The Effects of the New Methodology Application on the Method of Pricing of Drugs-The Case of the Republic of Macedonia.

BACKGROUND: The introduction of a new methodology for the pricing of drugs by the Agency of Medicines of the Republic of Macedonia for the period 2012 to 2015 resulted in a price reduction of 1386 drugs. OBJECTIVE: This pioneer study evaluated the effects of the price changes during this period of 4 years and the consequent effects on the sale quantities for the segmented Anatomical Therapeutic Chemical groups. METHODS: The drugs were grouped by the size of the reductions, by segmenting the drugs by generic names, and by the Anatomical Therapeutic Chemical classification, in which the quantities are grouped by generic names and the prices are calculated by average values for a period of 1 year. RESULTS: Analysis of the relations between price changes and quantities sold showed that since the introduction of the new methodology the decrease in the prices pushed down the sales of the drugs. CONCLUSIONS: This article presents not only the market developments but also projects the tendencies, concluding clearly that focusing only on the price reduction of drugs and not on the implementation of the pharmacoeconomic studies is deviating the supply of drugs that are on the market and affecting their quality. The trends indicate that patients are using old-generation drugs, packaging forms that do not fully answer the market demand, and policies that significantly affect the suppliers. The presented analysis confirms that if the new methodology is only partially implemented and is not followed in full consideration of the pharmacoeconomic studies, negative consequences will also have an impact on regional pharmaceutical markets, which are benchmarking prices of drugs with the Macedonian market.

Cross-reactive epitopes present in campylobacter jejuni serotypes isolated from enteritis patients.

Campylobacter jejuni (C. jejuni) infection frequently triggers autoimmune-mediated neuropathies, especially the Guillain-Barre syndrome (GBS). The molecular mimicry between the core oligosaccharides of bacterial lipopolysaccharides (LPSs) and the human gangliosides presumably results in the production of anti-neural cross-reactive antibodies which are likely to be a contributory factor in the induction and pathogenesis of GBS. The aim of our study was to determine the presence of cross-reactive epitopes in C. jejuni LPSs isolated from enteritis patients and to determine their antigen reactivity. For that purpose we collected stool specimens from 21 patients with enteritis and without neurological symptoms. Seven different serotypes of C. jejuni (0:27; 0:6/0:7; 0:38; 0:3; 0:1/0:44; 0:19; 0:37) were detected using the Penner system. Unexpectedly, one serotype from this group was detected as 0:19, a serotype rarely isolated from enteritis patient and in close association with GBS. Binding studies using cholera toxin-B subunit and peanut agglutinin, showed the presence of ganglioside-like epitopes in C. jejuni strains 0:37, 0:19 and 0:27. Reactivity with sera from patient with GBS, with confirmed previous exposure to C. jejuni and with high a titre of anti-ganglioside antibodies, showed that the same three LPSs from C. jejuni serotypes 0:37, 0:19 and 0:27 bear cross-reactive epitopes in their LPSs structures. Our results confirm the results from previous studies that LPSs from certain C. jejuni serotypes bear cross-reactive ganglioside-like epitopes which might be involved in the induction of GBS after C. jejuni infection.