Ibrahim Alabbadi

The price of medicines in Jordan: The cost of trade-based intellectual property

Jordan dramatically strengthened the level of intellectual property protection it provides for pharmaceutical products in consequence of joining the World Trade Organization in 2000 and signing a Free Trade Agreement with the United States in 2001. This study assesses the impact of higher levels of intellectual property protection on access to medicines by quantifying the effects on the private retail pharmaceutical market of delayed market entry of generic products. Adjusted for increased sales volume and inflation, from 1999 to 2004 there was a 17% increase in total annual expenditure for medicines in Jordan. When assessing originator medicines that were marketed in both 1999 and 2004, and for which there were generic equivalents, the weighted average price of originator medicines increased while the weighted average price of equivalent generic medicines decreased. Delayed market entry of generics due to enhanced intellectual property protection is estimated to have cost Jordanian private consumers approximately 18 million U.S. dollars in 2004. Jordan should consider amending its current regulatory scheme on data protection and amending the Unfair Competition and Trade Secrets Law of 2000. Jordan should also consider increased spending on public health to offset the adverse impact on consumers of strengthening its intellectual property protection relevant to pharmaceutical products.

One-Year assessment of joint procurement of pharmaceuticals in the public health sector in Jordan

BACKGROUND About 10% of the gross domestic product in Jordan is spent on health care, and almost one third of that is spent on pharmaceuticals. The public health sector in Jordan has 4 main governmental parties that purchase medicines independently through annual tenders (ie, the process of bidding, being awarded, ordering, paying for, and receiving drugs) issued in the generic (or scientific) name of the medicines or therapeutic groups. Double purchasing is a problem that leads to higher spending on drugs and poor availability of medicines throughout the year. To remedy this problem, a joint procurement process was established in Jordan in 2004 and went into practice in 2006. OBJECTIVE The aim of this research was to assess the first year of purchasing pharmaceuticals in the public health sector in Jordan through the joint procurement process for the 4 participating parties in comparison with purchasing pharmaceuticals independently before the institution of joint procurement. METHODS The first tender under the joint procurement process was issued in 2007 for antibiotics, anti-HIV medications, and antituberculosis agents, which represent 15% of the annual pharmaceutical public-sector purchases in Jordan. A research committee solicited lists of purchased quantities and final purchase prices of these pharmaceuticals obtained in 2006 by each participating group and in 2007 through the joint procurement process. The quantity-comparison method was used to compare the costs of drugs purchased in 2006 and 2007, and estimated cost savings were calculated for each product for each party for 2006 and 2007 under the assumption that the same quantities purchased by each participating party in 2006 would be purchased through joint procurement (prices of 2007). RESULTS Purchasing through the joint procurement process achieved an estimated savings of 2.4%. This savings increased to 8.9% after excluding 1 item (a cephalosporin), the raw material price of which increased markedly in 2007 compared with 2006 because of an international shortage of raw materials. CONCLUSION Based on these initial findings, applying a joint procurement system for pharmaceuticals in the public health sector in Jordan has potential to reduce expenditures for the purchase of medicines and provide treatment continuously throughout the year.

Patterns of antiepileptic drugs use in epileptic pediatric patients in Jordan.

Objectives: To determine prescribing patterns of antiepileptic drugs (AEDs) in pediatric patients with confirmed diagnosis of epilepsy, and to provide knowledge of general practice of physicians. Methods: The study was a multi-center cross-sectional observational study, in specialized clinics for management of epilepsy in north, central and south Jordan. This study was conducted from January 2014 to July 2014. These were 3 from university tertiary care hospitals and 4 from governmental tertiary care hospitals. Results: A total of 694 pediatric patients were included. Monotherapy AED use had the highest frequency 465 (67.0%), followed by dual therapy 162 (23.3%). The frequency of monotherapy in university hospitals was lower than governmental hospitals (p<0.05); however, Polytherapy was more frequent in younger children. Two old AEDs were most frequently prescribed as a monotherapy; Valproic acid 235 (50.5%) and carbamazepine 155 (33.3%). The most common combination in dual therapy was valproic acid with carbamazepine 28 (17.3%). The second most common combinations were carbamazepine with levetiracetam 21 (13.0%) or valproic acid with levetiracetam 20 (12.3%). Conclusion: Older AED remain first line drugs for use in both monotherapy and combination therapy for epileptic disorders. Polytherapy is associated with younger kids and being treated in a university hospital.

Multi-indication Pharmacotherapeutic Multicriteria Decision Analytic Model for the Comparative Formulary Inclusion of Proton Pump Inhibitors in Qatar

PURPOSE The formulary inclusion of proton pump inhibitors (PPIs) in the government hospital health services in Qatar is not comparative or restricted. Requests to include a PPI in the formulary are typically accepted if evidence of efficacy and tolerability is presented. There are no literature reports of a PPI scoring model that is based on comparatively weighted multiple indications and no reports of PPI selection in Qatar or the Middle East. This study aims to compare first-line use of the PPIs that exist in Qatar. The economic effect of the study recommendations was also quantified. METHODS A comparative, evidence-based multicriteria decision analysis (MCDA) model was constructed to follow the multiple indications and pharmacotherapeutic criteria of PPIs. Literature and an expert panel informed the selection criteria of PPIs. Input from the relevant local clinician population steered the relative weighting of selection criteria. Comparatively scored PPIs, exceeding a defined score threshold, were recommended for selection. FINDINGS Weighted model scores were successfully developed, with 95% CI and 5% margin of error. The model comprised 7 main criteria and 38 subcriteria. Main criteria are indication, dosage frequency, treatment duration, best published evidence, available formulations, drug interactions, and pharmacokinetic and pharmacodynamic properties. Most weight was achieved for the indications selection criteria. Esomeprazole and rabeprazole were suggested as formulary options, followed by lansoprazole for nonformulary use. The estimated effect of the study recommendations was up to a 15.3% reduction in the annual PPI expenditure. Robustness of study conclusions against variabilities in study inputs was confirmed via sensitivity analyses. IMPLICATIONS The implementation of a locally developed PPI-specific comparative MCDA scoring model, which is multiweighted indication and criteria based, into the Qatari formulary selection practices is a successful evidence-based cost-cutting exercise. Esomeprazole and rabeprazole should be the first-line choice from among the PPIs available at the Qatari government hospital health services.

Hypoglycaemia Fear among Diabetics = الخوف من هبوط مستوى السكر عند مرضى السكري

Background: This study aimed to evaluate whether fear of hypoglycaemia (FOH) ispresent in diabetic patients receiving oral hypoglycemic agents or insulin and factorsthat can influence it. Methods: This study is a cross sectional survey of diabetic patients attendingendocrine clinics in Jordan University Hospital, King Abdullah University Hospital and Royal Medical Services, from June 2013 till may 2014. Results: Out of 326 approached 268 patients participated. The mean age ofparticipants was (49.81±14.09), and 141 (52.6%) were females. FOH was present in allpatients and with all antidiabetic medications. Among antidiabetic agents, patientstaking insulin were found to have the highest score of overall FOH (p<0.001). Level offear correlated with type of diabetes (p<0.01), and being female (p<0.01). Patientsworking in medical field behavioral fear scores were higher compared with patientsworking in non-medically related field (p<0.01). In addition, as the duration of diabetesincreases the overall FOH increases (p<0.01). It had been found that as the FOHincreases the quality of life decreases (p<0.001). Conclusion: Type of diabetes, age and type of antidiabetic agent affect FOH. Diabetes Mellitus duration and gender affect the behavioral scale of hypoglycaemia fear survey. FOH has been found to affect quality of life.

An Investigation of Physicians' Perception of Pharmaceutical Trade Names in Jordan's Private Sector Using Real-World and Simulated Approaches

IntroductionExisting research tackling the influence of pharmaceutical trade-name types upon physician prescription behavior is rather minimal.ObjectiveThe aim of this study was to investigate physicians’ perception of pharmaceutical trade (brand) names in Jordan’s private sector using two approaches—a real-world setting approach, and another simulated approach.MethodsFor the real-world setting approach, 13 trade-name types were used to test physician perception versus their prescription predictors (clarified benefits, conveyed efficacy, enhanced memorability, and reduced confusion), then linked to physician perception in terms of prescription behavior, as measured by increased prescription preference for each of the trade-name types. Regarding the simulated approach, a sample of 100 pharmaceutical product trade names was utilized to demonstrate the relationship between their unit-wise sales and the type of trade name to which they belong.ResultsResults for the real-world setting approach revealed that physicians had a favorable perception of names that are derived from the site of action, those that are experiential, and functional names. A neutral perception was demonstrated for name types with a hint of competitive advantage, as well as short names. An unfavorable perception was observed for evocative names, geographical location-derived names, fricative names, manufacturer-derived names, and poetic and plosive names. As for the simulated approach, unit-wise sales were highest for functional as well as evocative trade-name types.ConclusionsThe pharmaceutical trade-name types that are most favorable are those that reflect the drug’s site of action, experiences delivered, and function. It was recommended that pharmaceutical companies choose more appropriate trade names for their products based on physicians’ preference.

Budget Impact of Adding One Dipeptidyl Peptidase-4 Inhibitor to Ministry of Health Jordan Tender List in the Treatment of Type II Diabetes Mellitus = أثر إضافة أحد أدوية مثبطات أنزيم دايببتايل-4 لقائمة عطاء وزارة الصحة الأردنية لمعالجة السكري على الموازنة

Total health expenditure in Jordan accounted for 7.72% of the Jordanian GDP in 2011 in which about one third is spent on pharmaceuticals. Number of people with type2 diabetes is increasing in every country, in Jordan; the prevalence of diabetes in adults ≥25 years of age is 17.1%, while an additional 7.8% of Jordanians have impaired glucose tolerance. The aim was to investigate the impact of adding one DPP-4 inhibitor as an oral hypoglycemic agent to the tender list of Jordanian MoH in the treatment of Type II DM. Quantities purchased by MoH in 2010 for oral hypoglycemic agents were used to calculate how many patients will be treated using these quantities. Annual cost of treating hypoglycaemia caused by oral hypoglycemics and their current acquisition cost were estimated. Costs of treating adverse effects were estimated based on MoH prices. Private pharmacy retail price for Vildaglaptin was used to estimate budget impact of adding this DPP-4 inhibitor to the treatment options for DM patients in the public sector. It was concluded that budget impact of adding Vildaglaptin to the tender list of MoH seems to have a very good potential of savings that is badly needed to treat more DM patients.

Investigating the Effect of Data Exclusivity on the Pharmaceutical Sector in Jordan = دراسة أثر نظام حماية البيانات على قطاع الأدوية في الأردن

Multinational pharmaceutical companies and generic drug manufacturers have long been at odds over “data exclusivity” regulations. The latter requires a waiting period of at least five years before they can access valuable clinical trial data necessary to bring less expensive forms of innovative drugs to market. Jordan has implemented Data exclusivity since joining the World Trade Organization and signing Free Trade Agreement with the United State in 2001. Before 2001 Jordan allowed Jordanian Pharmaceutical companies to “copy” molecules of Multinational Pharmaceutical companies and sell them under their own trade names. The arrival of the product patent and data exclusivity meant that Jordanian pharmaceutical companies could no longer copy. This has created lot of problems for the Jordanian Pharmaceutical companies as their Research & Development for new molecules is at a very emerging stage. The purpose of this study was to find out what is the effect of the application of data exclusivity on the pharmaceutical sector in Jordan. After analyzing 140 medicines used in treating chronic diseases in Jordan in the period between 2004 & 2010 in Jordan. It was found that at least 16 % of these 140 medicines had no competition from a generic equivalent as a result of data exclusivity. This was perceived negatively by local pharmaceutical companies as the originator companies were relying mainly on the use of data exclusivity instead of patents to preclude generic competition. Data exclusivity was one of the main reasons behind the delay of the presence of the equivalent generic drug in Jordan contributed to rising of the pharmaceutical expenditure in Jordan.

Pharmaceutical Business and Pharmaceutical Industry : New Tracks in Pharmacy Education Initiated in Jordan = الصيدلة الصناعية و أعمال الصيدلة : مسارات جديدة في التعليم الصيدلاني في الأردن

Design and develop a market driven pharmacy study plan with new tracks. Identifying locally determined needs and services and using those to facilitate comprehensive education development toward achieving competencies. Comparative analysis for current study plans of several pharmacy schools combined with a multi-stakeholder in the pharmaceutical industry interviewing approach for an assessment of the needs of the community regarding pharmacy profession. Needs-based education, ongoing consultation and co-operation between related stakeholders including higher education policy makers. Development of Pharmaceutical business and Pharmaceutical industry new tracks as an initiative in Jordan followed by implementation of this outcomes-based education strategy. Providing market driven study plan to serve the local, regional and international community by skilful professional pharmacy graduates will satisfy pharmaceutical industry needs. Persistence toward successful implementation of this initiative in Jordan will encourage other areas of the world to follow as per their local market needs.

Jordanian stakeholder attitudes toward generic substitution

About 10% of Jordan’s gross domestic product is spent on health care, almost one-third of which is spent on pharmaceuticals. Jordan’s pharmaceutical spending is a substantially higher percentage of gross domestic product than that of other developed countries. Generic substitution is a mechanism that could lower pharmaceutical spending costs in Jordan, but Jordan’s domestic law currently forbids pharmacists in the private market from dispensing generic equivalents to branded medicines without a physician’s approval. This article provides the results of a study that surveyed prominent organizational stakeholders (n = 17, RR 100%) in Jordan’s health care system and evaluates their opinions about generic substitution. The study finds there is a broad base of support for allowing and encouraging generic substitution in the private sector, and for mandating generic substitution in the public sector. Given that generic substitution may help to reduce health care costs and improve access to medicines, policymakers should consider legal and policy changes to facilitate generic substitution. The research suggests that key players in Jordan’s health care system will support such proposals.