Journal of Pharmacoeconomics and Pharmaceutical Management
Volume:1 Issue: 3, Summer-Autumn 2015

The volume of the global pharmaceutical market reached 956 billion US dollars in 2011. The reported volume of global exported pharmaceutical products in 2010 exceeds $585 billion. Despite the potential of the market and the suitable geographical location, the volume of Iran’s pharmaceutical export has been reported to be only 122 million dollars in the year 2011. Experimental: The purpose of current cross-sectional study was to evaluate the pharmaceutical industries’ situation and identify effective factors in pharmaceutical products exportation in successful exporting countries and to compare the results with the situation of pharmaceutical industries in Iran and the factors affecting their exportation experiences. Therefore, we devised an analytic open-ended questionnaire consisting 32 questions in 8 fields. The subjects were 20 experts of pharmaceutical industries, pharmaceutical products exporting companies, and relevant governmental sections. Relevant information on pharmaceutical industries and exportation of pharmaceutical products by target countries was collected through library and the Internet research. All the studied countries had experienced growth in pharmaceutical export during recent years, the fastest growth was in China with 24.8% in 2010. These countries’ volume of pharmaceutical export varied from Spain with more than $11 billion in 2011, to Egypt with $250 million in 2010. The worth of Iran’s pharmaceutical export was only $122 million in 2011 which was unfavorable. Interviewees’ ideas about Iran’s situation in pharmaceutical export were obtained through the questionnaire. Accordingly, the emphasized factors impeding improvement of pharmaceutical export in Iran were: lack of motivation as a result of not feeling the need to change, weakness in representing quality of products by producing documentaries and obtaining international standards, shortages in the industry structure and facilities, inadequate progression in new technologies, lack of a competitive view in pharmaceutical industries, the poor share for research and development (R&D) in these companies, discordant and unstable policies and laws regarding exportation, short period of positions held by managers, lack of a vision towards exportation, shortage of experts in marketing and exportation of pharmaceutics, lack of supportive policy-making by the government to help exportation through providing transportation facilities, insurance issues, not rewarding successful exporters, not establishing regional and international relationships, lack of prioritizing economical relationships with other countries through political negotiations, shortage in introducing Iranian pharmaceutical products to allied countries with harmonious policies, not building favorable infrastructures in the fields of information and equipment, no substantial long-term planning with an export-oriented view, no support for modernization of pharmaceutical industries, no encouraging funding in R&D section through tax breaks, inadequate provision of facilities to hold congresses, etc. While Iran has not experienced a successful exporting process, India, Jordan, Spain and China have taken successful steps in the field of exportation during recent years by implementing desirable exports expanding policies. It seems that disharmonies and lack of a desirable policy and insufficiencies of applied procedures are responsible for mentioned situation of Iran.

Self-medication is one of the largest social, economic and health problems in developing communities such as Iran. It is considered as an unsafe treatment behavior. This study aimed to assess self-medication status among referring patients to Kashan pharmacies. This descriptive cross-sectional study was conducted in 2012; 12 pharmacies were selected randomly from 56 pharmacies in Kashan. The data was collected through observation, interviews and semi-structured questionnaire. The data were analyzed through SPSS v.18. About 26% of patients requested drug without a prescription. Of 208 persons, 143 persons (%68.8) were men, and 65 (31.3%) women; 119 (57.2%) had high school or academic education. The most requested drugs were analgesics (36.5%), antibiotics (30.8%), cold remedies (16.8%), gastrointestinal (513.5%), tranquilizers and antidepressants (11.5%). Main excuses for self-medication were having previous experience of using the drug (46.7%) and low importance of the disease (25%). In Iran, the rate of self-medication is very high and analgesics and antibiotics are among the most without-prescription requested drugs. Clearly, providing help to raise public awareness on the over-the-counter (OTC) drugs and prescription-only medicines’ (POM) risks and side effects is needed. According to the reasons mentioned for self-medication immediate action for reducing nonprescription medicine request are essential.

In this study we aim to assess the clinical evidence on the effectiveness of Fulvestrant compared with other alternatives to explore whether it has any advantage in the treatment outcomes of postmenopausal advanced breast cancer or not. Experimental: A systematic review was conducted through Medline, Scopus, ISI Web of Science and Google Scholar. The used keywords were “Fulvestrant” and “breast cancer”, and the search was limited to articles published during 1990- 2012. The inclusion criteria were English language studies on advanced breast cancer and with one arm of Fulvestrant. The outcomes of interest included time to progression (TTP), objective response (OR), clinical benefit (CB), time to treatment failure (TTF) and overall survival (OS). The included studies were classified into two groups based on the Fulvestrant arm: “Fulvestrant as single treatment strategy” and “Fulvestrant as combination treatment strategy”. In the first group the included studies comparing Fulvestrant with Anastrozole (three reports), Exemestane (one report) and Tamoxifen (one report) indicated no significant advantage of Fulvestrant. In second group based on one study there was no significant difference between Anastrozol and Fulvestrant compared with Fulvestrant in terms of TTP, CB, OR, TTF, and OS and based on the second randomized controlled trial (RCT) the combination therapy was significantly more effective in term of OS and TTP but not CB and OR. Regarding the reviewed evidence, Fulvestrant neither as single treatment strategy compared with Exemestane, Anastrozole and Tamoxifen nor as combination treatment strategy by being added to Anastrozole could be considered advantageous in term of effectiveness.

Access to medications is affected by multiple factors including distribution of pharmacies. Improvement of access to medications is of the main goals of the National Drug Policy (NDP) of Iran. The aim of this study was to assess the geographical distribution of pharmacies within two provincial capitals in Iran. Two Southwestern provincial capital cities; Khorramabad and Ahwaz, were selected. As each city in Iran is divided to several districts called municipal areas, the population percentages and the percentage of pharmacies located in each area were calculated. Areas’ pharmacy distributions were compared in order to create an overview of the present status of distribution and access to pharmacies in each area. Ahwaz and Khorramabad with populations of approximately 1,000,000 and 5,200,000 are separated into eight and three municipal areas, respectively. The results showed that there is one pharmacy for every 5,600 persons in Ahwaz and one pharmacy for every 8,155 persons in Khorramabad. Based on this study, pharmacy distribution is not proportional to population in neither Ahwaz nor Khorramabad. This can be explained by the fact that physicians are mostly concentrated in central areas attracting pharmacists to the same locations.

Irrational prescribing of injections is common in Iran. According to the statistics of the National Committee of Rational Use of Drugs (NCRUD), more than 40% of rescriptions have at least one injectable form, while injectable dosage form of dexamethasone is on the top of the list. Considering the side effects of corticosteroids, the objective of this study was to investigate the prescribing pattern of dexamethasone in all physicians'' prescriptions from 2007 to 2011 in Iran. A cross-sectional study was carried out on a collection of prescriptions collected from health insurance companies from 2007 to 2011. The inspection was for prescriptions including injectable form of dexamethasone using special software called Rx Analyst and cost analysis was conducted using NCRUD. Almost 365 million prescriptions were reviewed. Those prescriptions including at least one injectable form were identified. Among prescriptions including injectable form of medicines, more than 21% had at least one injectable dosage form of dexamethasone making it the first prescribed medicine by general practitioners. An overall increasing tendency in prescribing pattern and the cost of injectable dosage form of dexamethasone were evident over the observation period. Prescribing the injectable form of dexamethasone was 12.28% in 2007, 13.11% in 2010 and 12.10% in 2011 by all physicians. All related costs were calculated using governmental prices and finally total costs were adjusted to 2011 fees in USD. Irrational pattern of prescribing injectable form of dexamethasone was extracted from the results of this study. It seems that general practitioners are trying to substitute pain relievers’ drugs by injectable dosage form of dexamethasone. Irrational prescriptions of injectable dexamethasone cause not only further costs but also adverse reactions associated with steroid injections. A robust strategy to promote rational use of medicine is strongly needed to correct the pattern of dexamethasone prescription in Iran.

Health care improvement has had a critical role in increasing life expectancy throughout the world. The expenditures of research and development and also marketing for new pharmaceutical products are much higher than already existing medicines, resulting in higher prices for the former products. Therefore governments and health insurance organizations are interested in implementing policies that control drug prescription and utilization. One of these policies is Prior Authorization (PA). The main goal of PA is to reduce drug expenditures by substituting expensive medicines with less costly ones. PA policy has both scientific and economical aspects. The aim of this article is to assess the state of implementation of PA policy in Iran. There are several bodies to regulate medicines and their price in Iranian pharmaceutical market. There are two main insurance companies in Iran with similarities and differences in implementing this policy. Price ceiling and Reference Based Pricing are two main methods for implementing PA policy in Iran.

Health care section as an important social part of a community plays a determining role in people’s health and therefore all people must equally and purposefully enjoy health services and facilities; failure in this regard may lead to unpleasant consequences. The research is both applied and analytical which ranks the counties of Sistan and Baluchestan province in terms of entitlement to health structural indicators in 2011. Thus, 15 health structural indicators were selected and data were collected from Statistical Center of Iran. Experts’ opinions and FAHP technique were used to weight the indicators. Finally the counties ranked by TOPSIS technique. Data were analyzed using Excel, Expert Choice, and LINGO. FAHP’s results showed that indicator of health house workers (Behvarz) in health centers was more important and dentist indicator less important than other indicators. Besides, TOPSIS technique showed that Zahedan, Zabol, and Iranshahr were the highest and Delgan, Zaboli, and Sib and Suran were the least entitled counties, respectively. Based on our findings, there seems to be a huge gap between the counties of the province in terms of their entitlement to health structural indicators. It is therefore suggested that authorities of the health section set the priorities according to the counties’ entitlement to the indicators to remove inequalities in the province.

Looking at the performance of the Iranian knowledge based pharmaceutical companies in recent years shows that, despite extensive capabilities in technological development, many companies involved in technology commercialization have been unsuccessful. Studies show that many components have played role in success or failure of technology commercialization in such companies. This study attempts to identify, and measure the impact of factors affecting technology commercialization in knowledge based pharmaceutical companies, and provides recommendations and considerations for active managers in this field. In this survey, questionnaires were distributed among 10 knowledge based pharmaceutical companies with 19 commercial products. The data were collected, and analyzed to rank the factors based on importance. Support of senior management, organizational and operational characteristics, extraction of new product concepts, forming risk-taking team and project management, have the greatest impact on technology commercialization in these companies. Based on the study results, adequate attention to these elements by the managers of knowledge based companies can lead to success in technology commercialization actions in knowledge based pharmaceutical companies.