<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0213-9111</journal-id>
<journal-title><![CDATA[Gaceta Sanitaria]]></journal-title>
<abbrev-journal-title><![CDATA[Gac Sanit]]></abbrev-journal-title>
<issn>0213-9111</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Española de Salud Pública y Administración Sanitaria (SESPAS)]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0213-91112020000200008</article-id>
<article-id pub-id-type="doi">10.1016/j.gaceta.2019.02.008</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Análisis de la evolución en el acceso a los medicamentos huérfanos en España]]></article-title>
<article-title xml:lang="en"><![CDATA[Analysis of the evolution in the access to orphan medicines in Spain]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Mestre-Ferrándiz]]></surname>
<given-names><![CDATA[Jorge]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Iniesta]]></surname>
<given-names><![CDATA[Margarita]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Trapero-Bertran]]></surname>
<given-names><![CDATA[Marta]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Espín]]></surname>
<given-names><![CDATA[Jaime]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
<xref ref-type="aff" rid="A a"/>
<xref ref-type="aff" rid="A6"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Brosa]]></surname>
<given-names><![CDATA[Max]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Madrid  ]]></institution>
<addr-line><![CDATA[Madrid ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Asociación Española de Laboratorios de Medicamentos Huérfanos y Ultrahuérfanos  ]]></institution>
<addr-line><![CDATA[Madrid ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Universitat Internacional de Catalunya Institut de Recerca en Avaluació i Polítiques Publiques ]]></institution>
<addr-line><![CDATA[Barcelona ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Escuela Andaluza de Salud Pública  ]]></institution>
<addr-line><![CDATA[Granada ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af5">
<institution><![CDATA[,Instituto de Investigación Biosanitaria  ]]></institution>
<addr-line><![CDATA[Granada ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af6">
<institution><![CDATA[,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública  ]]></institution>
<addr-line><![CDATA[Madrid ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af7">
<institution><![CDATA[,Oblikue Consulting, S.L.  ]]></institution>
<addr-line><![CDATA[Barcelona ]]></addr-line>
<country>España</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>04</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>04</month>
<year>2020</year>
</pub-date>
<volume>34</volume>
<numero>2</numero>
<fpage>141</fpage>
<lpage>149</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_arttext&amp;pid=S0213-91112020000200008&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_abstract&amp;pid=S0213-91112020000200008&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_pdf&amp;pid=S0213-91112020000200008&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Objetivo Evaluar el acceso al mercado de los medicamentos huérfanos en España que a fecha de 31 de diciembre de 2017 tuvieran vigente su designación, y para aquellos comercializados en España estimar los tiempos entre la asignación de código nacional (CN) por parte de la Agencia Española de Medicamentos y Productos Sanitarios (AEMPS) y la fecha de comercialización efectiva.  Método La base de datos para identificar los medicamentos huérfanos autorizados por la Agencia Europea de Medicamentos (EMA), a fecha 31 de diciembre de 2017 (n = 142), es su Registro Comunitario publicado por la Comisión Europea. La EMA publica los medicamentos huérfanos que han perdido la designación. Las fechas de asignación de CN provienen de la AEMPS, y las de comercialización, de Bot PLUS. Se llevó a cabo un análisis descriptivo de las variables de estudio. Las variables cuantitativas se describieron utilizando la media y mediana, así como la desviación estándar y su rango. Las variables cualitativas se describieron según frecuencias absolutas y relativas. La comparación de resultados se realizó mediante contrastes paramétricos y no paramétricos en función de la aplicabilidad, con un nivel de significación del 5%.  Resultados Entre 2002 y 2017, la EMA autorizó (con designación vigente a 31 de diciembre de 2017) 100 medicamentos huérfanos. De ellos, 86 tienen CN asignado, y de estos, 54 se han comercializado en España (54% de los medicamentos huérfanos vigentes y 63% de aquellos con CN). Para todos los medicamentos huérfanos con fecha de comercialización (53), el tiempo (mediana) desde la asignación del CN hasta su comercialización en España es de 13,4 meses (desviación estándar: 17,0; mínimo: 2,1; máximo: 91,7). La mediana para los comercializados en 2002-2013 y 2014-2017 es de 12,4 meses y 14,0 meses, respectivamente (p = 0,46). Esta diferencia no es estadísticamente significativa, lo que cabría esperar dado el número limitado de medicamentos huérfanos en nuestra «población».  Conclusión Numerosos factores determinan el acceso a los medicamentos huérfanos. La autorización centralizada de comercialización en Europa es un éxito; su acceso es más limitado, dadas las complejidades de evaluación de la evidencia disponible en los procesos de financiación y precio. Es necesario implementar nuevas políticas que reduzcan las desigualdades en el acceso y permitan la sostenibilidad del sistema. Para conseguir estos objetivos, podrían contemplar un proceso acelerado en la decisión de financiación y precio, y el pago por resultados con incertidumbre alta.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Objective To assess the access to orphan medicines in Spain, focusing on those with an active &#8220;orphan&#8221; designation, as of 31st December 2017; and for those orphan medicines in the Spanish market, estimate the time between being assigned a National Code (NC) by the Agencia Española de Medicamentos y Productos Sanitarios (AEMPS) and being approved for launch.  Method We used the European Commission's Public Register of orphan medicines to identify the orphan medicines authorised by the European Medicines Agency (EMA), as of 31 December 2017, while we sourced expired orphan indications from the EMA's website. Dates when NCs were assigned were sourced from the AEMPS, and commercialisation dates from Bot PLUS. A descriptive analysis of the study variables was done. The quantitative variables were described using means and medians, as well as standard deviations and ranges. The qualitative variables were described according to absolute and relative frequencies. The comparison of results was performed by parametric and non-parametric contrasts according to the applicability, at a 5% significance level.  Results The EMA has approved 100 orphan medicines (with designation as of 31/12/2017) between 2002-2017. Eighty-six have a NC assigned by the AEMPS. Fifty-four have been launched in Spain (representing 54% of the full sample; 63% with NC). For the 53 orphan drugs with launch date in Spain, the median time between receiving its NC and its launch is 13.4 months (standard deviation: 17.0; minimum: 2.1; maximum: 91,7). The median time is 12.4 months and 14.0 months for those medicines launched in Spain between 2002-2013 and 2014-2017 respectively (p = 0.46). This difference is not statistically significant, which is what could be expected given the low numbers of orphan medicines in the &#8220;population&#8221;.  Conclusion Complex factors determine the access to orphan drugs in Europe. The centralised procedure to obtain marketing authorisation at European level is a success. However, access is more limited, given the complexities of the evaluation of the available evidence for pricing and reimbursement decisions. It is therefore necessary to implement new policies that reduce inequalities in access and help achieve sustainable healthcare systems. To achieve this, they will need to offer the possibility of allowing earlier access, and using payment by results when there is high uncertainty.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Medicamentos huérfanos]]></kwd>
<kwd lng="es"><![CDATA[Enfermedades raras]]></kwd>
<kwd lng="es"><![CDATA[Autorización de comercialización]]></kwd>
<kwd lng="es"><![CDATA[Acceso]]></kwd>
<kwd lng="es"><![CDATA[Financiación]]></kwd>
<kwd lng="en"><![CDATA[Orphan medicines]]></kwd>
<kwd lng="en"><![CDATA[Rare diseases]]></kwd>
<kwd lng="en"><![CDATA[Marketing authorization]]></kwd>
<kwd lng="en"><![CDATA[Access]]></kwd>
<kwd lng="en"><![CDATA[Reimbursement]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<collab>European Communities</collab>
<article-title xml:lang=""><![CDATA[Reglamento (CE) n. 141/2000 del Parlamento Europeo y del Consejo, de 16 de diciembre de 1999, sobre medicamentos huérfanos]]></article-title>
<source><![CDATA[Official Journal of the European Communities]]></source>
<year>2000</year>
</nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<collab>US Food and Drug Administration</collab>
<article-title xml:lang=""><![CDATA[Orphan Drug Act: Congressional findings for the Orphan Drug Act. Amended]]></article-title>
<source><![CDATA[Federal Register Journal]]></source>
<year>2013</year>
<volume>78</volume>
<numero>113</numero>
<issue>113</issue>
<page-range>35117-35</page-range><publisher-loc><![CDATA[MD, USA ]]></publisher-loc>
<publisher-name><![CDATA[Food &amp; Drug Administration (FDA)]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Schlander]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Garattini]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Holm]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Incremental cost per quality-adjusted life year gained? The need for alternative methods to evaluate medical interventions for ultra-rare disorders]]></article-title>
<source><![CDATA[J Comp Eff Res]]></source>
<year>2014</year>
<volume>3</volume>
<page-range>399-422</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="book">
<collab>NICE Citizens Council</collab>
<source><![CDATA[NICE Citizens Council Report: Ultra orphan drugs]]></source>
<year>2004</year>
<publisher-name><![CDATA[NICE]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="book">
<collab>European Medicines Agency (EMA)</collab>
<source><![CDATA[Human regulatory; Research and Development: Orphan incentives]]></source>
<year></year>
<publisher-loc><![CDATA[Londres ]]></publisher-loc>
<publisher-name><![CDATA[EMA]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Eve Young]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Soussi]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Hemels]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A comparative study of orphan drug prices in Europe]]></article-title>
<source><![CDATA[J Mark Access Health Policy]]></source>
<year>2017</year>
<volume>5</volume>
<page-range>1</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gammie]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Lu]]></surname>
<given-names><![CDATA[CY]]></given-names>
</name>
<name>
<surname><![CDATA[Babar]]></surname>
<given-names><![CDATA[ZU-D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Access to orphan drugs: a comprehensive review of legislations, regulations and policies in 35 countries]]></article-title>
<source><![CDATA[PLoS One]]></source>
<year>2015</year>
<volume>10</volume>
<page-range>1-24</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="">
<collab>European Commission</collab>
<source><![CDATA[Inventory of Union and Member State incentives to support research into, and the development and availability of, orphan medicinal products. State of play 2015]]></source>
<year>2016</year>
</nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Zozaya]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Iilloro]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Hidalgo]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<source><![CDATA[Criterios de financiación y reembolso de los medicamentos huérfanos]]></source>
<year>2016</year>
<publisher-loc><![CDATA[Madrid ]]></publisher-loc>
<publisher-name><![CDATA[Instituto de Salud Carlos III. Ministerio de Economía y Competitividad. Agencia de Evaluación de Tecnologías Sanitarias]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="book">
<collab>European Commission</collab>
<source><![CDATA[Pharmaceuticals - Community Register]]></source>
<year></year>
<publisher-loc><![CDATA[Bruselas ]]></publisher-loc>
<publisher-name><![CDATA[European Commission, Public Health]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="book">
<collab>European Medicines Agency (EMA)</collab>
<source><![CDATA[Science, medicines, health]]></source>
<year></year>
<publisher-loc><![CDATA[Londres ]]></publisher-loc>
<publisher-name><![CDATA[EMA]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="">
<source><![CDATA[Gobierno de España. Ministerio de Sanidad, Consumo y Bienestar Social]]></source>
<year></year>
<publisher-loc><![CDATA[Madrid ]]></publisher-loc>
</nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="book">
<source><![CDATA[Portalfarma]]></source>
<year></year>
<publisher-name><![CDATA[Consejo General de Colegios Oficiales de Farmacéuticos]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="">
<collab>Orphanet</collab>
<source><![CDATA[Informes Periódicos]]></source>
<year>2018</year>
</nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Austin]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Dawkins]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Medical research: next decade's goals for rare diseases]]></article-title>
<source><![CDATA[Nature]]></source>
<year>2017</year>
<volume>548</volume>
<page-range>158</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Badia]]></surname>
<given-names><![CDATA[X]]></given-names>
</name>
<name>
<surname><![CDATA[Sheperd]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<source><![CDATA[European approved orphan drugs between 2012 &amp; 2016. Analysis of P&amp;R situation in Spain]]></source>
<year>2018</year>
<publisher-name><![CDATA[Omakase Consulting]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Zamora]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Maignen]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[O'Neill]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<source><![CDATA[Comparing access to orphan medicinal products in the United Kingdom and other European countries. OHE Consulting Report]]></source>
<year>2017</year>
<publisher-loc><![CDATA[London ]]></publisher-loc>
<publisher-name><![CDATA[Office of Health Economics]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Garau]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Mestre-Ferrandiz]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<source><![CDATA[Access mechanisms for orphan drugs: a comparative study of selected European countries. OHE Briefing]]></source>
<year>2009</year>
<publisher-loc><![CDATA[London ]]></publisher-loc>
<publisher-name><![CDATA[Office of Health Economics]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Deticek]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Locatelli]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Kos]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Access to medicines for rare diseases in European countries]]></article-title>
<source><![CDATA[Value in Health]]></source>
<year>2018</year>
<volume>21</volume>
<page-range>553-60</page-range></nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kanters]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Redekop]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Hakkaart]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[International differences in patient access to ultra-orphan drugs]]></article-title>
<source><![CDATA[Health Policy and Technology]]></source>
<year>2018</year>
<volume>7</volume>
<page-range>57-64</page-range></nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Drummond]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Towse]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Orphan drugs policies: a suitable case for treatment]]></article-title>
<source><![CDATA[Eur J Health Econ]]></source>
<year>2014</year>
<volume>15</volume>
<page-range>335-40</page-range></nlm-citation>
</ref>
<ref id="B22">
<label>22</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Schlander]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Charalabos-Markos]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Gandjour]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Budgetary impact and cost drivers of drugs for rare and ultrarare diseases]]></article-title>
<source><![CDATA[Value in Health]]></source>
<year>2018</year>
<volume>21</volume>
<page-range>525-31</page-range></nlm-citation>
</ref>
<ref id="B23">
<label>23</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Schey]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Milanova]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Hutchings]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Estimating the budget impact of orphan medicines in Europe: 2010-2020]]></article-title>
<source><![CDATA[Orphanet J Rare Dis]]></source>
<year>2011</year>
<volume>6</volume>
<page-range>62</page-range></nlm-citation>
</ref>
<ref id="B24">
<label>24</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hutchings]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Schey]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Dutton]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Estimating the budget impact of orphan drugs in Sweden and France 2013-2020]]></article-title>
<source><![CDATA[Orphanet J Rare Dis]]></source>
<year>2014</year>
<volume>9</volume>
<page-range>22</page-range></nlm-citation>
</ref>
<ref id="B25">
<label>25</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Espín Balbino]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Brosa Riestra]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Oliva]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Cuestiones controvertidas en evaluación económica (III): la evaluación económica de intervenciones sanitarias en tres situaciones especiales: enfermedades raras, los tratamientos al final de la vida y las externalidades en las evaluaciones]]></article-title>
<source><![CDATA[Rev Esp Salud Publica]]></source>
<year>2015</year>
<volume>89</volume>
<page-range>125-35</page-range></nlm-citation>
</ref>
<ref id="B26">
<label>26</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nicod]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Why do health technology assessment coverage recommendations for the same drugs differ across settings? Applying a mixed methods framework to systematically compare orphan drug decisions in four European countries]]></article-title>
<source><![CDATA[Eur J Health Econ]]></source>
<year>2017</year>
<volume>18</volume>
<page-range>715-30</page-range></nlm-citation>
</ref>
<ref id="B27">
<label>27</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Drummond]]></surname>
<given-names><![CDATA[MF]]></given-names>
</name>
<name>
<surname><![CDATA[Wilson]]></surname>
<given-names><![CDATA[DA]]></given-names>
</name>
<name>
<surname><![CDATA[Kanovos]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Assessing the economic challenges posed by orphan drugs]]></article-title>
<source><![CDATA[Int J Technol Assess Health Care]]></source>
<year>2007</year>
<volume>23</volume>
<page-range>36-42</page-range></nlm-citation>
</ref>
<ref id="B28">
<label>28</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Drummond]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Challenges in the economic evaluation of orphan drugs]]></article-title>
<source><![CDATA[Eurohealth]]></source>
<year>2008</year>
<volume>14</volume>
<page-range>16-7</page-range></nlm-citation>
</ref>
<ref id="B29">
<label>29</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[McCabe]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Claxton]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Tsuchiya]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Orphan drugs and the NHS]]></article-title>
<source><![CDATA[BMJ]]></source>
<year>2005</year>
<volume>331</volume>
<page-range>1016-9</page-range></nlm-citation>
</ref>
<ref id="B30">
<label>30</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[McCabe]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Tsuchiya]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Claxton]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Assessing the economic challenges posed by orphan drugs: a comment on Drummond et al]]></article-title>
<source><![CDATA[Int J Technol Assess Health Care]]></source>
<year>2007</year>
<volume>23</volume>
<page-range>397-404</page-range></nlm-citation>
</ref>
<ref id="B31">
<label>31</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Annemans]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Aymé]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Le Cam]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Recommendations from the European Working Group for Value Assessment and Funding Processes in Rare Diseases (ORPH-VAL)]]></article-title>
<source><![CDATA[Orphanet J Rare Dis]]></source>
<year>2017</year>
<volume>12</volume>
<page-range>50</page-range></nlm-citation>
</ref>
<ref id="B32">
<label>32</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Morel]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Arickx]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Befrits]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Reconciling uncertainty of costs and outcomes with the need for access to orphan medicinal products: a comparative study of managed entry agreements across seven European countries]]></article-title>
<source><![CDATA[Orphanet J Rare Dis]]></source>
<year>2013</year>
<volume>8</volume>
<page-range>1-15</page-range></nlm-citation>
</ref>
<ref id="B33">
<label>33</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Campillo-Artero]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Llano]]></surname>
<given-names><![CDATA[J Del]]></given-names>
</name>
<name>
<surname><![CDATA[Poveda]]></surname>
<given-names><![CDATA[JL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Contratos de riesgo compartido, ¿con medicamentos huérfanos?]]></article-title>
<source><![CDATA[Farmacia Hospitalaria]]></source>
<year>2012</year>
<volume>36</volume>
<page-range>455-63</page-range></nlm-citation>
</ref>
<ref id="B34">
<label>34</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Persson]]></surname>
<given-names><![CDATA[U]]></given-names>
</name>
<name>
<surname><![CDATA[Jonsson]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The end of the international reference pricing system?]]></article-title>
<source><![CDATA[Appl Health Econ Health Policy]]></source>
<year>2016</year>
<volume>14</volume>
<page-range>1-8</page-range></nlm-citation>
</ref>
<ref id="B35">
<label>35</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Espin]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Rovira]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Olry de Labry]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<source><![CDATA[Review series on pharmaceutical pricing policies and intervention. Working paper 1: External reference pricing]]></source>
<year>2011</year>
</nlm-citation>
</ref>
<ref id="B36">
<label>36</label><nlm-citation citation-type="">
<collab>NICE</collab>
<source><![CDATA[Interim Process and Methods of the Highly Specialised Technologies Programme. Updated to reflect 2017 changes]]></source>
<year>2017</year>
</nlm-citation>
</ref>
<ref id="B37">
<label>37</label><nlm-citation citation-type="">
<collab>National Institute for Health and Care Excellence (NICE)</collab>
<source><![CDATA[Social value judgements. Principles for the development of NICE guidance]]></source>
<year>2008</year>
<edition>2nd</edition>
</nlm-citation>
</ref>
<ref id="B38">
<label>38</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[López-Bastida]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Oliva]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Antoñanzas]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Propuesta de guía para la evaluación económica aplicada a las tecnologías sanitarias]]></article-title>
<source><![CDATA[Gac Sanit]]></source>
<year>2010</year>
<volume>24</volume>
<page-range>154-70</page-range></nlm-citation>
</ref>
<ref id="B39">
<label>39</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Garrison Jr]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Towse]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Briggs]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Performance-based risk-sharing arrangements - good practices for design, implementation, and evaluation: report of the ISPOR Good Practices for Performance-Based Risk-Sharing Arrangements Task Force]]></article-title>
<source><![CDATA[Value in Health]]></source>
<year>2013</year>
<volume>16</volume>
<page-range>703-71</page-range></nlm-citation>
</ref>
<ref id="B40">
<label>40</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Garattini]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Curto]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Performance-based agreements in Italy: "trendy outcomes" or mere illusions?]]></article-title>
<source><![CDATA[PharmacoEconomics Auckl]]></source>
<year>2016</year>
<volume>34</volume>
<page-range>967-9</page-range></nlm-citation>
</ref>
<ref id="B41">
<label>41</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Messori]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[De Rosa]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Pani]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Alternative pricing strategies for cancer drugs]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2016</year>
<volume>313</volume>
<page-range>857</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
