ArticleThe European journal of health economics : HEPAC : health economics in prevention and care2026
A comparative analysis of managed entry agreements in Europe: trends, reporting practices, and financial outcomes.
Article in The European journal of health economics : HEPAC : health economics in prevention and care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
Abstract
backgroundPayers use Managed Entry Agreements (MEAs) across Europe to manage the financial risks associated with high-cost medicines. While these agreements aim to improve affordability and address uncertainty, their confidential nature raises concerns about transparency, international price referencing, and the validity of economic evaluations. This study examines MEA practices across 13 European countries, analyzing adoption trends, reporting practices, and financial outcomes, and their implications for payer decision-making.
methodsData from 2016 to 2022 were collected through (1) mapping national MEA frameworks, stakeholders, and implementation processes; (2) desk research on publicly available activity and financial reports; and (3) validation interviews with public-sector negotiators in each country.
resultsAcross 13 countries, 24 MEA frameworks were identified. MEA usage increased substantially, with the highest numbers in 2022 in Germany (356) and France (349), and the largest growth in Belgium (+ 250%) and Norway (+ 227%). Reported expenditure reductions ranged from €0.04 billion (Slovakia) to €5.56 billion (France), with estimated discounts between 14% (Germany) and 54% (Belgium). Reporting remained heterogeneous, with activity data available for fourteen frameworks and financial data for ten. More granular reporting, such as by discount mechanism (Netherlands), therapeutic class (France), or gender (Sweden), was uncommon.
conclusionThe growing use of MEAs across Europe has widened the gap between list and actual prices. Incomplete and non-standardized reporting reduces the ability to assess financial performance and limits cross-country comparability. Harmonized reporting of aggregated data, without compromising confidentiality, could improve transparency, accountability, and support value-based pricing strategies.
Indexed as
Identifiers
42371355What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.