title: Implications of external price referencing of pharmaceuticals in Middle East countries.
abstract: BACKGROUND
  External price referencing (EPR) is applied frequently to control pharmaceutical prices. Our objective was to analyse how EPR is used in Middle Eastern (ME) countries and to compare the price corridor for original pharmaceuticals to non-pharmaceutical services not subjected to EPR.
  
  
  METHODS
  We conducted a survey on EPR regulations and collected prices of 16 patented pharmaceuticals and 14 non-pharmaceutical services in seven Middle Eastern (ME) countries. Maximum and minimum prices of each pharmaceutical and non-pharmaceutical technology were compared to mean prices in the countries studied by using market exchange rates. Influencing factors of pharmaceutical prices were assessed by multivariate linear regression analysis.
  
  
  RESULTS
  The average price corridor is narrower for pharmaceuticals (-39.8%; +35.9%) than for outpatient and hospital services (-81.7%; +96.3%).
  
  
  CONCLUSIONS
  Our analysis revealed the importance of population size and EPR implementation on drug price levels; however, EPR results in higher pharmaceutical prices in lower-income countries compared to non-pharmaceutical services.
authors.affiliation: a 1 Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary.|b 2 Syreon Research Institute, Budapest, Hungary.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Kaló
authors.affiliation: c 3 University of Jordan, Amman, Jordan.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Alabbadi
authors.affiliation: d 4 Ministry of Health, Abu Dhabi, UAE.
authors.forename: Ola Ghaleb
authors.initials: OG
authors.lastname: Al Ahdab
authors.affiliation: e 5 Kuwait University, Yarmook, Kuwait.
authors.forename: Maryam
authors.initials: M
authors.lastname: Alowayesh
authors.affiliation: f 6 Central Administration For Pharmaceutical Affairs (CAPA), Ministry of Health, Cairo, Egypt.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Elmahdawy
authors.affiliation: g 7 Drug Policy & Economics Center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
authors.forename: Abdulaziz H
authors.initials: AH
authors.lastname: Al-Saggabi
authors.affiliation: h 8 Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon.
authors.forename: Vito Luigi
authors.initials: VL
authors.lastname: Tanzi
authors.affiliation: i 9 College of Pharmacy, Qatar University, Doha, Qatar.
authors.forename: Daoud
authors.initials: D
authors.lastname: Al-Badriyeh
authors.affiliation: j 10 Dasman Diabetes Institute, Dasman, Kuwait.
authors.forename: Hamad S
authors.initials: HS
authors.lastname: Alsultan
authors.affiliation: k 11 Supreme Council of Health, Doha, Qatar.
authors.forename: Faleh Mohamed Hussain
authors.initials: FM
authors.lastname: Ali
authors.affiliation: f 6 Central Administration For Pharmaceutical Affairs (CAPA), Ministry of Health, Cairo, Egypt.
authors.forename: Gihan H
authors.initials: GH
authors.lastname: Elsisi
authors.affiliation: l 12 Novartis Pharma Services AG, Dubai, UAE.
authors.forename: Kasem S
authors.initials: KS
authors.lastname: Akhras
authors.affiliation: a 1 Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary.|b 2 Syreon Research Institute, Budapest, Hungary.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Vokó
authors.affiliation: m 13 Department of Social Policy, London School of Economics, London, UK.
authors.forename: Panos
authors.initials: P
authors.lastname: Kanavos
mesh_terms: D000553:Ambulatory Care / Q000191:economics; D003132:Commerce / Q000191:economics*; D003363:Cost Control; D016527:Drug Costs / Q000706:statistics & numerical data*; D004469:Economics, Hospital / Q000706:statistics & numerical data; D006801:Humans; D007182:Income; D016014:Linear Models; D008877:Middle East; D015999:Multivariate Analysis; D004364:Pharmaceutical Preparations / Q000191:economics*
chemical_list: D004364:Pharmaceutical Preparations
keywords: Middle East countries; cross-national price comparison; external reference pricing; international society of pharmacoeconomics and outcomes research; pharmaceutical pricing; price corridor for pharmaceuticals