Authors:Dag Morten Dalen, Steinar Strøm, Marilena Locatelli Pages: 11 - 23 Abstract: Our objective is to study the competition effect of biosimilar entry in centralized tenders for an expensive category or drugs - TNF-inhibitors. We use monthly observations of prices and volumes for all brands and biosimilars in this drug category in Norway, covering the period from Jan. 2006 to Dec. 2016. Descriptive statistics and regression models are used to investigate the impact of biosimilars on the drug price and the effect of the number of brands on the intensity of competition. Both the entry of biosimilars and new branded drugs have increased competition and reduced prices. According to our estimates, an increase in the market share of biosimilars from 10 % to 60 %, will be accompanied with a 50 % reduction in the expected price. Only two years after entry, the first biosimilars in this drug category had gained a market share of 40 % in Norwegian hospitals. Although entry barriers for biosimilars are higher than for generics of chemical substances, significant cost savings are expected from patent expirations of expensive biologics as well. The centralized design of the tenders is an important institutional factor behind the strong competition effect. Published: Online January 2020 PubDate: 2021-01-04 DOI: 10.5617/njhe.7394 Issue No:Vol. 9, No. 1 (2021)
Authors:Vibe Bolvig Hyldgård, Søren Paaske Johnsen, Henrik Støvring, Andreas Albertsen, Rikke Søgaard Pages: 24 - 37 Abstract: Many consider inequality in health unfair if it is caused by inequality within the healthcare system but less unfair when caused by individuals’ health behaviour. However, healthcare systems are challenged when it comes to ensuring equal care for equal need. In Roemer’s equality of opportunity theory, people have equal opportunity for obtaining something if obtaining it reflects their effort instead of their circumstances. Very little is known about how responsibility exerted by patients prior to illness affects the healthcare they are provided by the healthcare system. We aimed to apply Roemer’s theory to an acute care setting where healthcare is most directly in the hands of the healthcare system in order to study the role of patient-exerted responsibility for their opportunities in the healthcare system. We operationalised the responsibility patients exert as Body Mass Index (BMI), smoking and alcohol habits, and their circumstances as demographics, socioeconomics, prognostic factors and year of discharge. Opportunity in healthcare was defined as patients’ attainment of clinical guideline-recommended acute hospital care. In Roemer’s theory, we detected inequality of opportunity as restricted attainment of healthcare was mainly associated with patients’ circumstances, such as lower education, old age or living alone. We also identified a strong association with BMI; being underweight negatively affected patients’ opportunities as it led to suboptimal healthcare, while the opposite was found for being overweight and, in particular, obese. Hence, patient-exerted responsibility affected patients’ opportunities in healthcare, though perhaps in an unexpected way. This improved understanding of inequality may help to focus future research and, in the long term, support clinical and political efforts to achieve equal care for equal needs. Published: Online March 2021. PubDate: 2021-03-04 DOI: 10.5617/njhe.7822 Issue No:Vol. 9, No. 1 (2021)
Authors:Tore Bersvendsen, Jochen Jungeilges, Eirik Abildsnes Pages: 38 - 55 Abstract: Home-based reablement (HBR) aims to restore or increase patients’ level of functioning, thereby increasing the patients’ self-reliance and consequently decreasing their dependence on healthcare services. To date, the evidence on whether HBR is an efficient method has not been comprehensively reviewed. The aim of this study was to provide a concise summary of relevant existing findings. In addition, we provide a critical constructive assessment of the publications reflecting the extant research. The relevant literature on this topic was identified through a systematic search of appropriate databases. Thereafter, we screened the studies, first by title, followed by abstract and then by assessing full-text eligibility. A checklist of 15 criteria was developed and used as the basis for the quality assessment. In total, 12 studies from Australia, New Zealand, the USA and Norway were included in the full-text review. The studies reported estimated cost differences between HBR and usual care after the intervention. All the studies indicated lower costs for HBR, but not all of them reported a significant difference. The same pattern was also found for other measures of physical functioning and quality of life. The assessment revealed one specific common pattern: None of the papers scrutinized provided sufficient information about the data or the statistics employed, and all lacked external validity. Some promising results have been reported with respect to HBR reducing the need for specialist or residential care. In short, the existing evidence regarding the effects of HBR is still inconclusive. The findings from the quality assessment should motivate a multidisciplinary approach for future research on HBR. Published: Online May 2021. PubDate: 2021-05-28 DOI: 10.5617/njhe.7838 Issue No:Vol. 9, No. 1 (2021)
Authors:Ulf Persson, Sara Olofsson, Ning Yan Gu, Cynthia L. Gong, Xiayu Jiao, Joel W. Hay Pages: 56 - 73 Abstract: The outbreak of the pandemic COVID-19 (Coronavirus) has resulted in various international and national strategies, including non-pharmaceutical interventions (NPIs) such as social distancing and travel bans, which have purportedly mitigated the health loss due to the pandemic but also given rise to a severe economic crisis. Both factors, the pandemic and the NPIs, can be expected to have an impact on the Health-Related Quality-of-Life (HRQoL) of the population. The objective of this study was to estimate the impact on HRQoL of the Swedish adult population during the outbreak of the COVID-19 pandemic. A web-based survey was sent to randomised samples of the adult Swedish population before the outbreak of the pandemic in Sweden in February 2020 (n=1,016) and during the outbreak of the pandemic. The first wave pandemic data was collected in April 2020 (n=1,003), one-month after the outbreak and, the second wave data was collected in January 2021 (n=1,013), after 10-months living under the pandemic. HRQoL was measured using the EQ-5D-5L in the pandemic surveys, whereas the Visual Analogue Scale (VAS) was used in all surveys. The results suggested a reduction in average HRQoL as measured by VAS in the adult Swedish population, with 0.059 points reduction in VAS in April 2020 and 0.074 points reduction in January 2021, compared to the pre-pandemic measurement in February 2020. The loss in HRQoL was significant among respondents in the working age population (<65 years), suggesting that the social and economic impact of NPIs were the primary drivers for this specific cohort. Findings of this study supports a wide public health perspective and future HRQoL measurements at the population level throughout the pandemic. Published: Online September 2021 PubDate: 2021-09-21 DOI: 10.5617/njhe.8332 Issue No:Vol. 9, No. 1 (2021)
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