This survey was undertaken to find out the extent of sales of antibiotics without an official medical prescription in Pondicherry, a Union Territory in India.

Financial constraints versus public desire for more-generous healthcare create a difficult dilemma for countries globally. As each market strives to manage its prescription drug market, highly specific market access requirements and challenges abound for drugmakers. Innovative developers must engage with payers much earlier in the product development cycle in order to optimize trial design to satisfy specific MA and payer requirements on demonstrating innovation (e.g. selecting the appropriate comparator, targeting the correct/local patient population, gathering the most compelling head-to-head). By exploring how pricing and reimbursement (P&R) decisions are made in many major and developing markets around the world, we have developed a Country Archetypes model that identifies similarities among payer requirements, and, vitally, determines where product value messaging can be leveraged to optimize market access strategy. Data on payer type and drug review processes, payer fragmentation, percentage of individuals covered by a health insurance system, size of the pharmaceutical market, percentage of government and individuals in healthcare spending, and use as a reference country for other nations were collected for 27 of the largest pharmaceutical markets in the world. Considerations around free pricing, health technology assessment, and review of pharmacoeconomic and outcomes research data rules were made, and further segmentations on decision impact, size of reimbursable market, out-of-pocket costs, role of health insurance and market fragmentation applied. Ultimately, from the 27 nations examined, six groups emerged, each comprising countries with commonalities across all measures, albeit distinct profiles that affect P&R: Accountants, Pragmatists, Evidence seekers, Deal-makers, Ceiling setters, and Independents. Our Country Archetype model is intended to help multinational pharmaceutical companies prepare for local reimbursement evaluations, and pinpoint where decision-makers can be found. With classifications based on the most important set of reimbursement criteria necessary to attain favorable access in each market, the keys to access can be found and turned.

Economic analysis is regularly used to inform decisions on allocating healthcare budgets but not routinely for allocating health research budgets which may mean that the research budget is not delivering value for money. The study aims to use 'value of information' analysis to prioritise research funding across an entire clinical area. In particular, exploring the usefulness of such methods in prioritising the treatment uncertainties identified by the James Lind Alliance (JLA) Priority Setting Partnership (PSP) for atopic eczema. Whilst the research will primarily identify what the future research priorities within eczema should be, it will also act as a case study of how such methods could be applied to JLA PSPs for other conditions. The potential benefit of this research is in reducing the first two stages of research waste (i) 'Questions relevant to research users?' And (ii) 'Appropriate research design, conduct and analysis?' identified by Chalmers and Glasziou (2009). The methods proposed for doing the work will be described, with a focus on those stages already underway. This includes defining the decision problems, building on the work of the eczema JLA PSP, and conceptual modelling, understanding the disease process and service pathways for eczema with expert input. The potential usefulness and challenges of the approach will be discussed. Strengthening methods around research prioritisation and study design is important to ensure value for money from limited research funding. Reference: Chalmers I, Glasziou P. Avoidable waste in the production and reporting of research evidence. Lancet 2009; 374: 86-89 PRM272 UsE of a MUlti-dEcision cRitERia analysis to sUPPoRt hEalthcaRE dEcision-Making foR PRiVatE PayERs in BRazil: dEVEloPMEnt of a ModEl to gUidE REiMBURsEMEnt dEcisions do Nascimento