Health Policy and Technology最新文献

{"title":"Biosimilar medicines in Malaysia: Unveiling new guidance for practice","authors":"N Saad,&nbsp;Coleen SB Choo,&nbsp;H Chandriah,&nbsp;N Ahmad","doi":"10.1016/j.hlpt.2025.101135","DOIUrl":"10.1016/j.hlpt.2025.101135","url":null,"abstract":"<div><h3>Background</h3><div>Biologics have transformed the treatment of chronic diseases, but their high-cost limits access and burdens healthcare budgets. Biosimilars, highly similar versions of approved biologics, offer a more affordable alternative. However, their complex nature necessitates distinct regulatory and clinical guidance to ensure their safe and effective use in the healthcare facilities.</div></div><div><h3>Objective</h3><div>This article highlights the policy initiatives undertaken by the Ministry of Health (MOH) Malaysia to develop a Position Statement, aimed at guiding the integration of biosimilars into Malaysia’s public healthcare system.</div></div><div><h3>Method</h3><div>A multi-stage process began in 2019 and involved structured stakeholder engagement, literature reviews, and consensus-building across medical and regulatory disciplines. Key areas addressed included interchangeability, switching, automatic substitution, prescribing, procurement, and pharmacovigilance. Two rounds of review were conducted, and stakeholder consensus was obtained through a binary survey, with a 70 % agreement threshold.</div></div><div><h3>Results</h3><div>Stakeholders from multiple specialties emphasized cautious but positive attitudes toward biosimilar use, especially for treatment-naïve or short-term therapy patients. The final guidance includes ten statements across five domains, emphasizing physician-led switching, prohibition of automatic substitution, indication-specific prescribing, and the need for robust pharmacovigilance. A total of 83 % of stakeholders supported the content, and 88 % endorsed its dissemination. The document was officially endorsed by the MOH Medicines Formulary Panel for implementation across all MOH facilities.</div></div><div><h3>Conclusion</h3><div>The position statements represent a critical step toward structured biosimilar adoption in Malaysia’s public healthcare. Ongoing implementation, education, and post-market evaluation will be essential to strengthen prescriber confidence, improve pharmacovigilance, and enhance patient trust in biosimilars.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101135"},"PeriodicalIF":3.7,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of assistive technologies on caregiver burden and perseverance for people with dementia at home","authors":"G. Bagnasco ,&nbsp;J. van Exel","doi":"10.1016/j.hlpt.2025.101134","DOIUrl":"10.1016/j.hlpt.2025.101134","url":null,"abstract":"<div><h3>Objectives</h3><div>This study examines the relationship between the use of assistive technologies and the burden and perseverance time of informal caregivers of community-dwelling people with dementia.</div></div><div><h3>Methods</h3><div>An online survey of 342 informal caregivers in the Netherlands assessed objective burden (tasks and time involved in caregiving), subjective burden (personal experience of stress and strain), current perseverance time (time expected to be able to continue providing care), and well-being (overall happiness). Data included demographics, housing, neighbourhood characteristics, assistive technology use, and preferences for additional technologies. Multiple logistic regressions examined associations between assistive technology categories and caregiver outcomes (i.e., below-median weekly caregiving hours, Self-Rated Burden score; above-median CarerQol-7D score, CarerQol-VAS score, and Current Perseverance Time in months). Furthermore, multiple logistic regressions estimated the impact of the most desired technology category on the likelihood of extending the perseverance time by more than six months. Analyses were stratified by caregiver living arrangement (co-residing vs living nearby).</div></div><div><h3>Results</h3><div>Among co-residing caregivers, daily living support technologies were associated with reduced caregiving hours, whereas risk prevention technologies were linked to longer current perseverance time but also higher self-rated burden. Risk response technologies were also associated with higher self-rated burden. Among caregivers living nearby, risk prevention technologies were associated with higher quality of life. Moreover, daily living support and risk response technologies most strongly extended perseverance time beyond six months in both groups.</div></div><div><h3>Conclusions</h3><div>Assistive technologies play a nuanced role in supporting informal caregivers of community-dwelling people with dementia, with impacts differing by living arrangement and technology type.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101134"},"PeriodicalIF":3.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Value-centred commissioning in primary health care: reform lessons from the Portuguese experience","authors":"Paulo Santos ,&nbsp;Isabel Nazaré ,&nbsp;Luísa Sá","doi":"10.1016/j.hlpt.2025.101133","DOIUrl":"10.1016/j.hlpt.2025.101133","url":null,"abstract":"<div><h3>Background</h3><div>Portuguese Primary Health Care commissioning has transitioned from centrally managed agreements to performance-based models. Despite this evolution, persistent structural and procedural inefficiencies limit its capacity to generate value. Comparative European experiences highlight alternative frameworks that emphasise outcome relevance, decentralisation, and system learning.</div></div><div><h3>Objective</h3><div>To propose a conceptual model for primary health care commissioning aligned with structure–process–outcome logic.</div></div><div><h3>Methods</h3><div>We conducted a narrative review to trace the evolution of commissioning in Portuguese Primary Health Care, focusing on its regulatory, financial, and performance roles. We used several sources, including legislation, policy documents, national and European reports, and academic literature. Analysis followed a structure–process–outcome framework. Comparative insights highlighted governance models, incentive structures, and reform opportunities aligned with value-based care and European benchmarks.</div></div><div><h3>Results</h3><div>Portuguese commissioning systems lack clinically meaningful outcome indicators and remain rigid in design. The new model offers a framework for aligning commissioning processes with population health needs, clinical relevance, and system adaptability. Comparative analysis shows that decentralised, context-sensitive models from other European countries are applicable and promising.</div></div><div><h3>Conclusions</h3><div>Commissioning reforms should centre around auditable, evidence-based outcome indicators tailored to local contexts. These indicators can enhance motivation, accountability, and continuous learning. Reforms are achievable within current organisational structures and planning cycles. Policymakers should consider decentralisation and a value-oriented approach to improve Primary Health Care delivery and responsiveness, particularly in systems facing similar structural constraints.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101133"},"PeriodicalIF":3.7,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145569334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Four years upscaling telemonitoring to future-proof health care delivery in Dutch university hospitals: Before and after - where do we stand and what are the results?","authors":"HJ Harm Gijsbers ,&nbsp;S Azam Nurmohamed ,&nbsp;Linda W Dusseljee–Peute ,&nbsp;Tom H van de Belt ,&nbsp;Marlies P. Schijven","doi":"10.1016/j.hlpt.2025.101132","DOIUrl":"10.1016/j.hlpt.2025.101132","url":null,"abstract":"<div><h3>Objectives</h3><div>Upscaling digital solutions is crucial for future-proofing healthcare, yet effective and sustainable methods are underrepresented in literature. In the Netherlands, a University Medical Center (UMC) network collaborated within the Citrien eHealth program to future-proof care using telemonitoring (TM). From 2020–2022, three TM activities were initiated: TM for cardiac rhythm abnormalities/heart failure (TMCardio), TM of blood pressure in high-risk pregnant women (TMAnteNatal), and continuous wireless monitoring of vital functions (TMVitals). This study evaluated the scale-up of these TM programs in seven Dutch UMCs.</div></div><div><h3>Methods</h3><div>An uncontrolled before-after study design was used.Primary outcome, ‘normalization of telemonitoring,’ was assessed using the 20-item NoMAD questionnaire. Results were structured according to the non-adoption, abandonment, scale-up, spread and sustainability (NASSS) framework. Secondary outcomes included the number of UMCs offering TM programs and the number of patients using TM.</div></div><div><h3>Results</h3><div>The NoMAD questionnaire had a 61 % response rate. Respondents were familiar with TM (<em>N</em> = 85, mean = 7.27, SD=2.13) and believed it would become more normal in their work (<em>N</em> = 98, mean = 8.42, SD=1.64). However, a significant difference between current practice and expected future use of TM was observed (<em>p</em>≤ 0.001). All UMCs ran TM programs, but not all implemented all three projects. TMCardio patients increased from 190 to 5185, TMAnteNatal from 41 to 1162, and TMVitals from 2666 to 13630.</div></div><div><h3>Conclusion</h3><div>Telemonitoring uptake increased across Dutch UMCs, but not uniformly. The complexity of scale-up is highest in NASSS domains 4, 5, and 6, with a focus on management, resources, health care reimbursement, and regulations. Understanding the impact of the Citrien network collaboration on scale requires further qualitative analysis.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101132"},"PeriodicalIF":3.7,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145569230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teleconsultation for chronic disease management among community-dwelling older adults: A call for innovation","authors":"Su Wei Wan ,&nbsp;Lina Choe ,&nbsp;Gretel Jianlin Wong ,&nbsp;Wee Ling Koh ,&nbsp;Janelle Shaina Ng ,&nbsp;Wee Hian Tan ,&nbsp;Joanna Li Xin Ooi ,&nbsp;Jacquelyn Melody ,&nbsp;Ker Kan Tan","doi":"10.1016/j.hlpt.2025.101131","DOIUrl":"10.1016/j.hlpt.2025.101131","url":null,"abstract":"<div><h3>Objectives</h3><div>Telehealth services have been around for a while but utilization of teleconsultation among older adults remains low despite its extensive and known benefits. Behavioural intentions are multifactorial and nuanced, and qualitative evidence describing the acceptance of teleconsults for chronic disease management is scarce. Hence, this study explored the perspectives of older adults towards teleconsultation use in the primary care setting.</div></div><div><h3>Methods</h3><div>A descriptive multi-site qualitative study was conducted. Semi-structured interviews guided by the Unified Theory of Acceptance and Use of Technology (UTAUT) model were held with twenty community-dwelling older adults ≥ 65 years on routine follow-up for three common chronic diseases in Singapore: hypertension, hypercholesterol, and type II diabetes mellitus. Data was analysed using the inductive thematic approach.</div></div><div><h3>Results</h3><div>Five themes were yielded: (i) more than just a physical consult; (ii) the difference in modes – does it really matter?; (iii) psychological receptivity to new technology; (iv) appropriateness of teleconsultation for medical condition; and (v) moderating factors. Participants were generally ambivalent towards teleconsultation as they could foresee its advantages but also its limitations which were thought to affect treatment. Many lacked knowledge of this remote modality which led to preconceptions of it being non-intuitive and difficult to adopt in the absence of facilitators that promote their viability.</div></div><div><h3>Conclusions</h3><div>Older adults’ acceptance of teleconsultation for chronic disease management seems conditional and non-optimistic at present. Physician advocacy, digital trainings, structured policies and age-appropriate teleconsult configurations with matured features that can mitigate the shortfalls of remote consultation will help enhance older adults’ acceptance of such services.</div></div><div><h3>Public interest summary</h3><div>While the potential and proven merits of telemedicine are plentiful, this remote modality remains foreign and intimidating to the majority of older adults. This study explored teleconsult acceptability for chronic disease management with the UTAUT framework. Findings revealed several pressing concerns which indicate the need for more digital initiatives and healthcare advocacy for its uptake in the community. Besides user-related programs, there is room for system improvements to include mature features that may offload the burden on users to learn the technology.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101131"},"PeriodicalIF":3.7,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145569231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orphan medicine policy and decision-making frameworks: A narrative review of HTA methodologies","authors":"Mohammadreza Mobinizadeh ,&nbsp;William V. Padula ,&nbsp;Min-Hua Jen ,&nbsp;Efat Mohamadi ,&nbsp;Sahar Salehi","doi":"10.1016/j.hlpt.2025.101130","DOIUrl":"10.1016/j.hlpt.2025.101130","url":null,"abstract":"<div><h3>Objectives</h3><div>Orphan medicinal products (OMPs) often face unique policy and reimbursement challenges due to small patient populations, limited clinical data, and high costs. This review aims to provide the first comprehensive, cross‑methodological and cross‑stage synthesis of how CEA, GCEA, MCDA, and BIA have been applied in OMPs policymaking, addressing critical gaps in integrating findings across HTA stages and income‑level contexts.</div></div><div><h3>Methods</h3><div>This narrative review searched PubMed and Google Scholar for English‑language studies published between 2008 and 2024, using keywords related to rare diseases, policymaking, and the three key stages of the health technology policymaking process: topic selection, assessment, and appraisal. Studies were included if they addressed at least one of these stages in the context of OMPs.</div></div><div><h3>Results</h3><div>This review identified 17 studies related to policymaking for orphan medicinal products, of which 6 focused on topic selection—including 3 that explicitly examined horizon scanning—and 11 on the combined assessment and appraisal stages. Methodologically, 3 studies applied CEA or GCEA, 8 explored MCDA (2 for topic selection and 6 for assessment and appraisal stages), and 2 employed BIA, with some studies using more than one approach. CEA serves as the standard but struggles to incorporate societal, ethical, and dynamic market factors, often limiting its applicability for OMPs. GCEA addresses such gaps with additional considerations like disease severity and equity but remains methodologically complex. MCDA offers a more comprehensive framework by integrating clinical, economic, and qualitative benefits, although challenges like attribute weighting and stakeholder inclusion persist. BIA is instrumental in assessing affordability but lacks clinical outcome integration. Additionally, Managed Entry Agreements (MEAs) although not an HTA methodology in themselves - have emerged in several countries as practical policy tools for mitigating financial risk and bridging evidence gaps, thereby complementing the application of CEA, GCEA, MCDA, and BIA in real‑world OMPs decision‑making.</div></div><div><h3>Conclusion</h3><div>Integrating GCEA, MCDA, BIA, and complementary tools such as MEAs alongside systematic horizon scanning within the topic selection stage creates a robust framework for addressing the complexities of orphan drug policymaking across all HTA stages. Future work should focus on developing a technical input–output design for the proposed integrated chain HTA model, ensuring that outputs from horizon scanning and topic selection feed directly into structured assessment modules, and that appraisal outputs are systematically linked to policy tools such as MEAs and BIA.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101130"},"PeriodicalIF":3.7,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A real-world comparison of outcomes and healthcare resource utilization of Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR)","authors":"Giaele Moretti ,&nbsp;Chiara Seghieri ,&nbsp;Claudio Passino ,&nbsp;Milena Vainieri","doi":"10.1016/j.hlpt.2025.101129","DOIUrl":"10.1016/j.hlpt.2025.101129","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to assess and compare the real-world outcomes and healthcare resource utilization of Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) procedures, acknowledging the challenges associated with medical device evaluations.</div></div><div><h3>Methods</h3><div>The two cohorts of TAVI and SAVR patients were identified using individual-level administrative data in the Tuscany region of Italy from 2016 to 2021. Patients in treatment cohorts were followed for up to one-year post-procedure, with outcomes and costs assessed. Clinical indicators were selected from the Valve Academic Research Consortium-3 (VARC-3) consensus document. Follow-up costs, in euros (€), were calculated for each patient up to three years post-procedure, from the perspective of the Italian National Healthcare System.</div></div><div><h3>Results</h3><div>No significant differences in 30-day and 1-year mortality were found between TAVI and SAVR, though TAVI showed a slight increase in 3-year mortality (OR 1.05, <em>p</em> = 0.004). TAVI patients had higher rates of conduction disturbances and pacemaker implantation at all time points. They also experienced more ER admissions and hospital readmissions at 3 years, but shorter hospital stays. At 1 year, TAVI incurred in €234 higher total costs, driven mainly by higher ER costs, while pharmaceutical costs were similar. At 3 years, total costs were €2132 for TAVI and €1915 for SAVR, with higher ambulatory and ER costs in the TAVI group but lower pharmaceutical costs.</div></div><div><h3>Conclusion</h3><div>The study explores the potential of Real-World Evidence to inform the clinical and economic evaluation of new technologies and procedures. The study differs from some prior randomized controlled trial-based studies, highlighting the impact of diverse analytical approaches and patient populations.</div></div><div><h3>Public interest abstract</h3><div>Aortic stenosis (AS) is a common heart valve disease in the elderly, whose standard treatment consists of Surgical Aortic Valve Replacement (SAVR). For patients that are ineligible for surgery due to high risk or comorbidities, Transcatheter Aortic Valve Implantation (TAVI), has emerged as a less invasive option. This study used real-world data from Tuscany, Italy, to compare clinical outcomes and costs. We found no significant difference in mortality rates between TAVI and SAVR at 30 days and one year and higher mortality at 3 years. TAVI patients were more likely to experience conduction disturbances, often requiring pacemaker implantation. Cost differences were modest, with TAVI patients incurring €234 more in total healthcare expenses over one year and €217 at three years. These findings highlight the value of real-world evidence in assessing the safety, effectiveness, and financial sustainability of new treatments like TAVI.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101129"},"PeriodicalIF":3.7,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145520258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Co-design and formative usability evaluation of a multifunctional mhealth app for chronic vestibular syndrome management","authors":"Xuejiao Cao ,&nbsp;Yanping Yu ,&nbsp;Ruiqi Zhang ,&nbsp;Huawei Li ,&nbsp;Wenyan Li ,&nbsp;Peixia Wu","doi":"10.1016/j.hlpt.2025.101128","DOIUrl":"10.1016/j.hlpt.2025.101128","url":null,"abstract":"<div><h3>Objectives</h3><div>Chronic vestibular syndrome (CVS) refers to chronic dizziness and imbalance symptoms persisting for ≥3 months. The treatment and management of patients with CVS remain a global challenge. The effectiveness of mobile application in assisting people with other chronic conditions has been proved. This study aims to co-design and develop an app prototype for patients with CVS innovatively, then explore users’ formative evaluation for this app prototype.</div></div><div><h3>Methods</h3><div>This research adopted the qualitative research method. Two rounds of focus groups were conducted to determine the modules and functions of the app. Then the app prototype was developed accordingly. Subsequently, patients or their main caregiver were interviewed to explore their formative evaluation and optimization requirements, which in accordance with the ISO 9241–11 usability framework.</div></div><div><h3>Results</h3><div>During the focus groups, eight modules were identified for this app, including 20 specific functions in total. On the basis of focus group results, an app prototype was developed over a period of six months. Interview results indicated that participants expressed positive evaluations regarding the usefulness of this app. However, there were several impediments in terms of usability. In the end, seven user requirements for app optimization were obtained.</div></div><div><h3>Conclusions</h3><div>This study designed and developed an app based on expert focus groups. Target users provided relatively positive evaluations on this prototype. This study provided preliminary evidence on the acceptability and usability of mobile apps for managing patients with CVS.</div></div><div><h3>Public Interest Summary</h3><div>Chronic dizziness and imbalance can significantly affect daily life, making it hard for people with chronic vestibular syndrome (CVS) to manage their condition. In our study, we created a user-friendly mobile health app specifically designed for CVS patients. The app offers features to support symptom tracking, rehabilitation exercises, and educational resources. By involving both medical experts and patients in the co-design process, we ensured the app meets the real needs of users. Preliminary feedback from patients suggests that the app is practical and could help improve their quality of life. This innovation has the potential to make managing CVS more accessible and effective, reducing the challenges these patients face every day.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101128"},"PeriodicalIF":3.7,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare providers’ perspectives of first-tier NIPS' implementation in Canada","authors":"Tierry M. Laforce ,&nbsp;Vardit Ravitsky ,&nbsp;Marie-Christine Roy ,&nbsp;Anne-Marie Laberge","doi":"10.1016/j.hlpt.2025.101127","DOIUrl":"10.1016/j.hlpt.2025.101127","url":null,"abstract":"<div><h3>Objective</h3><div>This article presents an analysis of barriers and facilitators concerning the implementation of first-tier non-invasive prenatal screening (NIPS) in Canada, as identified by healthcare providers, using the Consolidated Framework for Implementation Research (CFIR).</div></div><div><h3>Study Design</h3><div>Semi-structured interviews were conducted with 16 healthcare professionals. Obstetricians-Gynecologists (OBGYN), family physicians, geneticist, midwives, and genetic counselors from 5 provinces were recruited. CFIR was used both for the interview guide and the coding dictionary. Discourse analysis was done for all interviews after data saturation was attained.</div></div><div><h3>Results</h3><div>The findings reveal a contrast in participant perspectives. While NIPS is perceived as a superior screening tool with the potential to replace traditional screening, concerns linger regarding its impact on pregnant individuals and the healthcare system. Participants acknowledge the positive perception of NIPS and its potential to replace traditional screening. They emphasize that NIPS does not address a gap in the screening pathway since other methods already detect the screened conditions. Despite facilitators like positive perceptions and increased accessibility to information, it necessitates careful consideration concerning NIPS' place in the prenatal screening pathway. Access to NIPS is considered a facilitator, potentially reducing inequalities, but widespread availability may compromise care for some pregnant individuals. Barriers include the lack of novelty in NIPS information and its inability to replace diagnostic tests.</div></div><div><h3>Conclusion</h3><div>Our research offers a comprehensive understanding of barriers and facilitators, aiding anticipation of potential implementation as a first-tier test and maximizing the likelihood of successful implementation. The use of CFIR to analyze the prenatal screening pathway provides a structured approach to identify possible tensions in implementing first-tier NIPS, and actionable insights. This research provides valuable insights for policymakers and decision-makers, underscoring the importance of education and deliberate consideration when determining NIPS's appropriate role in prenatal screening.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101127"},"PeriodicalIF":3.7,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining fair medicines prices. What do citizens think?","authors":"Alexander Roediger ,&nbsp;Lennart Pirktl ,&nbsp;Georg Schönbächler ,&nbsp;Helmut Brand","doi":"10.1016/j.hlpt.2025.101126","DOIUrl":"10.1016/j.hlpt.2025.101126","url":null,"abstract":"<div><h3>Objectives</h3><div>There is a lively debate about the fair price of medicines, mainly led by experts. Little is known about the public’s opinion, although in most health systems with universal coverage medicines are procured by public money through payers or governments. This study assesses public opinion about fair medicine prices, the criteria that define fairness, and the policy implications.</div></div><div><h3>Methods</h3><div>A population survey amongst 1000 people across the Swiss population in all 3 language regions has been conducted between September and October 2024.</div></div><div><h3>Results</h3><div>Access for all (986), transparency of the cost structure (914) and a price reflecting the costs of a medicine (911) have ranked as the most relevant factors for a fair price of medicine. In contrast, the additional benefit of a new therapy is considered less important as a criterion. A large majority supports pharmaceutical companies making a profit. Asked how to align the different objectives, the majority supports the statement that medicines prices should be the result of a fair process (568), followed by the statement that governments should control profits (431).</div></div><div><h3>Conclusions</h3><div>This study suggests that citizens consider the balance between patient access and investment in research and development as the most relevant for a fair price of a medicine. When access and cost create a dilemma, citizens favour fair procedures. In contrast to expert opinions, the additional benefit of a medicine seems to be a less relevant criterion. The survey results indicate a nuanced and pragmatic approach to fairness, considering societal, scientific, and economic factors.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101126"},"PeriodicalIF":3.7,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145418421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}