is a professor at the Research Centre for Pharmaceutical Care and Pharmaco-economics. He is a health economist and leads the Centre's research into the economics of medicines, medical devices and related products. His research interests focus on issues surrounding competition and regulation of the pharmaceutical industry, and economic evaluation of medicines and medical devices. Sandra De Costergraduated from the Katholieke Universiteit Leuven as a pharmacist. She spent two years in the pharmaceutical industry, where she participated in the regulatory affairs of herbal medicines. She then joined the Research Centre for Pharmaceutical Care and Pharmaco-economics as a research fellow. Her research interests focus on pharmacotherapy. In addition to this, she works part-time as a community pharmacist.Abstract The size of generic medicines retail markets varies widely among European countries, owing to differences in the policy environment surrounding generic medicines. This study aims to provide a comparative analysis of policy tools that European countries have used to develop their generic medicines market and to formulate recommendations for sustaining generic medicines markets. The European experience indicates that there is no single approach towards developing a generic medicines market. Penetration of generic medicines is more successful in countries that permit (relatively) free medicine pricing. Reference-pricing systems do not aid generic medicine use if the price of originator medicines falls to the reference price level. Physician budgets stimulate generic medicine use if accompanied by rewards/sanctions for budget surpluses/deficits, respectively. Generic substitution aids generic medicine use if it is financially attractive to pharmacists to substitute generic for originator medicines. Patient co-payment seems to affect demand for generic medicines. This study shows that coordinated government policies are critically needed in many European countries. To sustain the development of a generic medicines market, countries need to supplement supply-side policies, such as pricing reductions, by demandside policies that create incentives for physicians, pharmacists and patients to use generic medicines.

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This study aims to estimate annual savings from increased generic substitution in the retail market of 11 European countries in 2004. Savings from generic substitution were calculated for the top ten active substances by public expenditure on originator medicines in each country. For each active substance, average price levels weighted by volume of sales of medicines belonging to the group of originator medicines and to the group of generic medicines were calculated. The price difference between originator and generic medicines was multiplied by the volume of originator medicines to be substituted. The analysis considered that, following generic substitution, 5 per cent of market volume for each active substance would be made up by originator medicines and 95 per cent by generic medicines. Increased generic substitution for the top ten active substances generated total potential savings of around S 3bn, with country savings ranging from S 11m in Poland to S 1bn in Germany. Increased generic substitution would be expected to reduce public expenditure on originator medicines containing these active substances by at least 20 per cent in each country. Countries that pursue the development of their domestic generic medicines market, therefore, can expect to gain substantial savings from increased generic substitution.

The aim of the study was to analyse the clinical and economic indicators of the treatment of acute exacerbations of chronic obstructive pulmonary disease (COPD). The study focused specifically on antimicrobial therapy and the use of fluoroquinolones in the management of exacerbations. Data on the consumption of antibiotics to treat exacerbations in ambulatory care were derived from IMS Health. Also, an observational, retrospective analysis was carried out of patients who entered the clinical pathway for COPD exacerbations in University Hospitals Leuven. IMS Health data showed that there is a trend towards the increasing use of broad-spectrum penicillins and fluoroquinolones, and decreasing use of tetracyclines in the treatment of COPD exacerbations in ambulatory care in Belgium in the first half of the 2000s. The observational analysis enrolled 267 patients who were hospitalised between October 2000 and October 2005 to manage 359 exacerbations according to the clinical pathway. Median length of stay per exacerbation amounted to 10 days. Mean quality of life associated with an exacerbation was 74 using the Chronic Respiratory Disease Questionnaire. Median costs of hospital treatment amounted to euro5514 (third-party payer reimbursement and patient co-payment) per exacerbation. Treatment costs were driven by hospital stay (75% of total costs), diagnostic and laboratory tests (20%) and medication (5%). Antibiotics played a role in the hospital management of 75% of exacerbations. Fluoroquinolones were used to treat more severe exacerbations. Treatment of acute exacerbations of COPD imposes a significant clinical and economic burden on patients, the healthcare system and the society.

Background Approximately 1000 protein encoding genes common for vertebrates are still unannotated in avian genomes. Are these genes evolutionary lost or are they not yet found for technical reasons? Using genome landscapes as a tool to visualize large-scale regional effects of genome evolution, we reexamined this question. Results On basis of gene annotation in non-avian vertebrate genomes, we established a list of 15,135 common vertebrate genes. Of these, 1026 were not found in any of eight examined bird genomes. Visualizing regional genome effects by our sliding window approach showed that the majority of these "missing" genes can be clustered to 14 regions of the human reference genome. In these clusters, an additional 1517 genes (often gene fragments) were underrepresented in bird genomes. The clusters of “missing” genes coincided with regions of very high GC content, particularly in avian genomes, making them “hidden” because of incomplete sequencing. Moreover, proteins encoded by genes in these sequencing refractory regions showed signs of accelerated protein evolution. As a proof of principle for this idea we experimentally characterized the mRNA and protein products of four "hidden" bird genes that are crucial for energy homeostasis in skeletal muscle: ALDOA, ENO3, PYGM and SLC2A4. Conclusions A least part of the “missing” genes in bird genomes can be attributed to an artifact caused by the difficulty to sequence regions with extreme GC% (“hidden” genes). Biologically, these “hidden” genes are of interest as they encode proteins that evolve more rapidly than the genome wide average. Finally we show that four of these “hidden” genes encode key proteins for energy metabolism in flight muscle.