United Kingdom Parliament
Publications & records
Advanced search
 HansardArchivesResearchHOC PublicationsHOL PublicationsCommittees
Select Committee on European Union Twentieth Report


CHAPTER 2: THE COMMISSION PROPOSAL

9.  The Commission Proposal[10] derives from a Resolution of the Council of Health Ministers of 14 December 2000[11] calling on the Commission to make proposals for incentives, regulatory and other supporting measures to ensure through clinical research and development that new medicinal products for children, as well as those already on the market, should be fully adapted to the specific needs of children.

10.  The Commission stated their general objectives were:

  • to increase the development of medicines for use in children;
  • to ensure that medicines used to treat children are subject to high-quality research and are appropriately authorised for use in children;
  • to improve the information available on the use of medicines in children; and,
  • to achieve these objectives without subjecting children to unnecessary clinical trials and in full compliance with the Clinical Trials Directive[12].

11.  The Proposal therefore combined procedures to regulate clinical trials of medicines for use in children with incentives designed to encourage the pharmaceutical industry to develop and submit for approval medicines specifically developed for the treatment of children.

APPROVALS PROCEDURE

12.  The approvals procedure proposed by the Commission for the Regulation is based on the use of the European Community's Clinical Trials Directive[13] and operated through the European Medicines Agency (EMEA)[14], which is the European Union's centralised body for authorising medicinal products.

13.  The key elements of the Proposal[15] are:

  • an expert Paediatric Committee should be set up by the EMEA to:

    (a)  oversee the process by assessing and agreeing Paediatric Investigation Plans for the development of medicinal products intended for use in children;

    (b)  assess compliance with Paediatric Investigation Plans from the results of studies;

    (c)  advise the EMEA on data collection for surveys carried out under the Regulation and the adoption of an Inventory of Therapeutic Needs;

    (d)  support and advise the EMEA in establishing a European Network for coordinating studies related to paediatric medicinal products and building up the necessary scientific and administrative competence throughout the EU; and,

    (e)  give scientific and professional advice to the EMEA on documents to be issued under the Regulation or any other questions related to paediatric medicines.

  • the Paediatric Committee should be composed of:

    (a)  five members of the EMEA Committee for Medicinal Products for Human Use (CMPHU);

    (b)  one person appointed by each Member State which is not represented on the CMPHU; and,

    (c)  six persons appointed by the Commission, through a public call for expressions of interest, representing paediatricians and the interests of patient associations.

  • no members of the Paediatric Committee should have financial or other interests in the pharmaceutical industry which could affect their impartiality.
  • applications to the EMEA for marketing authorisation for new medicines, or the development of existing patent-protected products, would have to be accompanied by a Paediatric Investigation Plan approved by the Paediatric Committee, unless the Committee granted a waiver on the grounds that the medicines concerned were unlikely to benefit children.
  • the Paediatric Committee may authorise requests for deferral of studies in children where initial experience of using a product in adults would be appropriate before use in children was authorised, or where studies in children might take longer to conduct than studies in adults.
  • to avoid unnecessary studies in children, the Paediatric Committee may grant waivers from the requirements of the Regulation where the product concerned is likely to be ineffective or unsafe for all or part of the paediatric population, where the disease or condition for which the product is being developed occurs only in adult populations or where the product does not represent a significant therapeutic benefit over existing treatments for paediatric patients.
  • details of trials carried out under paediatric investigation plans and data collected by Member States on existing uses of medicinal products in children should be entered by the EMEA on the European Clinical Trials Database established under the Clinical Trials Directive.
  • the EMEA would coordinate the establishment of a European Paediatric Clinical Trials Network to encourage communication and collaboration between existing European networks of scientific expertise in paediatric studies.
  • the Commission would also examine the possibility of setting up an independent paediatric study programme, entitled Medicines Investigation for the Children of Europe (MICE), to fund studies into the paediatric use of medicines.

AUTHORISATION PROCEDURES: REWARDS AND INCENTIVES

14.  To stimulate research and development on medicines suitable for use in children, the Commission propose to introduce the following rewards and incentives where studies have been carried out under an approved Paediatric Investigation Plan:

15.  Ten years of data protection for new paediatric studies (but not market exclusivity) would also be granted to off-patent medicinal products developed specifically for use in children. Safety, quality and efficacy in children would need to be demonstrated. Products authorised under this provision would be granted Paediatric Use Marketing Authorisation (PUMA).

PRODUCT IDENTIFICATION

16.  To identify suitability for the purpose, medicinal products granted marketing authorisation for paediatric use would have to display on the label, alongside the name of the product, the letter "P" in blue lettering surrounded by an outline of a star also in blue.

REVIEW PROCEDURES

17.  The Commission would be required to publish annually a list of all the companies that have benefited from any of the rewards or incentives under the Regulation and those that have failed to comply with any of the obligations in the Regulation. This would be based on information supplied by Member States and the EMEA.

18.  Within six years of entry into force of the Regulation, the Commission would also be required to publish a general report on the application of the Regulation, including a detailed inventory of all medicinal products authorised for paediatric use under the Regulation.

LEGAL BASE

19.  The Commission propose that the legal base for the Regulation should be Article 95 of the EC Treaty, which allows the Community to adopt measures for harmonising national laws. This Article requires co-decision by qualified majority.

JUSTIFICATION FOR THE PROPOSAL

20.  In justifying the Proposal[16] the Commission explained that:

  • because between 50-90% of all medicinal products used in children have never been specifically studied or authorised for such use, prescribers have no alternative but to use either products authorised for adults which have not been tested or authorised for paediatric use or completely unauthorised products;
  • the results of tests of medicines in adults cannot necessarily be extrapolated directly to children because they have different developmental, physiological and psychological characteristics than adults;
  • many drugs are formulated in a way that is not suitable for administration to children, especially the very young;
  • because of the relatively small size and complexity of the market, pharmaceutical companies often find it is not worthwhile to carry out the lengthy and expensive research and development needed to produce or adapt medicines specifically for children;
  • attempts by Member States to encourage manufacturers to develop or adapt medicines for use in children voluntarily have largely been unsuccessful.

21.  The Commission pointed out that similar voluntary initiatives in the USA had also been largely unsuccessful. The situation there had changed dramatically when legislation to encourage clinical trials in children had been introduced in 1997 and 1998. The combination of incentives and obligations in the US legislation had been extremely successful in stimulating the development of medicinal products for paediatric use.

22.  The Community Regulation on orphan medicinal products[17], introduced in 2000, had similarly stimulated the authorisation of medicines to treat rare diseases.

23.  The Commission concluded[18] that self-regulation by the industry to develop a Code of Practice would not provide the necessary stimulus for development of medicines specifically for children. Government intervention would be required to ensure that the right studies were done for the benefit of children, rather than because of anticipated market returns.

24.  While Member States could help with research and training programmes, the regulation of medicines was a Community-based function and the problem required Community-wide co-ordination.

CONSULTATION BY THE COMMISSION

25.  Following preliminary consultations and studies, the Commission launched a public consultation on a draft proposal for the Regulation in March 2004. This attracted 69 responses: 27 from health-care professionals, 18 from industry, 15 from regulators, 3 each from insurance companies and patients' associations and 3 from other sources[19].

26.  The draft Proposal was generally welcomed. But changes were proposed to the composition of the Paediatric Committee. Industry representatives suggested that the SPC extension should be for 12 rather than 6 months. Some respondents favoured stronger incentives for off-patent medicines.

27.  The central database was generally welcomed. But industry respondents were concerned about the confidentiality of information and wanted the information that would be accessible to the public to be clearly defined.

28.  Some respondents regretted the lack of an explicit commitment to fund the proposed Medicines Investigation for Children of Europe (MICE) programme.

IMPACT ASSESSMENT

29.  The Commission engaged Rand Europe[20] to assess the economic social and environmental impacts of the draft Regulation.

30.  The Rand Europe Study Report (Rand Study)[21] estimated that:

    (a)  To handle the expected increase in the number of applications the EMEA budget would have to be increased by between 67-150%. In the worst case this would mean a rise of between €130-195 million.

    (b)  The costs of developing paediatric investigation plans and the related studies in children would increase costs to the pharmaceutical industry by an average of €4 million per product.

    (c)  The initial costs to industry for paediatric testing would be around €560 million in the first year, falling to between €160-360 million in subsequent years (bearing in mind that the average cost of developing new drugs was estimated in 2000 to be around US$802 million).

    (d)  Marginal costs of testing passed on directly to consumers would be likely to increase drug prices between 0.1% and 0.4% (although it noted that in many EU Member States the price of medicines is controlled by Government).

31.  The Commission admit that estimating the financial value of social savings through health improvement likely to result from the Regulation is "very difficult". They quote Rand Study figures which would appear to indicate that hospital costs caused by unlicensed and off-label use of medicines in children could be between €140-252 million. But they urge caution in interpreting these figures.

32.  The Rand study estimated that the incentives to the innovative pharmaceutical industry proposed in the Regulation could enable drug companies to cover the costs of testing and make a profit of between
€63-205 million in ten years.

33.  The six month SPC extensions available to the innovative pharmaceutical industry were predicted by the Rand study to cost generic drug manufacturers between €4-51 million through delayed market access. But the study calculated that the cost of adjusting to the new market conditions could be absorbed by the generics industry over a period of five years.

34.  The Rand Study estimated the cost impact of these incentives on total European health care as between 0.01% and 0.04% in total European health care expenditure and between 0.06% and 0.25% of annual European pharmaceutical expenditure. But, because of the difficulty of accurately estimating potential costs and savings, the Commission concluded that these figures should be regarded as a "worst case scenario".


10   Commission reference 13880/04 COM (2004) 599 final Back

11   See http://ue.eu.int/ueDocs/cms_Data/docs/pressData/en/lsa/14517.en0.doc.html#_Toc503256039 Back

12   See paragraph 12 Back

13   Directive 2001/20/EC dated 4 April 2001 Back

14   Established in 2004 by Regulation (EC) 726/2004 Back

15   Commission reference 13880/04 COM (2004) 599 final Back

16   Commission reference 13880/04 COM (2004) 599 final and Commission Staff Working Paper 13880/04 ADD I SEC (2004) 1144 Back

17   Regulation (EC) 141/2000 Back

18   Commission Staff Working Paper 13880/04 ADD 1 SEC (2004) 1144 Back

19   Details given in Annex 4 of the Commission Staff Working Paper 13880/04 ADD 1 SEC (2004) 1144. Back

20   Rand Europe is part of the US-based Rand Corporation, described on its website [www.rand.org] as a non-profit research organization providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the World.  Back

21   Quoted in Commission External Impact Statement SEC (2004) 1144 (The Rand Europe Study Report is available on http://pharmacos.eudra.org.) Back


 
previous page contents next page

House of Lords home page Parliament home page House of Commons home page search page enquiries index

© Parliamentary copyright 2006