Pharma companies are exercising considerable influence over the health technology assessment (HTA) process in Poland leading to an “ever-increasing number of recommendations for expensive and potentially ineffective drugs”, according to UK researchers.
A new study in the journal Health Policy, based on interviews with more than 100 people involved in HTA in Poland and an analysis of recent recommendations by the Polish Agency for Health Technology Assessment (AHTAPol), concludes that multinational drug companies “are deploying their massive financial resources to capture stakeholders at every stage of the process”.
The researchers found evidence of widespread conflict of interest, including sponsored conferences in exotic locations such as Dubai and the payment of research grants to state experts, as well as fees in return for lectures.
University of Cambridge sociologist Professor Lawrence King -who led the study – said: “the drug industry is a key actor in the process of issuing recommendations [in Poland].”
“The influence exerted by multinational drug companies calls into question the validity of Poland’s HTA, given some of these conflicts of interest we’ve uncovered.”
Poland is the largest pharmaceutical market in Central Europe, estimated to be worth around $11.3bn in 2011 but expected to decline around 16 per cent this year as a result of a new reimbursement policy by the Polish government in May, according to Business Monitor International.
The new policy has reduced the number of reimbursable drugs on the market and encourages the use of parallel imported medicines.
“Our research is the first to look at HTA in Poland … which faces huge popular pressure at reimbursing novel drugs – as well as suffering from an underfinanced healthcare system,” said King.
The research, conducted with Dr Piotr Ozieranski of the University of Leicester and Professor Martin McKee of the London School of Hygiene and Tropical Medicine, revealed that an increasing number of drugs were being recommended for reimbursement, even though more than 50 per cent were not deemed cost-effective at their current pricing.
Brain drain
“The most troubling finding from our research is the extent of privatisation of state expertise by the pharmaceutical sector,” commented Dr Ozieranski.
“Our interviews and official data show the excellent experts, educated with public money, are almost immediately captured by the pharmaceutical industry – able to offer them a much better deal than the AHTAPol,” he added.
To remedy the situation, King et al call for broader use of professional codes of conduct for experts performing HTA, tighter controls over employment after leaving the public sector, full disclosure of expert conflicts of interest and increased state support for patient and public involvement in HTA.
There should also be “well-defined institutional separation between HTA and political decision-makers,” they note.
Poland’s Minister for Health recently announced that the AHTAPol agency is in line to be replaced. It has been in operation since 2005.