{"id":"https://openalex.org/W7222804182","doi":"https://doi.org/10.1016/j.hpopen.2026.100189","title":"High-impact medicines, system sustainability and the role of access management: evidence from Catalonia","display_name":"High-impact medicines, system sustainability and the role of access management: evidence from Catalonia","publication_year":2026,"publication_date":"2026-10-17","ids":{"openalex":"https://openalex.org/W7222804182","doi":"https://doi.org/10.1016/j.hpopen.2026.100189","pmid":"https://pubmed.ncbi.nlm.nih.gov/42964861","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/13720820"},"language":"en","primary_location":{"id":"doi:10.1016/j.hpopen.2026.100189","doi":"https://doi.org/10.1016/j.hpopen.2026.100189","is_oa":true,"landing_page_url":"https://doi.org/10.1016/j.hpopen.2026.100189","pdf_url":null,"source":{"id":"https://openalex.org/S4210236858","display_name":"Health Policy OPEN","issn_l":"2590-2296","issn":["2590-2296"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-c","norway-1","poland-20"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Health Policy OPEN","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.1016/j.hpopen.2026.100189","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5158939134","display_name":"E. Lizano","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I157913058","display_name":"Generalitat de Catalunya","ror":"https://ror.org/01bg62x04","country_code":"ES","type":"government","lineage":["https://openalex.org/I157913058"]}],"countries":["ES"],"is_corresponding":false,"raw_author_name":"E. Lizano Gispert","raw_affiliation_strings":["Medicine Area, Catalan Health Service (CatSalut), Barcelona, Spain"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Medicine Area, Catalan Health Service (CatSalut), Barcelona, Spain","institution_ids":["https://openalex.org/I157913058"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5158963575","display_name":"D. Gay","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I157913058","display_name":"Generalitat de Catalunya","ror":"https://ror.org/01bg62x04","country_code":"ES","type":"government","lineage":["https://openalex.org/I157913058"]}],"countries":["ES"],"is_corresponding":false,"raw_author_name":"D. Gay","raw_affiliation_strings":["Medicine Area, Catalan Health Service (CatSalut), Barcelona, Spain"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Medicine Area, Catalan Health Service (CatSalut), Barcelona, Spain","institution_ids":["https://openalex.org/I157913058"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5158989466","display_name":"M. Fontanet","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I123044942","display_name":"Universitat Aut\u00f2noma de Barcelona","ror":"https://ror.org/052g8jq94","country_code":"ES","type":"education","lineage":["https://openalex.org/I123044942"]},{"id":"https://openalex.org/I157913058","display_name":"Generalitat de Catalunya","ror":"https://ror.org/01bg62x04","country_code":"ES","type":"government","lineage":["https://openalex.org/I157913058"]}],"countries":["ES"],"is_corresponding":false,"raw_author_name":"M. Fontanet","raw_affiliation_strings":["Department of Pharmacology, Therapeutics and Toxicology, Autonomous University of Barcelona, Cerdanyola de Vall\u00e8s, Barcelona, Spain","Medicine Area, Catalan Health Service (CatSalut), Barcelona, Spain"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Pharmacology, Therapeutics and Toxicology, Autonomous University of Barcelona, Cerdanyola de Vall\u00e8s, Barcelona, Spain","institution_ids":["https://openalex.org/I123044942"]},{"raw_affiliation_string":"Medicine Area, Catalan Health Service (CatSalut), Barcelona, Spain","institution_ids":["https://openalex.org/I157913058"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5045732754","display_name":"Montserrat Gasol","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I157913058","display_name":"Generalitat de Catalunya","ror":"https://ror.org/01bg62x04","country_code":"ES","type":"government","lineage":["https://openalex.org/I157913058"]}],"countries":["ES"],"is_corresponding":false,"raw_author_name":"M. Gasol","raw_affiliation_strings":["Medicine Area, Catalan Health Service (CatSalut), Barcelona, Spain"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Medicine Area, Catalan Health Service (CatSalut), Barcelona, Spain","institution_ids":["https://openalex.org/I157913058"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5158947221","display_name":"A. Clopes","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I157913058","display_name":"Generalitat de Catalunya","ror":"https://ror.org/01bg62x04","country_code":"ES","type":"government","lineage":["https://openalex.org/I157913058"]}],"countries":["ES"],"is_corresponding":false,"raw_author_name":"A. Clopes","raw_affiliation_strings":["Medicine Area, Catalan Health Service (CatSalut), Barcelona, Spain"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Medicine Area, Catalan Health Service (CatSalut), Barcelona, Spain","institution_ids":["https://openalex.org/I157913058"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5091462488","display_name":"Antonio Vallano","orcid":"https://orcid.org/0000-0002-3648-3492","observed_orcids":["https://orcid.org/0000-0002-3648-3492"]},"institutions":[{"id":"https://openalex.org/I123044942","display_name":"Universitat Aut\u00f2noma de Barcelona","ror":"https://ror.org/052g8jq94","country_code":"ES","type":"education","lineage":["https://openalex.org/I123044942"]},{"id":"https://openalex.org/I157913058","display_name":"Generalitat de Catalunya","ror":"https://ror.org/01bg62x04","country_code":"ES","type":"government","lineage":["https://openalex.org/I157913058"]}],"countries":["ES"],"is_corresponding":true,"raw_author_name":"A. Vallano","raw_affiliation_strings":["Catalan Health Institute, Barcelona, Spain","Department of Pharmacology, Therapeutics and Toxicology, Autonomous University of Barcelona, Cerdanyola de Vall\u00e8s, Barcelona, Spain","Medicine Area, Catalan Health Service (CatSalut), Barcelona, Spain"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Catalan Health Institute, Barcelona, Spain","institution_ids":[]},{"raw_affiliation_string":"Department of Pharmacology, Therapeutics and Toxicology, Autonomous University of Barcelona, Cerdanyola de Vall\u00e8s, Barcelona, Spain","institution_ids":["https://openalex.org/I123044942"]},{"raw_affiliation_string":"Medicine Area, Catalan Health Service (CatSalut), Barcelona, Spain","institution_ids":["https://openalex.org/I157913058"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5091462488"],"corresponding_institution_ids":["https://openalex.org/I123044942","https://openalex.org/I157913058"],"apc_list":{"value":2740,"currency":"USD","value_usd":2740},"apc_paid":{"value":2740,"currency":"USD","value_usd":2740},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.81287888,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"11","issue":null,"first_page":"100189","last_page":"100189"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11792","display_name":"Pharmaceutical Economics and Policy","score":0.9926999807357788,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},"topics":[{"id":"https://openalex.org/T11792","display_name":"Pharmaceutical Economics and Policy","score":0.9926999807357788,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T10804","display_name":"Health Systems, Economic Evaluations, Quality of Life","score":0.004399999976158142,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T12708","display_name":"Economic and Financial Impacts of Cancer","score":0.0010999999940395355,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/pharmaceutical-expenditure","display_name":"pharmaceutical expenditure","score":0.75},{"id":"https://openalex.org/keywords/health-system-sustainability","display_name":"health system sustainability","score":0.8190000057220459},{"id":"https://openalex.org/keywords/managed-access-agreements","display_name":"managed access agreements","score":0.9010000228881836},{"id":"https://openalex.org/keywords/outcome-based-payment","display_name":"outcome-based payment","score":0.7670000195503235},{"id":"https://openalex.org/keywords/spending-caps","display_name":"budget caps","score":0.7170000076293945},{"id":"https://openalex.org/keywords/drug-reimbursement","display_name":"drug reimbursement","score":0.5569999814033508},{"id":"https://openalex.org/keywords/catalonia","display_name":"Catalonia","score":0.49000000953674316},{"id":"https://openalex.org/keywords/health-technology-assessment","display_name":"health technology assessment","score":0.4519999921321869},{"id":"https://openalex.org/keywords/real-world-evidence","display_name":"real-world evidence","score":0.4399999976158142},{"id":"https://openalex.org/keywords/access-to-innovation","display_name":"access to innovation","score":0.44600000977516174}],"concepts":[{"id":"https://openalex.org/C2779703844","wikidata":"https://www.wikidata.org/wiki/Q760125","display_name":"Reimbursement","level":3,"score":0.7770000100135803},{"id":"https://openalex.org/C144133560","wikidata":"https://www.wikidata.org/wiki/Q4830453","display_name":"Business","level":0,"score":0.5954999923706055},{"id":"https://openalex.org/C2780265253","wikidata":"https://www.wikidata.org/wiki/Q1416012","display_name":"Managed care","level":3,"score":0.5508999824523926},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.5288000106811523},{"id":"https://openalex.org/C145097563","wikidata":"https://www.wikidata.org/wiki/Q1148747","display_name":"Payment","level":2,"score":0.49570000171661377},{"id":"https://openalex.org/C66204764","wikidata":"https://www.wikidata.org/wiki/Q219416","display_name":"Sustainability","level":2,"score":0.4722000062465668},{"id":"https://openalex.org/C71745522","wikidata":"https://www.wikidata.org/wiki/Q2476929","display_name":"Confidentiality","level":2,"score":0.4674000144004822},{"id":"https://openalex.org/C100001284","wikidata":"https://www.wikidata.org/wiki/Q2248246","display_name":"Public economics","level":1,"score":0.3917999863624573},{"id":"https://openalex.org/C2780877353","wikidata":"https://www.wikidata.org/wiki/Q2518253","display_name":"Health services research","level":3,"score":0.35440000891685486},{"id":"https://openalex.org/C30772137","wikidata":"https://www.wikidata.org/wiki/Q5164762","display_name":"Consumption (sociology)","level":2,"score":0.35010001063346863},{"id":"https://openalex.org/C47344431","wikidata":"https://www.wikidata.org/wiki/Q1519812","display_name":"Health policy","level":3,"score":0.33739998936653137},{"id":"https://openalex.org/C10138342","wikidata":"https://www.wikidata.org/wiki/Q43015","display_name":"Finance","level":1,"score":0.32330000400543213},{"id":"https://openalex.org/C2780378061","wikidata":"https://www.wikidata.org/wiki/Q25351891","display_name":"Service (business)","level":2,"score":0.32179999351501465},{"id":"https://openalex.org/C172497479","wikidata":"https://www.wikidata.org/wiki/Q302208","display_name":"Capital expenditure","level":2,"score":0.30799999833106995},{"id":"https://openalex.org/C524218345","wikidata":"https://www.wikidata.org/wiki/Q31218","display_name":"Health economics","level":3,"score":0.30720001459121704},{"id":"https://openalex.org/C2983635472","wikidata":"https://www.wikidata.org/wiki/Q334911","display_name":"Health insurance","level":3,"score":0.3019999861717224},{"id":"https://openalex.org/C3019492093","wikidata":"https://www.wikidata.org/wiki/Q29468924","display_name":"Access to medicines","level":3,"score":0.30059999227523804},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.28299999237060547},{"id":"https://openalex.org/C2988170871","wikidata":"https://www.wikidata.org/wiki/Q11000047","display_name":"Healthcare system","level":3,"score":0.27219998836517334},{"id":"https://openalex.org/C50522688","wikidata":"https://www.wikidata.org/wiki/Q189833","display_name":"Economic growth","level":1,"score":0.26820001006126404},{"id":"https://openalex.org/C2778030619","wikidata":"https://www.wikidata.org/wiki/Q7180762","display_name":"Pharmaceutical policy","level":4,"score":0.2624000012874603},{"id":"https://openalex.org/C162118730","wikidata":"https://www.wikidata.org/wiki/Q1128453","display_name":"Actuarial science","level":1,"score":0.2540999948978424}],"mesh":[],"locations_count":4,"locations":[{"id":"doi:10.1016/j.hpopen.2026.100189","doi":"https://doi.org/10.1016/j.hpopen.2026.100189","is_oa":true,"landing_page_url":"https://doi.org/10.1016/j.hpopen.2026.100189","pdf_url":null,"source":{"id":"https://openalex.org/S4210236858","display_name":"Health Policy OPEN","issn_l":"2590-2296","issn":["2590-2296"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-c","norway-1","poland-20"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Health Policy OPEN","raw_type":"journal-article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13720820","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13720820/","pdf_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13720820/pdf/main.pdf","source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Health Policy Open","raw_type":"Text"},{"id":"pmid:42964861","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42964861","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Health policy OPEN","raw_type":"Journal Article"},{"id":"pmh:oai:doaj.org/article:3efd867abb1f43e0b531b2a9de205912","doi":null,"is_oa":false,"landing_page_url":"https://doaj.org/article/3efd867abb1f43e0b531b2a9de205912","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Health Policy Open, Vol 11, Iss , Pp 100189- (2026)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.1016/j.hpopen.2026.100189","doi":"https://doi.org/10.1016/j.hpopen.2026.100189","is_oa":true,"landing_page_url":"https://doi.org/10.1016/j.hpopen.2026.100189","pdf_url":null,"source":{"id":"https://openalex.org/S4210236858","display_name":"Health Policy OPEN","issn_l":"2590-2296","issn":["2590-2296"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-c","norway-1","poland-20"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Health Policy OPEN","raw_type":"journal-article"},"sustainable_development_goals":[{"score":0.6240000128746033,"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being"}],"study_designs":[{"id":"https://openalex.org/study-designs/observational-study","display_name":"Observational Study"}],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7222804182.pdf","grobid_xml":"https://content.openalex.org/works/W7222804182.grobid-xml"},"referenced_works_count":16,"referenced_works":["https://openalex.org/W2059037762","https://openalex.org/W2163878956","https://openalex.org/W2570174586","https://openalex.org/W2604289185","https://openalex.org/W2990823864","https://openalex.org/W3168523769","https://openalex.org/W3214925188","https://openalex.org/W4319298491","https://openalex.org/W4366162807","https://openalex.org/W4388126631","https://openalex.org/W4392814505","https://openalex.org/W4392914747","https://openalex.org/W4406736471","https://openalex.org/W4409334247","https://openalex.org/W4416118274","https://openalex.org/W4416122354"],"related_works":["https://openalex.org/W4401526095","https://openalex.org/W4417479792","https://openalex.org/W2414034687","https://openalex.org/W2164165840","https://openalex.org/W2789419210","https://openalex.org/W2805134576","https://openalex.org/W7213548303","https://openalex.org/W4405749178","https://openalex.org/W1827171509","https://openalex.org/W2211147574"],"abstract_inverted_index":{"Background":[0],"The":[1,201,481],"reimbursement":[2,55],"of":[3,32,63,77,128,180,190,208,226,272,326,395,417,447,461,488],"high-impact":[4,66,398,426,437],"medicines":[5,67,204,321,399,427],"(HIMs)":[6],"poses":[7],"growing":[8],"clinical":[9,39,84,345,473],"and":[10,35,40,70,74,85,102,111,130,232,254,341,347,366,375,405,421,449,474,492],"budgetary":[11],"challenges":[12],"for":[13,107,164,206,307],"publicly":[14],"funded":[15],"health":[16,99,283,308,354,504],"systems.":[17,104,309],"In":[18,183],"Catalonia,":[19,401],"pharmaceutical":[20,327],"spending":[21,242,245],"has":[22],"increased":[23],"considerably":[24],"in":[25,54,68,153,173,213,311,329,400,443],"recent":[26],"years,":[27],"driven":[28],"by":[29,124,151,196],"the":[30,60,72,138,191,197,269,292,318,386,407,414,453,459,472],"uptake":[31],"high-cost":[33,479],"therapies":[34],"expanded":[36],"indications":[37,117,212],"under":[38],"economic":[41,61,75,348,376,415,475],"uncertainty.":[42,87],"To":[43,58,350],"mitigate":[44,471],"these":[45,227,352],"risks,":[46],"payers":[47],"have":[48,356,428],"increasingly":[49,357],"used":[50],"managed":[51,78,139,195,236,273,295,359,367,408,418,462,493],"access":[52,79,140,219,237,274,279,296,300,360,364,368,409,419,463,490,494,499],"mechanisms":[53,80,141,220,275,410,464],"strategies.":[56],"Objective":[57],"assess":[59],"impact":[62,377],"newly":[64,396,424],"reimbursed":[65,116,211,259,397,425],"Catalonia":[69],"describe":[71],"role":[73],"implications":[76,416],"applied":[81,222],"to":[82,120,146,159,169,223,280,290,298,301,385,470,500],"address":[83,351],"financial":[86],"Methods":[88],"We":[89],"conducted":[90],"a":[91,177,323,391,444,466,485],"retrospective":[92],"study":[93,383,389],"using":[94],"real-world":[95,393],"data":[96],"from":[97,118,156],"Catalonia's":[98],"service":[100],"registries":[101],"billing":[103],"Expenditure":[105],"trends":[106],"HIMs":[108,260,303],"between":[109],"2019":[110,145,166],"2024":[112,121,174,214],"were":[113,122,221],"analysed.":[114],"Newly":[115,210,258],"2022":[119],"evaluated":[123],"therapeutic":[125],"class,":[126],"volume":[127],"patients,":[129],"aggregated":[131,431],"expenditure":[132,149,167,186,194,263,328,404,432,441],"per":[133,433],"patient,":[134],"taking":[135],"into":[136],"account":[137],"applied.":[142,411],"Results":[143],"From":[144],"2024,":[147,184],"HIM":[148,185],"rose":[150],"53%":[152],"nominal":[154],"terms,":[155],"\u20ac1.10":[157],"billion":[158,172],"\u20ac1.69":[160],"billion;":[161],"after":[162],"adjustment":[163],"inflation,":[165],"corresponded":[168],"approximately":[170,181],"\u20ac1.30":[171],"euros,":[175],"indicating":[176],"real":[178],"increase":[179],"30%.":[182],"represented":[187,215],"about":[188,317],"11%":[189],"total":[192],"healthcare":[193],"Catalan":[198,482],"Health":[199],"Service.":[200],"top":[202],"10":[203],"accounted":[205],"43%":[207],"expenditure.":[209],"\u20ac23.6":[216],"million.":[217],"Managed":[218],"nearly":[224],"three-quarters":[225],"indications,":[228],"including":[229,362],"indication-based":[230,363],"restrictions":[231,365],"formal":[233],"agreements.":[234],"Formal":[235],"agreements":[238,420,495],"included":[239],"confidential":[240],"discounts,":[241],"caps,":[243,246],"patient-level":[244],"free-dose":[247],"schemes,":[248],"price\u2013volume":[249],"agreements,":[250,369],"outcome-based":[251],"payment":[252],"models,":[253],"staggered":[255],"payments.":[256],"Conclusions":[257],"exert":[261],"concentrated":[262,442],"pressure.":[264],"These":[265,456],"findings":[266,457],"illustrate":[267],"how":[268,489],"broad":[270],"use":[271],"can":[276,496],"support":[277,497],"balancing":[278],"innovation":[281,501],"with":[282,337,440,478],"system":[284,505],"sustainability.":[285,506],"Future":[286],"research":[287],"is":[288,314],"needed":[289],"identify":[291],"most":[293],"effective":[294],"strategies":[297],"facilitate":[299],"new":[302],"at":[304],"costs":[305],"sustainable":[306],"Research":[310],"context":[312],"What":[313,380,451],"already":[315],"known":[316],"topic?":[319],"High-impact":[320],"are":[322,452],"major":[324],"driver":[325],"many":[330],"countries.":[331],"Their":[332],"rapid":[333],"introduction":[334],"often":[335],"occurs":[336],"limited":[338],"long-term":[339],"evidence":[340,371],"substantial":[342],"uncertainty":[343,476],"regarding":[344],"outcomes":[346],"impact.":[349],"challenges,":[353],"systems":[355],"implemented":[358],"policies,":[361],"although":[370],"on":[372],"their":[373,403],"scope":[374],"remains":[378],"limited.":[379],"does":[381],"this":[382],"add":[384],"literature?":[387],"This":[388],"provides":[390],"comprehensive":[392],"analysis":[394],"quantifying":[402],"describing":[406],"It":[412],"estimates":[413],"shows":[422],"that":[423],"consistently":[429],"higher":[430],"patient":[434],"than":[435],"overall":[436],"medicine":[438],"use,":[439],"small":[445],"number":[446],"drugs":[448],"indications.":[450],"policy":[454,468],"implications?":[455],"underscore":[458],"importance":[460],"as":[465],"key":[467],"tool":[469],"associated":[477],"medicines.":[480],"experience":[483],"offers":[484],"transferable":[486],"example":[487],"governance":[491],"timely":[498],"while":[502],"preserving":[503]},"counts_by_year":[],"updated_date":"2026-11-04T10:54:05.112534","created_date":"2026-10-18T00:00:00"}