How to Best Procure

Essentially, there are two ways to purchase concentrates from manufacturers: either national tenders or individual agreements between centres and manufacturers. Payers — mostly health insurance companies — also enter the process, as do national regulators (mostly equivalents of our State Institute for Drug Control) and, last but not least, organisations similar to our society in many countries.

It turned out that for everyone, the most important criterion when selecting products is their safety, especially the impact on inhibitor development, but the absolutely decisive factor is the price. Also in play were the aspects of efficacy, administration comfort, and scientific support from the manufacturer. The result of the survey is that the order of preferences in Europe is:

1. price
2. safety
3. efficacy
4. support from manufacturers
5. administration comfort

The low popularity of administration comfort is somewhat surprising, since the respondents are mostly patient organisations. Perhaps they did not thoroughly consult their members' opinions — otherwise the results might have turned out somewhat differently.

The results of tenders and other purchasing methods are influenced to varying degrees in different countries by payers (insurance companies), specialist medical and pharmaceutical agencies, intermediary institutions, ministries of health or other similar local institutions, haemophilia centres, and patient organisations. In some places all of the above participate in the selection process, in others only some. The period covered by tender results ranges from one and a half to two and a half years. It is interesting that medical experts by no means participate in product selection everywhere — in a large number of cases, representatives of economic and scientific institutions make the decisions.

The data on product prices, all stated in euro cents per unit, are certainly interesting. For recombinant FVIII, the median is 56 in the range of 0.28–1.05 EUR for tenders; in other cases the values are roughly 10 cents higher. Plasma-derived products with a median of 40 lie between 0.16–1.16 EUR in the case of tenders; for alternative purchasing methods the range is much narrower, the median is 64, and values range between 18 and 90 cents. It is certainly noteworthy that recombinant products are cheaper than plasma derivatives in some places. Recombinant FIX costs 0.72 EUR, plasma-derived FIX 18 to 83 cents with a median of 40 for tenders and 54 in other cases.

Greater participation of medical specialists in the selection process and, above all, the exclusion of intermediary agencies clearly have a positive impact on reducing prices.

In a way surprising for our conditions, the survey results demonstrate the influence of patient organisation participation in tenders. On average, the price of rFVIII is around 73 cents, but where national societies are also invited, it drops to 55. For plasma-derived FVIII, the difference is 57 versus 42; rFIX shows 80 versus 72, and plasma-derived FIX 52 versus 44 cents. Frankly speaking, it is hard to imagine how the Czech Hemophilia Society could influence prices in tenders in any way.

The EHC draws the following conclusions: more advantageous prices result from purchasing through tenders; participation by physicians or patient organisations helps reduce them, but the participation of both parties helps the most. It sees the main advantages of such a system in better and more appropriate selection criteria, better evaluation of bids, lower prices, and a more open and transparent process — and also in the fact that price alone is not the only decisive factor, but other important aspects matter as well. The EHC considers the launch of a tender for nationwide procurement as a clearly proven benefit, but draws a somewhat surprising conclusion from the fact that the number of solicited companies or products plays no role.