Objective This study evaluated the budget impact of sacubitril/valsartan for treating heart failure with reduced ejection fraction compared with enalapril and assessed alternative funding mechanisms under decision uncertainty. Methods The study comprised 3 components. First, a decision tree and a Markov model were used to estimate the budget impact over a 5-year time horizon. The base-case adopted a payer perspective, including direct medical costs, whereas a scenario analysis incorporated direct non-medical and indirect costs. Second, a situation analysis identified key decision uncertainties. Third, an economic impact analysis evaluated alternative funding mechanisms relative to the current reimbursement system. Results In the base-case, the cumulative net budget impact was United States dollars (USD) 18.40 million. For the scenario analysis, the net economic impact decreased to USD 15.72 million, indicating a partial offset of the additional drug expenditure. The new treatment mix was estimated to avoid 300 heart failure hospitalizations and 146 cardiovascular deaths over 5 years. Key uncertainties included high budget requirements, limited epidemiological data, and variability in clinical outcomes. To address these, 2 funding mechanisms were explored: coverage with evidence development to reduce clinical uncertainty and a price-volume agreement with a capped budget to manage financial risk. Conclusion Sacubitril/valsartan increased total expenditure compared with the current treatment; however, savings from reduced hospitalizations and broader societal costs partially offset the additional drug cost. Sacubitril/valsartan may be a manageable option when implemented with coverage with evidence development and price-volume agreements, supporting financial sustainability and long-term health outcomes.
Objective To conduct a systematic review of complete economic evaluations related to malaria vaccines. Methods The review was conducted using articles from PubMed, EMBASE, Latin American and Caribbean Health Sciences Literature, and the Center for Reviews and Dissemination at the University of York, as well as reports from different Latin-American and European agencies covering the period 2009–2026. Key characteristics of the included studies were summarized following the Consolidated Health Economic Evaluation Reporting Standards 2022 guidelines. Quality and comparability were assessed through the respective tools. The review was registered in the Prospective Register of Systematic Reviews (CRD42025633693). Results A total of 12 studies were included: 10 evaluated the RTS,S/AS01 vaccine, 1 evaluated R21/Matrix-M, and 1 was not specified. According to the Quality of Health Economic Studies methodology, 2 studies were classified as high quality, 7 as medium quality, and 3 as low quality. None showed high comparability with the Colombian context. The cost per prevented disability-adjusted life-years ranged between 87 and 321 USD per prevented disability-adjusted life-years. Conclusions Direct comparative analyses between available malaria vaccines are needed. Although existing models are largely applicable to African settings, substantial adaptation is required for the American context.
Objectives No comprehensive global review has synthesized mechanisms, strengths, limitations, and implementation challenges of pharmaceutical pricing policies. This scoping review aimed to examine global pharmaceutical pricing policies and generate policy-relevant insights, particularly for low- and middle-income countries (LMICs). Methods Electronic searches were conducted in Medline, CINAHL, EconLit, and Embase using predefined inclusion criteria. Gray literature was identified through government publications and World Health Organization reports, and reference lists of relevant studies were screened. The review followed the Joanna Briggs Institute scoping review framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. Results Searches conducted up to May 2024 and updated in February 2026 identified 88 eligible studies. Reference pricing was the most commonly reported strategy, used in 85% of identified countries, offering simplicity and transparency through price benchmarking. Value-based pricing was widely adopted in high-income countries, aligning prices with health outcomes but requiring strong health technology assessment infrastructure. Managed entry agreements were reported in 56% of countries and were used to improve access to new medicines while mitigating financial risk. Indication-specific pricing was implemented in 9 countries but faced operational challenges. Compulsory licensing in several LMICs improved access to essential medicines at lower cost, although concerns regarding impacts on pharmaceutical innovation were noted. Most countries combined multiple pricing approaches to balance affordability, access, and innovation. Conclusions Although value-based pricing and managed entry agreements are common in high-income settings, simpler approaches such as reference pricing and compulsory licensing may be more feasible in LMICs. Context-specific strategies are needed to balance access, affordability, and sustainability.
