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        "titulo" => "Constrained competition in parallel drug importation&#58; the case of simvastatin in Germany&#44; the Netherlands&#44; and the United Kingdom"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p class="elsevierStyleSimplePara elsevierViewall">Examinar los efectos de la entrada de simvastatina paralelamente importada sobre el precio de los medicamentos en los 3 principales pa&#237;ses importadores de medicamentos en la Uni&#243;n Europea&#58; Reino Unido&#44; Alemania y Holanda&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Estimar la cuota de mercado de la simvastatina paralelamente importada&#44; as&#237; como el precio unitario &#40;del producto localmente producido y el importado&#41; ajustado por dosis diaria definida &#40;DDD&#41; en el pa&#237;s de importaci&#243;n&#44; y el precio unitario ajustado por DDD en el pa&#237;s de exportaci&#243;n &#40;Espa&#241;a&#41;&#46; Estimaciones por m&#237;nimos cuadrados ordinarios para determinar la existencia de competencia en precios&#44; derivada de la importaci&#243;n paralela de medicamentos en el per&#237;odo 1997-2002&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">La cuota de mercado de la simvastatina paralelamente importada experimenta un aumento progresivo &#40;sobre todo en el Reino Unido y Alemania&#41; en el per&#237;odo analizado&#44; sin que ello determine que la diferencia de precio entre la simvastatina localmente producida y la importada sea significativa&#46; Mientras que la evoluci&#243;n de precios tiende al alza en el Reino Unido y Alemania&#44; en Holanda muestra un efecto contrario&#46; No se hallan efectos competitivos derivados de la expansi&#243;n del comercio paralelo&#46;</p> <span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p class="elsevierStyleSimplePara elsevierViewall">La importaci&#243;n paralela de medicamentos en la Uni&#243;n Europea comporta efectos inesperados &#40;limitada competencia&#41; sobre los precios de los medicamentos&#44; al ser un competidor adicional en el mercado&#46; Ello en parte es el resultado de una regulaci&#243;n de precios que no incentiva la competencia&#44; y de la falta de transparencia en el reembolso de la distribuci&#243;n&#46; Esto &#250;ltimo es debido al efecto de los descuentos informales &#40;no observables para el investigador&#41;&#46; El caso de la simvastatina pone en duda los ahorros de recursos para el asegurador sanitario derivados del comercio&#46; Finalmente&#44; de los 3 pa&#237;ses analizados&#44; Holanda es el &#250;nico que muestra una tendencia a la baja en los precios de la simvastatina&#46; Ello puede atribuirse al sistema de recuperaci&#243;n de descuentos <span class="elsevierStyleItalic">&#40;claw back&#41;</span> informales &#40;impl&#237;citos&#41;&#46;</p>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p class="elsevierStyleSimplePara elsevierViewall">To examine the effects of parallel simvastatin importation on drug price in three of the main parallel importing countries in the European Union&#44; namely the United Kingdom&#44; Germany&#44; and the Netherlands&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStyleSimplePara elsevierViewall">To estimate the market share of parallel imported simvastatin and the unit price &#8211;both locally produced and parallel imported&#8211; adjusted by defined daily dose in the importing country and in the exporting country &#40;Spain&#41;&#46; Ordinary least squares regression was used to examine the potential price competition resulting from parallel drug trade between 1997 and 2002&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The market share of parallel imported simvastatin progressively expanded &#40;especially in the United Kingdom and Germany&#41; in the period examined&#44; although the price difference between parallel imported and locally sourced simvastatin was not significant&#46; Prices tended to rise in the United Kingdom and Germany and declined in the Netherlands&#46; We found no evidence of pro-competitive effects resulting from the expansion of parallel trade&#46;</p> <span class="elsevierStyleSectionTitle">Discussion</span><p class="elsevierStyleSimplePara elsevierViewall">The development of parallel drug importation in the European Union produced unexpected effects &#40;limited competition&#41; on prices that differ from those expected by the introduction of a new competitor&#46; This is partially the result of drug price regulation scant incentives to competition and of the lack of transparency in the drug reimbursement system&#44; especially due to the effect of informal discounts &#40;not observable to researchers&#41;&#46; The case of simvastatin reveals that savings to the health system from parallel trade are trivial&#46; Finally&#44; of the three countries examined&#44; the only country that shows a moderate downward pattern in simvastatin prices is the Netherlands&#46; This effect can be attributed to the existence of a system that claws back informal discounts&#46;</p>"
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