Access and Unmet Needs of Orphan Drugs in 194 Countries and 6 Areas: A Global Policy Review With Content Analysis

from Value in Health at https://bit.ly/3kMmIK6 on October 31, 2020 at 01:48PM

Available online 31 October 2020

Highlights

•

Before undertaking this study, we searched academic databases for all English systematic reviews on global orphan drug policies published before July 2019. We identified 1 review on orphan drug policies published in 2015 and 2 reviews on laws and national strategies for rare diseases from selected countries that were published in 2017 and 2018, respectively. These 3 reviews uncovered a plethora of governmental efforts that facilitate the availability of and access to orphan drugs, with critical differences in scope and approaches among countries.

•

Vast areas worldwide were omitted from previous reviews, such as Africa, India, Latin America, and Russia. No studies attempted an overview of orphan drug policies in all countries with both governmental and academic evidence. The current global landscape of orphan drug policy (ODP) remains unclear. By systematically reviewing pharmaceutical policies and academic literature from 200 countries/areas, our study presents the most comprehensive review on global ODP to date.

•

Of the 200 countries or areas examined, 92 had ODPs alongside a notable increase in ODP establishment in non-high-income countries/areas over the last decade. Our findings highlight disparities in ODP establishment and scope in countries/areas with different income levels. This allows respective stakeholders to reference orphan drug regulatory standards of countries/areas with similar political realities while informing policy formulation and advocacy direction for treatment access of patients with rare diseases.

Abstract

Objectives

Three hundred million people living with rare diseases worldwide are disproportionately deprived of in-time diagnosis and treatment compared with other patients. This review provides an overview of global policies that optimize development, licensing, pricing, and reimbursement of orphan drugs.

Methods

Pharmaceutical legislation and policies related to access and regulation of orphan drugs were examined from 194 World Health Organization member countries and 6 areas. Orphan drug policies (ODPs) were identified through internet search, emails to national pharmacovigilance centers, and systematic academic literature search. Texts from selected publications were extracted for content analysis.

Results

One hundred seventy-two drug regulation documents and 77 academic publications from 162 countries/areas were included. Ninety-two of 200 countries/areas (46.0%) had documentation on ODPs. Thirty-four subthemes from content analysis were categorized into 6 policy themes, namely, orphan drug designation, marketing authorization, safety and efficacy requirements, price regulation, incentives that encourage market availability, and incentives that encourage research and development. Countries/areas with ODPs were statistically wealthier (gross national income per capita = $10 875 vs $3950, P < .001). Country/area income was also positively correlated with the scope of the respective ODP (correlation coefficient = 0.57, P < .001).

Conclusions

Globally, the number of countries with an ODP has grown rapidly since 2013. Nevertheless, disparities in geographical distribution and income levels affect the establishment of ODPs. Furthermore, identified policy gaps in price regulation, incentives that encourage market availability, and incentives that encourage research and development should be addressed to improve access to available and affordable orphan drugs.

Keywords

drug regulatory

health equity

orphan drug policy

rare diseases

treatment access

View Abstract

© 2020 ISPOR-The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc.