Journal of Pharmaceutical Policy and Practice最新文献

{"title":"Comparison of affordability and availability of antidepressants in China from 2019 to 2022: evidence from national procurement database.","authors":"Xiao Han, Qingyuan Xue, Zhao Yang, Jifang Zhou, Bin Jiang","doi":"10.1080/20523211.2026.2719527","DOIUrl":"10.1080/20523211.2026.2719527","url":null,"abstract":"<p><strong>Background: </strong>Depression is a widespread mental disorder imposing significant societal burdens. The COVID-19 pandemic exacerbated its prevalence, emphasizing the need for improved access to affordable and effective treatments. This study aims to examine the trends of antidepressant availability and affordability in China from 2019 to 2022 and the role of the National Volume-Based Procurement (NVBP) policy.</p><p><strong>Methods: </strong>Using nationwide daily procurement data of 19 antidepressants encompassing all medical facilities in China from 2019 to 2022, this study adapted the World Health Organization/Health Action International (WHO/HAI) methodology. Availability was defined as the percentage of health facilities procuring specific antidepressant during the year. Affordability was expressed as the number of days at provincial minimum wage to pay for a one-month course of treatment. Temporal variations were described and explored using fractional logit regression, stratified by originator, NVBP involvement, clinical preference, hospital features, and regions.</p><p><strong>Results: </strong>Affordability improved steadily between 2019 and 2022 across most antidepressant groups. The largest improvement occurred among first-line NVBP antidepressants, where the monthly expenditure declined by 0.022-day minimum wage annually. In contrast, affordability changed little for first-line non-NVBP medicines (0.015-day decrease per year) and second-line non-NVBP medicines (0.004-day decrease per year). Availability of originator brands declined annually by 0.8 percentage points, while lowest-priced generics increased by 1.1 percentage points. The largest decline occurred in tertiary private facilities, where availability fell by 3.7 percentage points annually. Improvements in availability were mainly observed in secondary and tertiary public facilities, particularly in the East and Northeast regions. Overall, NVBP first-line medicines had 15.5 percentage points higher availability and greater affordability of 0.167-day minimum wage than other antidepressants.</p><p><strong>Conclusion: </strong>The study highlights the positive influence of the NVBP policy on antidepressant affordability and availability. Regional gaps and facility-specific disparities, though narrowed, still call for policy response.</p>","PeriodicalId":16740,"journal":{"name":"Journal of Pharmaceutical Policy and Practice","volume":"19 1","pages":"2719527"},"PeriodicalIF":2.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and psychometric evaluation of the knowledge, attitudes, and practices toward complementary and alternative medicine in stroke.","authors":"Lee Jia Jia, Stephanie Cheah Ee Lin, Kasmithra K Batu Ganesan, Devonnysa Saliboh, Jamuna Rani Appalasamy, Ng Khuen Yen, Jasmine Chia Siew Min, Yee Siew Mei, Amutha Selvaraj, Ali Haider Mohammed","doi":"10.1080/20523211.2026.2739009","DOIUrl":"10.1080/20523211.2026.2739009","url":null,"abstract":"<p><strong>Background: </strong>Stroke is a major public health concern and leading cause of long-term disability. Complementary and alternative medicine (CAM) is increasingly used in stroke management, yet public knowledge, attitudes, and practices (KAP) regarding its use remain poorly understood. Misconceptions or lack of awareness may lead to unsafe practices and delays in seeking medical care.</p><p><strong>Objective: </strong>The study aimed to develop the Knowledge, Attitude and Practice toward Complementary and Alternative Medicine use in Stroke Management (KAP-CAM-Stroke) questionnaire and conduct an initial psychometric evaluation.</p><p><strong>Methods: </strong>This multi-phase instrument-development study comprised Phase I, which included item generation, content validation using a two-round Delphi technique, face validity, and pilot testing, and Phase II, which used a cross-sectional survey to conduct an initial psychometric evaluation in 136 members of the Malaysian public. IRT was applied to the knowledge domain, whereas EFA was used for the attitude and practice domains.</p><p><strong>Results: </strong>The final questionnaire comprised 58 items across four sections: sociodemographic (16 items), knowledge (10 items), attitude (10 items), and practice (22 items). Content validity was supported by S-CVI/Ave values of at least 0.90 after Delphi Round 2. IRT identified variable item performance in the knowledge domain, including an unstable extreme discrimination estimate for item K4. EFA identified a four-factor attitude structure explaining 63.84% of the variance (Cronbach's alpha = 0.655) and a six-factor practice structure explaining 74.94% (Cronbach's alpha = 0.860). These findings provide preliminary evidence of content and structural validity; internal consistency met the prespecified threshold for the knowledge and practice domains but not for the attitude domain.</p><p><strong>Conclusion: </strong>The KAP-CAM-Stroke questionnaire provides preliminary psychometric evidence for assessing public knowledge, attitudes, and practices regarding CAM use in stroke management. Further evaluation in larger and more diverse samples, including test-retest reliability and confirmatory factor analysis, is required before the instrument can be considered fully validated.</p>","PeriodicalId":16740,"journal":{"name":"Journal of Pharmaceutical Policy and Practice","volume":"19 1","pages":"2739009"},"PeriodicalIF":2.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics, preventability, management, and predictors of adverse drug reaction-related hospital admissions: a cross-sectional study in a Thai tertiary care hospital.","authors":"Warisara Jiamsathit, Thanyamai Sapsinpan, Phrompassorn Khumwatrungruang, Anthony R Cox, Narumol Jarernsiripornkul","doi":"10.1080/20523211.2026.2734106","DOIUrl":"https://doi.org/10.1080/20523211.2026.2734106","url":null,"abstract":"<p><strong>Background: </strong>Adverse drug reaction (ADR)-related hospital admissions may be fatal and increase substantial healthcare costs, but several ADRs are preventable. However, studies on preventable ADRs in Thailand remain limited, particularly with respect to their management and prevention. Aim To determine the frequency, characteristics, and preventability of ADR-related hospital admission, and to evaluate the management, prevention strategies, and associated factors.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among patients admitted to a tertiary care teaching hospital. Data were extracted from the hospital's medical record database for a 9-month period. ADR-related hospital admissions were identified using the International Statistical Classification of Diseases and Related Health Problems, 10^th Revision (ICD-10).</p><p><strong>Results: </strong>During the study period, 29,927 patients were admitted to the hospital. Of these, 730 admissions were identified as ADR-related based on ICD-10 codes, and 200 patients were included using purposive sampling. The most frequently reported ADRs involved cardiovascular disorders (50.5%), and nervous system disorders (17.0%). The most common suspected drugs were warfarin (38.0%) and paracetamol (5.0%). Approximately 67.1% of ADRs were classified as probable or definite, and 66.0% were considered preventable. The primary management strategy was discontinuation of the suspected drug (82.5%), while discharge counselling was the most commonly employed preventive measure (56.0%). Inappropriate dosage was independently associated with the preventability of ADR-related hospital admissions (OR 0.007; 95% CI 0.001-0.074; <i>p</i> < 0.001), and age groups of 36-65 years and more than 65 years were independently associated with documented ADR-related hospital admissions (OR 7.688; 95% CI 1.533-38.548; <i>p</i> = 0.013 and OR 9.441; 95% CI 1.668-53.422; <i>p</i> = 0.011, respectively).</p><p><strong>Conclusions: </strong>Warfarin was the most frequently implicated drug in ADR-related hospital admissions. Inappropriate dosing was significantly associated with preventable ADR-related hospitalisations. Implementing targeted strategies, such as dose optimisation and appropriate clinical monitoring, may enhance medication safety and reduce preventable ADRs.</p>","PeriodicalId":16740,"journal":{"name":"Journal of Pharmaceutical Policy and Practice","volume":"19 1","pages":"2734106"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking assessment for practice readiness: policy implications of the OSCE-practice mismatch in Malaysia.","authors":"Athirah Bakhtiar, Angelina Lim, Li Ling Yeap, Daniel Malone, Han Yin Lim, Sunanthiny Krishnan","doi":"10.1080/20523211.2026.2735132","DOIUrl":"https://doi.org/10.1080/20523211.2026.2735132","url":null,"abstract":"<p><strong>Background: </strong>Experiential learning is central to pharmacy education, yet the translation of clinical skills from simulated examinations to actual practice remains under-researched. This study utilised mystery shopping to evaluate how well clinical competencies transfer when students move from university Objective Structured Clinical Examinations (OSCEs) to independent community pharmacy placements, shedding light on systemic barriers to clinical care integration.</p><p><strong>Methods: </strong>Using a sequential explanatory mixed-methods design, 57 third-year undergraduate pharmacy students were covertly evaluated during their placements by mystery shoppers reenacting clinical scenarios identical to those used in the primary-care component of their university OSCEs. Scores were compared using Wilcoxon signed-rank tests and Spearman's correlation. Additionally, semi-structured interviews explored students' perspectives on the performance gap and the systemic obstacles that prevent successful skill transfer.</p><p><strong>Results: </strong>Real-world performance was markedly lower than examination scores, with mystery shopping scores dropping to a median of 0% versus 91.67% in the OSCE (<i>p</i> < 0.001). No significant correlation existed between simulated success and independent execution (r_s = 0.14, <i>p</i> = 0.2934). Qualitative analysis identified three main drivers for this mismatch: the disconnect between structured examinations and fluid retail practice; environmental distractions; and restrictive public expectations that actively discouraged thorough clinical counselling.</p><p><strong>Conclusion: </strong>Simulated clinical competence does not reliably translate to independent practice. This performance drop illustrates how national policy and retail realities constrain a student's actual clinical output. Integrating independent workplace assessments, such as mystery shopping, may provide a more direct, unsupervised measure of readiness. Bridging this gap will likely require coordinated efforts among academic institutions, practising pharmacists, and regulatory bodies. These findings may offer preliminary insights relevant to other developing health systems navigating similar transitions in clinical pharmacy practice, pending further research across diverse settings.</p>","PeriodicalId":16740,"journal":{"name":"Journal of Pharmaceutical Policy and Practice","volume":"19 1","pages":"2735132"},"PeriodicalIF":2.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacy professionals' knowledge, attitudes, and behaviours regarding antibiotic use and antimicrobial resistance in Oman.","authors":"Zainab Said Al-Hashimy, Barbara R Conway, Marwa Al Qasmi, Huda Al Harthi, Rashid Al Harthi, Feras Darwish Elhajji, Mamoon A Aldeyab","doi":"10.1080/20523211.2026.2737505","DOIUrl":"https://doi.org/10.1080/20523211.2026.2737505","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated pharmacy professionals' knowledge, attitudes, and behaviours regarding antibiotic use and antimicrobial resistance (AMR) in Oman.</p><p><strong>Methods: </strong>A cross-sectional, questionnaire-based survey was conducted among 411 pharmacy professionals in Ministry of Health (MOH) institutions from January to June 2023. This questionnaire is based on instruments developed by the European Centre for Disease Prevention and Control and assesses knowledge, opportunities, behaviours, and awareness of national initiatives.</p><p><strong>Results: </strong>A total of 411 pharmacy professionals participated in the study. Overall, participants demonstrated knowledge of AMR, with an understanding of antibiotic effectiveness against viruses (89.3%) and inappropriate use (96.4%), but important gaps in knowledge of resistance transmission (44.8%) and antibiotic use for growth promotion in farm animals (31.4%). Higher median knowledge scores were observed among senior specialist pharmacists ( <math><mi>p</mi> <mo><</mo> <mn>0.001</mn></math> ), while respondents aged 36-45 years and those with 16-20 years of practice achieved the highest proportions of full knowledge scores ( <math><mi>p</mi> <mo><</mo> <mn>0.001</mn></math> ). Although 91% of respondents reported confidence in their understanding of AMR, specific knowledge gaps were identified: 56.2% were unsure whether antibiotic use for growth promotion in farm animals was legal in Oman, and 36% were unaware of or unsure about Oman's National Action Plan. Most respondents reported having opportunities to provide patient counselling (82%) and access to guidelines (63%), while 59.9% reported frequent antibiotic dispensing in practice. Importantly, among the 217 respondents who reported that the information changed their views, 208 (95.9%) participants indicated that this knowledge influenced their dispensing practices.</p><p><strong>Conclusions: </strong>Pharmacy professionals in Oman demonstrated awareness and positive perceptions regarding antibiotic use and antimicrobial resistance, although gaps remained in awareness and understanding of One Health principles, national initiatives, and the translation of knowledge into dispensing practice. Strengthening targeted education, guideline access, and pharmacist involvement in antimicrobial stewardship may improve appropriate antibiotic use and support AMR control.</p>","PeriodicalId":16740,"journal":{"name":"Journal of Pharmaceutical Policy and Practice","volume":"19 1","pages":"2737505"},"PeriodicalIF":2.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health system governance and pharmaceutical policy in Australia and Qatar: a comparative overview of access, reform, and equity.","authors":"Dina Abushanab, Daoud Al-Badriyeh","doi":"10.1080/20523211.2026.2734138","DOIUrl":"https://doi.org/10.1080/20523211.2026.2734138","url":null,"abstract":"<p><p>This commentary contrasts the healthcare systems in Australia and Qatar, emphasising how each nation addresses shifting health policy priorities amid demographic pressures, financing reforms, and pharmaceutical challenges. Australia, with its established Medicare system and institutionalised Health Technology Assessment (HTA), continues to face issues related to equity, rural access, and the demands associated with an aging population. In contrast, Qatar is actively reforming its healthcare infrastructure to support a young and diverse expatriate-majority population, with increasing investments in insurance coverage, HTA integration, and private sector participation. Despite their differing levels of system maturity and population needs, both countries are tackling common issues: the rising burden of non-communicable diseases, cost pressures from innovative treatments, and the necessity of aligning expenditures with measurable health outcomes. The commentary highlights value-based healthcare as a shared goal while critically assessing the impact of pharmaceuticals, data infrastructure, and stakeholder engagement in promoting sustainable and equitable access. By integrating insights and policy reflections within a comparative framework, this commentary identifies opportunities for cross-national learning and outlines potential directions for future research and practice.</p>","PeriodicalId":16740,"journal":{"name":"Journal of Pharmaceutical Policy and Practice","volume":"19 1","pages":"2734138"},"PeriodicalIF":2.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing interprofessional collaboration: exploring physicians' perceptions, preferences, and barriers regarding pharmacists' roles in Jordan.","authors":"Zelal Kharaba, Karem H Alzoubi, Mai Riziq, Lana Zuriegat, Rana Abu-Farha, Anan Jarab, Azza Ramadan, Feras Jirjees, Hala Afifi, Farah K El-Zubi, Yassen Alfoteih, Manal Buabeid","doi":"10.1080/20523211.2026.2736421","DOIUrl":"https://doi.org/10.1080/20523211.2026.2736421","url":null,"abstract":"<p><strong>Background: </strong>Interprofessional collaboration is crucial for improving healthcare delivery and addressing workforce challenges. Physician-pharmacist collaboration enhances patient care, improves medication management and health outcomes. While patients' perspectives have been studied, physicians' views in Jordan remain under-investigated. This study assessed physicians' perceptions, preferences, and barriers to pharmacist integration.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among practicing physicians between April 1st and September 30th, 2025. Despite an extended six-month recruitment period, severe clinical time constraints resulted in a final sample of 297 participants, representing a 21.6% shortfall from the initial target of 379 and yielding a post-hoc margin of error of 5.66%. Using a convenience sampling approach with multi-channel recruitment, the survey was distributed via professional social media networks, direct electronic contacts, and targeted in-person clinic visits. Data were analysed using descriptive and inferential statistics to summarise the variables and examine the sample characteristics.</p><p><strong>Results: </strong>The majority of physicians (95.3%) had collaborated with pharmacists, with face-to-face communication being the most preferred method (72.7%). The responding physicians generally perceived positive roles for pharmacists in advising on drug interactions (60.3%), improving patient adherence (60.3%), and adjusting medication dosages (58.9%). A significant association was observed between practice sector and physicians' perception scores (<i>p</i> = 0.021), with physicians working in the private health sector having lower perception scores towards pharmacists' professional roles compared with those working in the governmental health sector.. Key barriers included the logistics of dealing with multiple healthcare professionals (54.9%), lack of face-to-face communication (52.2%), and fragmentation of care (49.2%). Financial constraints (46.5%) and concerns over shared patient responsibility (46.6%) were also significant barriers.</p><p><strong>Conclusion: </strong>Although Jordanian physicians reported positive perceptions of pharmacists' expertise, systemic barriers and traditional role boundaries appear to hinder effective practice integration. Enhancing structured communication, implementing joint interprofessional training, and enacting target healthcare policy reforms are necessary to fostering effective physician-pharmacist collaboration and improving patient care outcomes.</p>","PeriodicalId":16740,"journal":{"name":"Journal of Pharmaceutical Policy and Practice","volume":"19 1","pages":"2736421"},"PeriodicalIF":2.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-hospital antimicrobial use and multidrug-resistant infections among COVID-19 patients in Northern Malaysia (COVAM): a multicentre study.","authors":"Kah Shuen Thong, Chii-Chii Chew, Meng Fei Cheah, E-Li Leong, Chee Tao Chang, Jason Choong Yin Lee, Philip Rajan Devesahayam, Hong Bee Ker, Jeyaseelan P Nachiappan, Zaiton Kamarruddin, Lay Ming Ding","doi":"10.1080/20523211.2026.2728836","DOIUrl":"https://doi.org/10.1080/20523211.2026.2728836","url":null,"abstract":"<p><strong>Background: </strong>During the COVID-19 pandemic, empirical antimicrobials were frequently prescribed despite low documented rates of bacterial and fungal co-infections. While early pandemic data exist, evidence evaluating antimicrobial consumption and multidrug-resistant organism (MDRO) dynamics during subsequent pandemic surges remains limited. This study evaluated antimicrobial receipt, associated factors, and the prevalence of MDROs among hospitalised COVID-19 patients in Northern Malaysia.</p><p><strong>Methods: </strong>This multicentre retrospective observational cohort study included adults (≥18 years) with confirmed COVID-19 admitted to ten government hospitals in Northern Malaysia between February 2020 and December 2021. Among 19,116 admissions, 480 cases were sampled, yielding 476 eligible patients. Study outcomes included antimicrobial receipt and MDRO prevalence. Monthly antimicrobial days of therapy (DOT) per 1,000 patient-days were compared with state-level COVID-19 hospital admissions. Predictors were analysed using a Poisson Generalized Linear Mixed Model.</p><p><strong>Results: </strong>Antibiotics were prescribed to 167 patients (35.1%), accounting for 381 prescriptions, predominantly β-lactam/β-lactamase inhibitors (54.1%). Most were empirical (92.9%), largely among non-ICU patients (72.2%) with pneumonia (82.9%). Antifungals were used in 13 patients (2.7%; 15 prescriptions), mainly empirical echinocandins (60.0%), and predominantly in ICU settings (66.7%). MDROs were detected in 8.4% (10/119) of patients with cultured specimens, representing patient-level MDRO prevalence. A significant positive correlation was observed between DOT and admissions (r = 0.701, <i>p</i> < 0.001, 95% CI [0.37-0.87]). Severe/critical COVID-19 stage, diabetes mellitus, chronic obstructive pulmonary disease and chronic kidney disease were consistently associated with antimicrobial prescription. Longer hospital stays, elevated neutrophil and C-reactive protein levels, smoking, and pre-hospital steroid/immunosuppressant use were additional predictors.</p><p><strong>Conclusion: </strong>Antimicrobial use was predominantly empirical and influenced by disease severity and admission surges. Although MDRO detection remained low, severity-driven prescribing highlights the risk of unnecessary antimicrobial exposure during pandemic waves. These findings inform outbreak-responsive antimicrobial stewardship strategies and support antimicrobial utilisation surveillance to guide resource planning during future public health emergencies.</p>","PeriodicalId":16740,"journal":{"name":"Journal of Pharmaceutical Policy and Practice","volume":"19 1","pages":"2728836"},"PeriodicalIF":2.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness and budget impact of Luspatercept in Thai adults with transfusion-dependent beta-thalassaemia: a multi-state Markov model based on national claims data.","authors":"Khachen Kongpakwattana, Peerapon Wong, Nattiya Teawtrakul, Pimlak Charoenkwan, Nilawan Upakdee","doi":"10.1080/20523211.2026.2735077","DOIUrl":"https://doi.org/10.1080/20523211.2026.2735077","url":null,"abstract":"<p><strong>Background: </strong>Luspatercept is a first-in-class erythroid maturation agent that reduces transfusion burden in adults with transfusion-dependent beta-thalassaemia (TDT). However, its cost-effectiveness has not been evaluated in middle-income settings. This study aimed to evaluate the cost-effectiveness and budget impact of Luspatercept for TDT in Thai adults.</p><p><strong>Methods: </strong>A hybrid decision tree and lifetime Markov cohort model was developed to compare Luspatercept plus best supportive care (BSC) with BSC alone from a societal perspective. Age-specific 12-week transition probabilities across three transfusion burden states (low, medium, and high) and death were derived from a multi-state Markov survival model fitted to national administrative claims data. Treatment efficacy was based on the phase 3 BELIEVE trial. Three treatment eligibility scenarios were evaluated: universal (all patients), targeted (medium and high transfusion burden), and restricted (high transfusion burden only). Deterministic, probabilistic, threshold price, and budget impact analyses were performed.</p><p><strong>Results: </strong>In the universal scenario, Luspatercept produced an incremental gain of 0.205 QALYs and an additional cost of 955,053 THB (29,048 US$) per patient, resulting in an incremental cost-effectiveness ratio (ICER) of 4,650,427 THB/QALY (141,442 US$/QALY). This value exceeds the Thai willingness-to-pay threshold of 160,000 THB/QALY by approximately 29-fold. Restricting eligibility to patients with higher transfusion burden did not improve cost-effectiveness; in the restricted scenario, Luspatercept was dominated. A price reduction of 90.5% would be required for Luspatercept to become cost-effective, which would also reduce the five-year cumulative budget impact from 2,505 million THB to 296 million THB.</p><p><strong>Conclusion: </strong>Luspatercept is not cost-effective for TDT in Thailand at its current price across all scenarios evaluated. A substantial price reduction would be necessary, though this would bring the budget impact to a manageable level. These findings may help inform pricing and reimbursement decisions in Thailand and other middle-income countries.</p>","PeriodicalId":16740,"journal":{"name":"Journal of Pharmaceutical Policy and Practice","volume":"19 1","pages":"2735077"},"PeriodicalIF":2.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmaceutical registration, essential medicines, and registration depth in Sri Lanka: a longitudinal analysis, 1991-2025.","authors":"Manori Jayasinghe, Amanda Rush, Andrew Wilson","doi":"10.1080/20523211.2026.2735527","DOIUrl":"10.1080/20523211.2026.2735527","url":null,"abstract":"<p><p>Pharmaceutical registration determines which medicines may enter the market, yet its role in shaping pharmaceutical market structure in relation to essential medicines has received limited attention, particularly in low- and middle-income countries. This study examined how pharmaceutical registration portfolios in Sri Lanka evolved in relation to essential medicines alignment, therapeutic composition, and sources of supply. Pharmaceutical registrations were analysed in Sri Lanka at three time points (1991, 2009, and 2025) to examine changes in the structure of the registration portfolio and alignment with the Essential Medicines List (EML) at both product and active substance levels. Data for 1991 were derived from a published study, while analyses were conducted for 2009 and 2025 using national registration records. The number of registered products increased substantially between 1991 and 2009 and remained high in 2025, while the number of active substances changed modestly. Product-level alignment with the EML declined from 71.0% in 1991 to 38.0% in 2025, whereas active-substance-level alignment increased from 31.4% to 59.4%. This divergence reflected broader coverage of essential active substances alongside fewer products per substance. The composition of the register shifted, with a declining share of anti-infective medicines and increasing representation of medicines for chronic conditions. The registration portfolio remained import dependent, although the proportion of locally manufactured substances increased between 2009 and 2025. Registration depth among active substances was uneven, with many substances represented by few or no registered products. Pharmaceutical registration in Sri Lanka remained broadly aligned with essential medicines priorities over time, but this alignment occurred through changing portfolio structures. The study shows that assessments based on the number of registered products may not capture therapeutic breadth at the active-substance level. The findings highlight the importance of considering registration depth and import dependence when interpreting pharmaceutical market structure and supply vulnerabilities in import-dependent health systems.</p>","PeriodicalId":16740,"journal":{"name":"Journal of Pharmaceutical Policy and Practice","volume":"19 1","pages":"2735527"},"PeriodicalIF":2.6,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13618154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}