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The Crucial Role of Pharmacoeconomic Data in Optimizing Healthcare in the MENA Region

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In the Middle East and North Africa (MENA) region, pharmacoeconomic data (PE) is essential for the pricing and reimbursement of pharmaceuticals to ensure that healthcare systems provide cost-effective and equitable access to treatments. This data helps policymakers and healthcare providers evaluate the economic value of medications by comparing their costs and outcomes relative to existing alternatives.

By integrating pharmacoeconomic assessments, such as cost-effectiveness and budget impact analyses, into decision-making processes, the MENA region can optimize healthcare resource allocation, improve patient outcomes, and support sustainable healthcare financing. This approach also aligns pharmaceutical pricing with the region’s economic realities and healthcare priorities, ultimately enhancing the overall efficiency and effectiveness of the healthcare system.

A recent study discovered the need for pharmacoeconomic data in several countries within the MENA region. Specifically, these countries include Algeria, Egypt, Iraq, Jordan, KSA, Lebanon, Morocco, Tunisia, and the UAE.

Varying Approaches to Pharmacoeconomic Evaluation in Algeria, Egypt, and Iraq

In Algeria, PE is needed but not mandatory. Often the need is not applicable since the drug agency looks to the same case in other reference countries and refers to their decision. PE may be requested for the entrance of expensive drugs, for example, for rare diseases, under specific conditions like the temporary authorization of use (ATU) which is an exception for drugs that need to be used even though they still do not have their market authorization in Algeria but are approved in their country of origin.

In Egypt, a pharmacoeconomic data dossier and evaluation are mandatory. The Egyptian Drug Authority established a pharmacoeconomic department in 2013. In the same year, the newly established unit launched a pharmacoeconomic evaluation program which developed the first pharmacoeconomic guideline model for the Middle-East region.

There has been no official information on the need for PE in drug evaluation for pricing and reimbursement in Iraq. The country suffers from substantial procurement and quality problems but there is rising awareness among the population, pharmacists, and regulators about the need to regulate this sector. It is expected that Iraq will move towards the adoption of pharmacoeconomic data after the establishment of the needed frameworks. Timelines for these are yet to be announced.

Pharmacoeconomic Evaluation in Jordan and Saudi Arabia: Approaches and Integration

In Jordan, the Reimbursement Drug List (RDL) serves as the national formulary, created through the collaboration of technical and national committees from various health sectors. Despite this comprehensive approach, cost-effectiveness analysis (CEA) does not influence the inclusion of new medications in the RDL. The King Hussein Cancer Center (KHCC), recognized as the national cancer institute, established Jordan’s first cancer-specific cost-effectiveness threshold (CET) to guide institutional decision-makers in approving only cost-effective medications.

Although the government has not allocated a specific budget for cancer care, KHCC aimed to implement a health technology assessment (HTA) framework to ensure that its formulary includes only cost-effective drugs. Starting in 2006, all new requests for novel cancer medications at KHCC must undergo a cost-effectiveness (CE) assessment, balancing the need for access to new treatments with the rising costs of medications.

Saudi Arabia has been progressively integrating pharmacoeconomic evaluation methods into the decision-making processes concerning the pricing and reimbursement of novel health technologies, including drugs, devices, procedures, or systems. Pharmacoeconomic analyses, such as cost-effectiveness analysis (CEA) or cost-utility analysis (CUA), play a crucial role in this framework. These evaluations compare the estimated costs and benefits of a health technology against a predefined “threshold” that signifies value for money. Such analyses are commonly utilized as a cornerstone of Health Technology Assessment (HTA), aiding policymakers and stakeholders in assessing the economic feasibility and potential impact of adopting new healthcare interventions.

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Pharmacoeconomic Data

Growing Interest in Pharmacoeconomic Data Across Lebanon, Morocco, Tunisia, and the UAE

Similar to Iraq, Lebanon is suffering from procurement and quality problems caused by drug shortages and smuggling alongside the ongoing economic crisis. PE data are not needed so far but like Iraq, there is a growing interest in adopting it. However, a framework first needed to be established as well as related educational and expertise programs. PE data are not needed in Morocco but like many countries in the MENA region, interest is growing for it.

Like Algeria, pharmacoeconomic data is needed but is not mandatory in Tunisia. There is a growing interest in it thanks to the establishment of The National Authority For Assessment And Accreditation In Healthcare (INEAS). INEAS is mandated to assess health technologies using scientific methods such as systematic reviews, cost-effectiveness, and budget impact analyses. It aims to provide decision-makers with rigorous and evidence-based recommendations to facilitate and inform coverage decisions. INEAS currently focuses on innovative technologies that are likely to have a major cost or an important impact on the Tunisian Health System.

In the UAE, pharmacoeconomic data data is supportive of drug approval but is not mandatory. Most companies are aware that the UAE refers to the country of origin for pricing and, as such, do provide PE data to strengthen their applications.

The Need for Enhanced Utilization of Pharmacoeconomic Data in MENA Healthcare Systems

In conclusion, in the Middle East and North Africa (MENA) region, pharmacoeconomic data remains underutilized in the decision-making processes for drug reimbursement, despite its potential to inform cost-effective healthcare policies. While some countries in the region have made strides in implementing pharmacoeconomic evaluations, many still face challenges in fully integrating these analyses into their healthcare systems. Limited awareness and expertise in pharmacoeconomics among policymakers, healthcare professionals, and stakeholders hinder the effective utilization of such data.

Additionally, there may be cultural and institutional barriers to adopting pharmacoeconomic approaches, as well as resource constraints that impede the collection and analysis of robust data. Without comprehensive pharmacoeconomic assessments, there is a risk of inefficient allocation of healthcare resources and missed opportunities to enhance patient access to cost-effective treatments. Therefore, there is a pressing need for increased investment in capacity-building initiatives, greater collaboration between academia, government agencies, and industry, and policy reforms to promote the widespread adoption of pharmacoeconomic data in drug reimbursement decisions across the MENA region.


Original Article: PharmacoEconomics Open 6. 137–145 (2022). doi: 10.1007/s41669-021-00293-4

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