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•a NICE tec nnoiogy appraisal ot tneir product is not scheduled to start witnin me tuneirame or the advice project.

le advice, generic oxycontin yellow mis oner synopsis snoua be no 4.Not much focus on tools & processes for market access early on in development 5.Push back from R&D on fragmentation of Payer opinions (e.g. NICE vs G-BA) & 'durability' of Payer decisions relative to FDA/EMA 6. Early scientific advice still in it infancy, with 'competition' developing for income between agencies (e.g.

EUnetHTA) - but could lead to a common EU clinical effectiveness assessment conducted by or with EMA VA GALBRAITH vy 1G H Trc thinking Pharma industry still making too many unforced errors 5 Our pricing strategies are stuck in the dark ages when we used to be chemical manufacturers GALBRAITH LCWIGHT^B Considerations for us when thinking about Pricing & Reimbursement discussions with Payers.... >At filing we know very little about the performance of our medicines in delivering health outcomes in a range of different patients at launch due to the very controlled nature of Phase II & III trials - Payers now assume the 'real life' results will be less good >We seldom know what the 'right' dose is of our new medicines until they have been used for several years in many patients - Payers have been 'hit' by 'dose creep' (e.g. Zyprexa) causing greater budget impact than generic oxycontin version predicted, which makes Payers distrust our forecasts >Most medicines are developed for multiple indications (~80% of a total brand value comes from dosing tramadol indications & forms after the first marketing authorisation), over several years, many of which will have a different value (ICER) from each other >We've generic oxycontin yellow told Payers for many years that the cost of our medicines to them is dependent on how much of it they use in each tablet, vial, infusion or injection - but manufacturing costs rarely feature in making Pharma pricing decisions - so why do we continue with this myth? GALBRAITH WIGHTF*^ Value delivered by the same medicine varies by disease •Bevacizumab in combination with a taxane generic oxycontin yellow for the first-line treatment of metastatic breast cancer - ICER for bevacizumab plus paclitaxel versus weekly apap hydrocodone w paclitaxel was between £110,000 and £259,000 per QALY gained •Bevacizumab in combination with oxaliplatin-containing regimens as a second-line treatment for metastatic colorectal cancer the ICER was £103,000 per QALY gained. •Bevacizumab in combination with paclitaxel and carboplatin for generic oxycontin yellow first-line treatment of advanced ovarian cancer gave a range of ICERs from £128,000 to £161,000 per QALY gained.

•Etanercept for active polyarticular-course juvenile idiopathic arthritis whose condition has not responded adequately to, or who have proved intolerant of, methotrexate the ICER is in the region of £15-30,000 per QALY •Etanercept for first-line treatment for early RA, the estimated ICER with methotrexate is £78,100 per QALY •Etanercept in adults with active psoriatic arthritis, the ICER was £12,480 per QALY gained when compared with best supportive care. GALBRAITH WIGHTR*^, Source: oxycontin yellow uk L A Market Access The value of innovative medicines is delivered over decades, with the majority of benefit delivered by generic use post patent expiry 'The fact that such a large proportion of the social surplus being appropriated by others than the innovator highlights the relevance of a societal perspective in economic evaluation. It may also make a case for considering looking a dynamic cost- effectiveness when assessing the hydrocodone codeine introduction of new therapies." VM GALBRAITH LCWIGHT^, Market Access 3 order phentermine Source: Cost-effectiveness of statins revisited: lessons learned about the value of innovation.

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