Reimbursement Legislations and Decision Making for Orphan Drugs in Central and Eastern European Countries

• Main Authors: Krzysztof Piotr Malinowski (Author), Paweł Kawalec (Author), Wojciech Trąbka (Author), Marcin Czech (Author), Guenka Petrova (Author), Manoela Manova (Author), Alexandra Savova (Author), Pero Draganić (Author), Lenka Vostalová (Author), Juraj Slabý (Author), Agnes Männik (Author), Kristóf Márky (Author), Zinta Rugaja (Author), Jolanta Gulbinovic (Author), Tomas Tesar (Author), Marian Sorin Paveliu (Author)
• Format: Book
• Published: Frontiers Media S.A., 2019-05-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 1663-9812; 10.3389/fphar.2019.00487
• Keywords: orphan drug; reimbursement policy; Central and East Europe; European Medicine Agency; kappa coefficient of agreement; marketing authorisation; Therapeutics. Pharmacology; RM1-950
• Source: Frontiers in Pharmacology, Vol 10 (2019)

BackgroundReimbursement policies influence access of patients to orphan drugs in the European countries.ObjectivesTo provide a comprehensive description of orphan drug reimbursement policies and to assess reimbursement decision-making process in the EU-CEE countries as well as the impact of the type of approval and disease on reimbursement decisions.MethodsFor each drug, the information regarding conditional approval or approval under exceptional circumstances was obtained from the EMA website. The reimbursement status for analyzed drugs was collected in a questionnaire survey performed in a group of experts in reimbursement policy. The agreement between countries was assessed using the κ coefficient, nominal variables tests were compared using the χ2 test or the Fisher exact test. The impact of the EMA's conditional approval and approval under exceptional circumstances was assessed using logistic regression and presented as an odds ratio (OR).ResultsThe analysis revealed that most orphan drugs were authorized for the treatment of oncological or metabolic diseases [36 drugs (38%) and 22 drugs (23%), respectively]. The shares of reimbursed orphan drugs varied significantly (p = 0.0031) from 6.3% in Latvia to 27.4% in Poland. No correlation (r = 0.02; p = 0.9583) with GDP per capita was observed. The highest agreement in reimbursement decisions was observed between Estonia and Lithuania, and the lowest - between Estonia and Latvia, with kappa of 0.69 and 0.11, respectively. Significant impact of the type of approval and reimbursement status was observed for Czechia, Lithuania and Slovakia where conditional approval and exceptional circumstances negatively influenced reimbursement decision. Type of disease has significant influence on reimbursement decision in 4 out of 10 analyzed countries with significant outweigh of positive decisions for oncological diseases.ConclusionIn considered countries specific regulations on reimbursement of orphan drugs are valid but in Lithuania and Romania no formal HTA process was employed; in case of some countries higher ICER values for orphans are used. The share of reimbursed orphan drugs varied significantly across the countries, but it was not associated with GDP per capita.