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LETTER TO THE EDITOR
Comment on: ‘‘Forecasting Pharmaceutical Prices for Economic
Evaluations When There is No Market: A Review’’
Przemysław Holko1
Published online: 27 January 2017
 The Author(s) 2016. This article is published with open access at Springerlink.com
Dear Editor,
In their publication in Pharmacoeconomics Open,
Akpinar et al. [1] reported the results of their review of
methods for forecasting drug prices for economic eval-
uations. This was an interesting article, and I agreed
with most of the conclusions. However, I disagree that
prices forecast using the price of a close substitute on
the same market may be more reliable. This conclusion
may be biased because of market-specific aspects that
were not incorporated in the study.
Akpinar et al. [1] obtained the actual (post-launch)
prices from official sources in the USA or Canada.
However, some of the economic analyses were con-
ducted for different markets. The mechanisms for con-
trolling prices differ between markets, and neglecting to
account for these differences may introduce bias. Hence,
the forecasting efficiency ([A - E]/E index proposed by
Akpinar et al. [1], where A is the actual and E is the
expected or forecast price of a drug) should be calcu-
lated using current prices in the same market for eco-
nomic evaluation. The updated information for economic
evaluations conducted outside of the USA and Canada
[2, 3] are presented in Table 1. Although the general
conclusions did not change (there is still no trend), the
forecasting efficiency did change drastically when mar-
ket-related aspects were incorporated. Additionally, there
is no advantage to the forecasting method that utilizes
the price of a close substitute, i.e. the average absolute
value of the (A - E)/E index for a method based on a
close substitute and others equalled—after correction—
84 and 45%, respectively. Those values in the study of
Akpinar et al. [1] were 68 and 80%, respectively, indi-
cating slightly better performance of the method using
the price of a close substitute. That conclusion no longer
holds true after the adjustment.
Additionally, the study touched on the conclusion that
the generalizability of economic evaluations may be lim-
ited, i.e. the cost effectiveness of a drug in a specific market
may not translate well to other markets, especially when
the economic evaluation is based on forecast prices. Cau-
tion is always recommended when accepting a cost-effec-
tiveness ratio based on forecast prices. Perhaps the best
way to minimize the risk of misinterpreting the results of
an economic evaluation and to limit the forecast price
impact is to show a ‘threshold price’ as an endpoint (in
base-case and all scenarios of sensitivity analyses). The
‘threshold price’ informs decision makers about the max-
imal price of a drug at which using it is still cost effective
(e.g. associated with a cost-effectiveness ratio below the
threshold [4] or less costly, depending on the type of
economic evaluation). Additionally, the ‘threshold price’
can be presented as a function of the threshold (Fig. 1),
price of a well-known drug used in the same indication
across markets as a reference, or both (Fig. 2). For exam-
ple, a new biological agent for the treatment of inflam-
matory bowel diseases (e.g. vedolizumab, ustekinumab)
can use infliximab as a reference in threshold pricing pre-
sentations. Such results can be used to obtain a ‘threshold
price’ for another market, although it is still not adjusted
for all differences (e.g. medical services valuation,
This comment refers to the article available at doi:10.1007/s41669-
016-0004-1.
& Przemysław Holko
p.holko@peresc.com
1 Pharmacoeconomic Research Center, Krako´w, Poland
PharmacoEconomics Open (2017) 1:69–70
DOI 10.1007/s41669-016-0008-x
treatment patterns). The approach can reduce the risk of
misinterpretation and solve major problems in the fore-
casting of pharmaceutical prices for economic evaluations.
Compliance with Ethical Standards
Conflict of interest PH has no conflicts of interest.
Funding No sources of funding were used to prepare this letter.
Open Access This article is distributed under the terms of the
Creative Commons Attribution-NonCommercial 4.0 International
License (http://creativecommons.org/licenses/by-nc/4.0/), which per-
mits any noncommercial use, distribution, and reproduction in any
medium, provided you give appropriate credit to the original author(s)
and the source, provide a link to the Creative Commons license, and
indicate if changes were made.
References
1. Akpinar I, Jacobs P, Tran TD. Forecasting pharmaceutical prices for
economic evaluations when there is no market: a review. Pharma-
coEconomics Open. 2016. doi:10.1007/s41669-016-0004-1.
2. Kawalec P, Holko P, Paszulewicz A. Cost-utility analysis of
Ruconest (conestat alfa) compared to Berinert P (human C1
esterase inhibitor) in the treatment of acute, life-threatening
angioedema attacks in patients with hereditary angioedema.
Postepy Dermatol Alergol. 2013;30(3):152–8.
3. Hiligsmann M, Reginster JY. Potential cost-effectiveness of
denosumab for the treatment of postmenopausal osteoporotic
women. Bone. 2010;47(1):34–40.
4. Bertram MY, Lauer JA, De Joncheere K, et al. Cost–effectiveness
thresholds: pros and cons. Bull World Health Organ.
2016;94:925–30.
Table 1 The forecasting efficiency of pharmaceutical prices for the markets outside of the USA and Canada
Ruconest (conestat alfa) Prolia (denosumab)
Study Kawalec et al. (2013) [2] Hiligsmann et al. (2010) [3]
Country (year of price forecasting) Poland (2012) Belgium (2009)
Forecast price PLN4816.52 EUR95.48
Forecast price inflated to 2016 PLN4825.89 EUR106.40
Actual price (source) PLN3702.66 (http://www.mz.gov.pl) EUR180.21 (http://www.cbip.be)
[A - E]/E index (origin market) (%) -23.3 69.4
[A - E]/E index (US/Canada market) [1] (%) 127.5 5.1
A actual price, E expected (forecast) price
Fig. 1 Example of association between the ‘threshold price’ and
willingness to pay for additional health effect (the threshold)
Fig. 2 Example of association between the ‘threshold price’, the
threshold, and price of a reference drug
70 P. Holko


Comment on: “Forecasting Pharmaceutical Prices for Economic Evaluations When There is No Market: A Review”

Immunomodulatory constituents of human breast milk and immunity from bronchiolitis

Jianming Zhou

Tao Dong

Zhou and Dong Journal on Wireless Communications
and Networking  (2017) 2017:25 
DOI 10.1186/s13638-016-0799-6RETRACTION NOTE Open AccessRetraction note: Invulnerability mechanism
based on mobility prediction and
opportunistic cloud computing with
topological evolution for wireless
multimedia sensor networks
Jianming Zhou1* and Tao Dong2The authors are retracting this article [1]. The main
contribution of this article is the prediction of node
mobility. The proposed algorithm was derived based on
the assumption of a linear channel response; however, the
algorithm did not consider the wireless channel, which is
usually non-linear with distance and forms random
processes due to noise and interference. Additionally, the
opportunistic cloud computational scheme proposed did
not consider the motion and the velocity of the node.
Author details
1School of Information and Electronics, Beijing Institute of Technology,
Beijing 100081, China. 2State Key Laboratory of Space-Ground Integrated
Information Technology, Space Star Technology CO., Ltd, Beijing 100018,
China.
Received: 15 December 2016 Accepted: 15 December 2016
Reference
1. Zhou, J, Dong, T. Invulnerability mechanism based on mobility prediction
and opportunistic cloud computing with topological evolution for wireless
multimedia sensor networks. EURASIP J. Wireless Commun. Netw. 2015 243
(2015).* Correspondence: zhoujm@bit.edu.cn
The online version of the original article can be found under doi:10.1186/
s13638-015-0471-6.
1School of Information and Electronics, Beijing Institute of Technology,
Beijing 100081, China
© The Author(s). 2017 Open Access This article
International License (http://creativecommons.o
reproduction in any medium, provided you giv
the Creative Commons license, and indicate ifis distributed under the terms of the Creative Commons Attribution 4.0
rg/licenses/by/4.0/), which permits unrestricted use, distribution, and
e appropriate credit to the original author(s) and the source, provide a link to
changes were made.


Retraction note: Invulnerability mechanism based on mobility prediction and opportunistic cloud computing with topological evolution for wireless multimedia sensor networks

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