCB, IMRT, and combined modality RT were 42%, 61%, and 93% higher, respectively, than for 3-fraction VCB. Differences were attributable to course duration and number of fractions/visits. Accumulation of cost throughout the cycle was steeper for VCB, rising rapidly within a shorter time frame. Personnel cost was the greatest driver for all modalities, constituting 76% and 71% of costs for IMRT and VCB, respectively, with VCB requiring 74% more physicist time. Total reimbursement for 5-fraction VCB was 40% higher than for 3-fractions. Professional reimbursement for IMRT was 31% higher than for 5-fraction VCB, vs. IMRT requiring 43% more physician TDABC than 5-fraction VCB. CONCLUSIONS: TDABC is a feasible methodology to quantify the cost of resources required for delivery of adjuvant IMRT and brachytherapy and produces directionally accurate costing data as compared with reimbursement calculations. Such data can inform institution-specific financial analyses, resource allocation, and operational workflows.


Assuntos
Braquiterapia/economia , Neoplasias do Endométrio/radioterapia , Custos de Cuidados de Saúde/estatística & dados numéricos , Instalações de Saúde/economia , Recursos em Saúde/economia , Radioterapia de Intensidade Modulada/economia , Braquiterapia/métodos , Braquiterapia/estatística & dados numéricos , Fracionamento da Dose de Radiação , Equipamentos e Provisões/economia , Feminino , Recursos em Saúde/estatística & dados numéricos , Humanos , Reembolso de Seguro de Saúde/estatística & dados numéricos , Medicare/economia , Radioterapia Adjuvante/economia , Radioterapia Adjuvante/métodos , Radioterapia Adjuvante/estatística & dados numéricos , Radioterapia de Intensidade Modulada/métodos , Radioterapia de Intensidade Modulada/estatística & dados numéricos , Salários e Benefícios/economia , Estados Unidos
10.
Health Policy Plan ; 34(3): 188-196, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31004143

RESUMO

Integration of parallel health commodities supply chains into one national supply chain is becoming more common globally as national health systems are strengthened and organizations realize the potential for increased effectiveness and cost reduction from integration. UNICEF conducted a 10-week pilot to integrate its supply chain for nutrition commodities into the national Ministry of Health supply chain for medical commodities. This paper is a cost analysis of the integration process in two counties, comparing four scenarios of cost structures before, during and after integration. It found as a result of integration, within the two counties involved in the 10-week pilot period, 14% cost savings were obtained on transport, warehousing and staff costs, when compared with the pre-integration total cost structure, and 37% when extrapolated out to a year as initial capacity development (training) costs were spread over a longer period. When looking only at recurrent costs and not one-time investments in capacity development, cost savings increased to 42%. More of the costs post-integration were invested in capacity building activities to strengthen the Kenyan health system, as opposed to pre-integration when more costs went towards higher transportation costs. Besides the positive impact on costs and savings generation, integration increased the reliability of forecasting and reporting, improved communication and coordination across stakeholders, decreased stock-outs and strengthened the capacity of the health system. This article also includes lessons learned and challenges of the integration process, useful to other country programmes considering similar integration. Because of the potential for a positive impact on health systems strengthening, combined with decreased costs and enhanced accountability, this is an exciting change not only for scale-up domestically, but for donors and implementing organizations to consider more broadly in other countries.


Assuntos
Equipamentos e Provisões/economia , Abastecimento de Alimentos/economia , Nações Unidas , Custos e Análise de Custo , Humanos , Quênia , Desnutrição/dietoterapia , Desnutrição/economia , Transportes/economia
11.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(2): 150-153, 2019 Mar 30.
Artigo em Chinês | MEDLINE | ID: mdl-30977619

RESUMO

Based on the Kraljic model,this paper established the scoring standard system for medical equipment procurement,and determined the weight coefficients of each evaluation factor by the analytic hierarchy process (AHP),then the procurement classification model of medical equipment was successfully established.It is proved that this model can classify medical equipment effectively,which enables the purchasing personnel to adopt corresponding purchasing strategies according to different classification.This model can be extended to all medical equipment procurement,realizing the delicacy and individualized procurement management of the equipment,which has strong operability and guiding significance.


Assuntos
Equipamentos e Provisões , Equipamentos e Provisões/economia , Modelos Teóricos
13.
Int Health ; 11(5): 379-402, 2019 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-30916303

RESUMO

Medicine and medical device donations have the potential to improve access to healthcare in some of the poorest parts of the world, but can do more harm than good. World Health Organization guidelines advise donors on how to make effective and useful donations. Our objective was to assess compliance of recent medicine or medical device donations with WHO guidelines from 2009 onwards. We searched media, academic and gray literature, including industry and organizational documents, to identify reports describing specific incidences of the donation of medicines or devices. We collected data on donation characteristics and guideline compliance. We identified 88 reports describing 53 donations. Most did not comply with at least some items in WHO guidelines and no reports provided sufficient information to assess compliance against all items. Donations that fail to comply with guidelines may be excessive, expired and/or burden recipient countries with storage and disposal costs. It was estimated that 40-70% of donated medical devices are not used as they are not functional, appropriate, or staff lack training. More effective donations involved needs assessments, training and the use of existing distribution networks. The donation of medicines and medical devices is frequently inadequately reported and at times inappropriate. Guidelines need to be enforced to ensure effective donations.


Assuntos
Equipamentos e Provisões , Doações , Fidelidade a Diretrizes/estatística & dados numéricos , Preparações Farmacêuticas , Equipamentos e Provisões/economia , Guias como Assunto , Humanos , Preparações Farmacêuticas/economia , Organização Mundial da Saúde
15.
BMJ Open ; 9(1): e023054, 2019 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-30782693

RESUMO

OBJECTIVE: To confirm that there is a defined group of products to be protected in the Spanish therapeutic arsenal known as 'medicinal products without commercial interest' (MPWCI) and propose the adoption of legal measures aimed at avoiding, or reducing, the lack of supply of said products. DESIGN: A cross-sectional study of proposed MPWCI based on a survey. The Spanish Agency of Medicines and Medical Devices (AEMPS) was asked for a list of presentations of medicines in order to identify those whose lack could have an impact on welfare. SETTING: A search on the AEMPS website and a survey conducted among 44 companies belonging to Farmaindustria has allowed for the development of a proposal list of presentations that should continue to be marketed in Spain. RESULTS: Products proposed as MPWCI are old (50% of them have an authorisation of more than 50 years) and are developed by active substances of chemical origin, parenterally administered much more frequently than the rest of the general market (44%vs6.6%, respectively). Unlike oral forms, injectable forms require adequate manufacturing facilities to guarantee the quality and sterility of the product, which naturally increases the cost of the product whose price is low or obsolete. The company experts have not valued the current price revisions as a sufficient enough mechanism to change the consideration of these medicines with respect to the interest on the part of some Marketing Authorisation Holders to maintain their commercialisation. CONCLUSIONS: As shown in the results, an upward revision of prices is necessary to contribute to the permanence of these presentations in the market, although some experts do not consider the current price revisions satisfactory enough to maintain these presentations in the market. Therefore, a specific regulation seems necessary to ensure the continuity on the market of these proposed products.


Assuntos
Equipamentos e Provisões/economia , Marketing/estatística & dados numéricos , Preparações Farmacêuticas/economia , Estudos Transversais , Equipamentos e Provisões/provisão & distribução , Humanos , Preparações Farmacêuticas/provisão & distribução , Espanha
18.
Am J Med ; 132(6): 718-721, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30639552

RESUMO

BACKGROUND: Public perception of whom to blame for health care costs varies. Whether there is a mismatch between the causes of rising health care costs and the blame attributed to potential culprits has emerged as a topic of debate. We sought to compare the allocation of blame for rising health care costs in lay media articles and academic literature with actual health care spending in the United States. METHODS: We performed a cross-sectional systematic analysis of published lay media and academic articles. On April 10, 2018, 200 PubMed (academic) and 200 Google News (lay media) articles were collected through searches using the terms "healthcare costs" and "health care costs." Articles were included if they criticized high cost of health care in the US. We calculated descriptive statistics for area(s) of health care blamed for high costs, publication type, and primary author affiliation. RESULTS: PubMed articles named 47 potential drivers of high cost and Google News articles named 225. Among PubMed articles, environment, lifestyle, and medical problems (n = 15/47; 32%) were the most commonly cited source of high cost of health care, followed by 'no group singled out' (n = 14/47; 30%), and drugs or devices (n = 8/47; 17%). Among Google News articles, insurers (n = 63/225; 28%) were most commonly cited as possible sources of high cost of health care, followed by 'no group singled out' (n = 46/225; 21%) and hospitals (n = 37/225; 17%). CONCLUSIONS: Allocation of blame for high health care costs is not always in proportion with true health care spending, and certain health care drivers are under- and overrepresented by academic and lay media publications.


Assuntos
Equipamentos e Provisões/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Jornais como Assunto , Publicações Periódicas como Assunto , Preparações Farmacêuticas/economia , Estudos Transversais , Humanos , Estados Unidos
19.
Ann Pharm Fr ; 77(1): 46-61, 2019 Jan.
Artigo em Francês | MEDLINE | ID: mdl-30075936

RESUMO

OBJECTIVE: Medical devices innovations and associated procedures represent a large part of health facilities budget. The aim of this work was to evaluate the cost of medical devices used during different surgical procedures. This cost was compare with the revenue collected from hospital stay pricing. METHOD: A prospective analysis of the medical devices used in operating room was carried out for different types of programmed surgeries. For five weeks, references of sterile single-use medical devices used during the interventions were collected. RESULTS: Expenditure on medical devices used during surgical procedures represented 5.7 % of the hospitalization value for an inguinal hernia repair, 12 % for a cholecystectomy, 9.35 % for a colectomy, 14.5 % for a hepatectomy and 7 % for pancreatectomy, any severity index combined. The most important correlations existed between act duration and patient's level of severity and between operating times and consumables expenditure. CONCLUSION: Cost optimization opportunities are equivalence of some medical devices ranges, purchases with national groupings and potential decreases in operating times related to the use of innovative medical devices.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/economia , Procedimentos Cirúrgicos do Sistema Digestório/instrumentação , Equipamentos e Provisões/economia , Redução de Custos , Custos e Análise de Custo , Humanos , Salas Cirúrgicas , Duração da Cirurgia , Estudos Prospectivos , Esterilização
20.
Int J Health Plann Manage ; 34(2): 583-593, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30549085

RESUMO

OBJECTIVES: In Japan, strong reimbursement pricing control measures for existing medical device products have rendered new medical device reimbursement pricing critical for manufacturers. Few studies have been conducted on this aspect; therefore, this paper (1) clarifies whether evaluation of innovation is appropriate or not and (2), if not, investigates its background. METHODS: In this research, 319 C1/C2 government decisions for new medical devices in the 10 years from April 2008 to March 2018 were analyzed. Evaluation of innovation was considered in terms of the reimbursement price, as well as the foreign average price ratio. RESULTS: Considering the degree of evaluation of innovation, the average premium rate for the similar function category comparison method was 10.2% during 2008 to 2010 (this means the newly set reimbursement price was 10.2% higher than that of corresponded exiting categories); it declined consistently thereafter, to 3.2% during 2016 to 2018. Moreover, evaluation of innovation by the foreign average price (FAP) ratio was 1.04 in 2008 to 2010, consistently decreasing to 0.88 in 2016 to 2018. The period from product approval to the non-Special Designated Treatment Material (non-STM) (a part of technical fee) price listing is much longer than that of the STM (own reimbursement price) listing. CONCLUSION: Several reasons were considered for the decline in innovation evaluation: (1) the lowering of the FAP upper limit ratio, (2) the possibility that there was not enough evidence at the time of price listing, (3) and the more rigorous standards to create a new separate functional category. However, some aspects were attributable to reimbursement system reform.


Assuntos
Equipamentos e Provisões/economia , Custos de Cuidados de Saúde , Invenções/economia , Política de Saúde , Humanos , Japão , Mecanismo de Reembolso/economia
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