title: From market access to patient access: overview of evidence-based approaches for the reimbursement and pricing of pharmaceuticals in 36 European countries.
abstract: BACKGROUND
  Coverage decisions determining the benefit baskets of health systems have been increasingly relying on evidence regarding patient benefit and costs. Relevant structures, methodologies, and processes have especially been established for pharmaceuticals but approaches differ. The objective of this work was thus to identify institutions in a broad range of European countries (n = 36) in charge of determining the value of pharmaceuticals for pricing and reimbursement purposes and to map their decision-making process; to examine the different approaches and consider national and supranational possibilities for best practice.
  
  
  METHODS
  Institutions were identified through websites of international networks, ministries, and published literature. Details on institutional practices were supplemented with information from institution websites and linked online sources.
  
  
  RESULTS
  The type and extent of information available varied considerably across countries. Different types of public regulatory bodies are involved in pharmaceutical coverage decisions, assuming a range of responsibilities. As a rule, the assessment of scientific evidence is kept structurally separate from its appraisal. Recommendations on value are uniformly issued by specific committees within or commissioned by responsible institutions; these institutions often also act as decision-makers on reimbursement status and level or market price. While effectiveness and costs are important criteria in all countries, the latter are often considered on a case-by-case basis. In all countries, manufacturer applications, including relevant evidence, are used as one of the main sources of information for the assessment.
  
  
  CONCLUSIONS
  Transparency of evidence-based coverage decisions should be enhanced. International collaboration can facilitate knowledge exchange, improve efficiency of information production, and strengthen new or developing systems.
authors.affiliation: Department of Health Care Management, Berlin University of Technology, Berlin, Germany. dimitra.panteli@tu-berlin.de.
authors.forename: Dimitra
authors.initials: D
authors.lastname: Panteli
authors.affiliation: Department of Health Care Management, Berlin University of Technology, Berlin, Germany. helene.eckhardt@gmail.com.
authors.forename: Helene
authors.initials: H
authors.lastname: Eckhardt
authors.affiliation: Federal Joint Committee (G-BA), Berlin, Germany. alexandra.nolting@g-ba.de.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Nolting
authors.affiliation: Department of Health Care Management, Berlin University of Technology, Berlin, Germany. rbusse@tu-berlin.de.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Busse
authors.affiliation: Federal Joint Committee (G-BA), Berlin, Germany. michael.kulig@g-ba.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Kulig
mesh_terms: D003132:Commerce; D003362:Cost-Benefit Analysis; D003657:Decision Making; D030881:Disclosure; D004345:Drug Industry / Q000191:economics; D005060:Europe; D019317:Evidence-Based Medicine; D033161:Government Regulation; D005102:Health Expenditures; D006291:Health Policy; D006801:Humans; D004364:Pharmaceutical Preparations / Q000191:economics*; D012051:Reimbursement Mechanisms; D013673:Technology Assessment, Biomedical; D057170:Translational Research, Biomedical
chemical_list: D004364:Pharmaceutical Preparations