Although vaccination is one of the most cost-effective health care interventions, under-vaccination and variation in coverage rates lower than policy targets is rising in developed countries, partly due to concerns about vaccination value and benefits. By merging various antigens into a single product, combination vaccines represent a valuable tool to mitigate the burden associated with the numerous injections needed to protect against vaccine preventable infectious diseases and increase coverage rate, possibly through various behavioral mechanisms which have yet to be fully explored. Beyond their cost-effectiveness in protecting against more diseases with fewer injections, combination vaccines also have several other benefits, for children, their parents/carers, as well as for the health system and the population as a whole. The objectives of this review are to identify and illustrate the value of combination vaccines for childhood immunization. Evidence was classified into 2 groups: benefits for society and benefits for public health and healthcare systems. This article also highlights the value of innovation and challenges of combination vaccine development as well as the need for an increased number of suppliers to mitigate the impact of any potential vaccine shortage. Increasing public confidence in vaccines and combination vaccines is also critical to fully exploit their benefits.

BackgroundA change in the pharmaceutical environment has occurred from previously only needing to convince regulators of a product's safety and efficacy to obtain marketing authorisation to now needing to satisfy the value perceptions of other stakeholders, including payers, to attain market access for products. There is thus the need to understand the concept of market access that may be defined as ‘the process that ensures the development and commercial availability of pharmaceutical products with appropriate value propositions, leading to their prescribing and to successful uptake decisions by payers and patients, with the ultimate goal of achieving profitability and best patient outcomes’. The aim of this research therefore was to explore the understanding of market access among various stakeholders and how their understanding of this concept could improve patient access to pharmaceutical products.MethodsA literature review was conducted on MEDLINE by using the term ‘market access’ to find articles with explicit definitions of market access for pharmaceutical products; non-peer–reviewed and other grey literature sources were also examined. A paper-based interview survey was also conducted in three different settings. The respondents were asked about what factors they think contribute to the successful development of pharmaceutical products, as well as their definition of market access for these medicines.ResultsThe peer-reviewed literature review did not reveal appropriate comprehensive definitions for market access, although several definitions were proposed from the non-peer–reviewed literature. These definitions ranged from basic to detailed. The survey of 110 respondents revealed differing levels of understanding of market access. Factors considered to influence successful market access, as described by the respondents, included unmet need/burden of disease (68.2%), clinical efficacy (47.3%), comparator choice (36.4%), safety profile (36.4%), and price (35.5%).ConclusionThe concept of market access is still poorly understood, and the definition varies depending on the stakeholders’ perspectives. For cost-effective products to be developed and made accessible to patients, there is a need for wider understanding of market access and the value perspectives of the various stakeholders. There is also a need to determine whether and how involved payers should be in the development of pharmaceutical products.

Objectives: The aim of the study is to analyze the burden of chronic diseases on public health care expenditures using pharmaceutical data regarding about 2 million individuals. MethOds: Data come from the administrative database of the third Belgian health insurance funds. Without explicit diagnoses of diseases in the database, chronic diseases are mainly estimated using drugs prescription (reimbursed medications only) for a treatment of at least 90 days/year. A multivariate linear model based on the OLS method is used to analyse the impact of 23 chronic diseases on health care expenditures, while controlling for age, sex, marital and social status, share of hospital expenditures, residential areas and year of death. Results: Monthly average health care costs for people with one or more chronic conditions is 6 times greater than the ones without any chronic conditions (€ 423 vs. € 71). All chronic diseases (except psoriasis) have a significant impact on health care (at 1% level). The last months of life, developing or living with cancer, chronic renal failure, rare disease and mental disorder are the factors having the greatest impact on monthly reimbursed health care expenditures. All things being equal, a person at the end of life costs more than € 2,236 per month to the health insurance compared to a person not at the end of life. Respectively this amounts to € 3,557, € 3,008, € 2,042 and € 1,151 for people living with a rare disease, chronic renal failure, mental disorder and cancer. cOnclusiOns: Results found in this study are similar to those observed in other countries. Our findings show in particular that chronic diseases significantly drive health care expenditures. Using secondary data allows to classify chronic diseases according to the financial weights while controlling for characteristics of the analysed population. Results highlight the high financial burden of chronic diseases for public health care expenditures and allow decision-makers to take appropriate public health measures. PHP143 tHe effect of cHIna's basIc meDIcal Insurance scHemes on HealtH servIce utIlIzatIonObjectives: Over the past decade increasing numbers of expensive drugs have entered the market, placing a financial burden on hospitals in particular. Many high-cost therapies require use or at least initiation in the hospital setting. Many European countries reimburse hospitals via diagnosis-related group (DRG) systems. However, DRG systems are often insufficient to cover the costs of expensive drugs. Here we assess how expensive drugs are funded in hospitals across markets, what the requirements are, and the process of additional funds being granted. MethOds: Publicly available documents, governmental guidelines and regulations were assessed to understand the different processes and requirements expensive drugs need to meet to receive additional funding. Countries included were the UK, Portugal. Results: In all included countries, hospital treatments are reimbursed via DRG systems, and most provide additional funding for expensiv...

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observational studies also confirmed the indirect protection provided by rotavirus vaccination in countries where rotavirus vaccination programmes have been introduced. France has not yet implemented such a programme. Previously reported models in France do not include herd protection, thus underestimating the effectiveness of vaccination. Our study uses a dynamic transmission model to account for herd protection and therefore better predict the effect of an oral rotavirus pentavalent vaccination programme in France. Methods:We developed a dynamic model to account for susceptibility of rotavirus infection as a function of both age and the number of previous infections. It was parameterized with French data on rotavirus gastro-enteritis (RVGE) incidence and age-specific contact rates. We evaluated the direct and indirect effects of vaccination on disease incidence and clinical outcomes. A three-dose vaccine course was assumed to be administered to 75% of infant annually. Results: Our model predicts that vaccination can reduce the burden of RVGE by 66% in the four years following vaccine introduction, gradually increasing to 73% in the long term for children under 5 years of age. Our calculations show that herd immunity accounts for 11% to 20% of the overall RVGE reduction in children. Incidence in the unvaccinated adult population would also be reduced by more than 40% through herd protection. Vaccination is also predicted to reduce pressure on the health care system with the model estimating an annual reduction of 84% and 82% in the number of hospitalization/nosocomial and outpatient visits for RVGE respectively. ConClusions: The use of dynamic models is critical to account for the indirect effects of rotavirus vaccination via herd protection and thus for policymakers to understand the true effectiveness of a country-wide rotavirus vaccination programme.