overview of health science policy council activities
DESCRIPTION
Overview of Health Science Policy Council Activities. May 16, 2005. OBJECTIVES. Describe Mission and Membership Discuss Structure and Activities Present Outcomes for 2005. OBJECTIVES. Describe Mission and Membership. MISSION. - PowerPoint PPT PresentationTRANSCRIPT
JPG 05/14/051
Overview of Health Science Overview of Health Science Policy Council ActivitiesPolicy Council Activities
May 16, 2005
JPG 05/14/052
OBJECTIVESOBJECTIVES•Describe Mission and
Membership•Discuss Structure and Activities•Present Outcomes for 2005
JPG 05/14/053
OBJECTIVESOBJECTIVES•Describe Mission and
Membership
JPG 05/14/054
MISSIONMISSION
To advise the Society on important science, research and policy issues in pharmacoeconomics and outcomes research
JPG 05/14/055
MEMBERSHIPMEMBERSHIP• Jon Clouse• Peter Davey• Michael
Drummond• Robert Epstein• Jean Paul Gagnon*• Bryan Luce• Eva Lydick
• Joel Hay• William McGhan• Donald Patrick• Jim Smeeding• Sean Sullivan• George Torrance• Milton Weinstein• Marilyn Dix-Smith
ISPOR Scribe - Daniel Klim*Chairman
JPG 05/14/056
OBJECTIVESOBJECTIVES• Describe Mission and
Membership• Discuss Structure and
Activities
JPG 05/14/057
STRUCTURESTRUCTURE• Council members identify and freely discuss wide ranging
issues at bi monthly meetings (Think Tank approach)• One month after meeting, lead constructs a draft brief
following approved format• After Council discussion at next meeting second draft
constructed• Final approval by Council and referral to Board for
discussion and action• Lead turns brief into Board action plan• Two weeks before meeting new issues submitted to
Committee Scribe
JPG 05/14/058
COUNCIL FORMAT FOR TWO COUNCIL FORMAT FOR TWO PAGE BRIEF ON ISSUEPAGE BRIEF ON ISSUE• TITLE• DESCRIPTION• ANALYSIS • ALTERNATIVE RESPONSES • RECOMMENDED ACTION
JPG 05/14/059
BOARD FORMAT FOR BOARD FORMAT FOR APPROVED ISSUE APPROVED ISSUE
• DEFINE ISSUE • DESCRIBE SPECIFIC TASKS AND/OR PRODUCTS
OF ACTION PLAN • PRIORITIZE THE INITIATIVES’ WORK ACTIVITIES
FOR CURRENT YEAR• PROVIDE CLARITY FOR OPERATIONALIZING THE
WORK ACTIVITIES, E.G., ORGANIZATION, TIMELINES, AND SUGGESTED WORK GROUP MEMBERS
JPG 05/14/0510
ACTIVITIESACTIVITIES• MEET EVERY TWO MONTHS• HELD SIX MEETINGS IN 2004/2005• DISCUSS CURRENT ISSUES• SURFACE NEW ISSUES AND GAUGE REACTION• REVIEW BOARD COMMENTS AND DISCUSS ACTION
PLAN• OPTIONAL – LEAD OR OTHER COUNCIL MEMBERS
PARTICIPATE IN IMPLEMENTATION OF ISSUE ACTION PLAN
• PRODUCED SIX ISSUES FOR BOARD
JPG 05/14/0511
OBJECTIVESOBJECTIVES• Describe Mission and
Membership• Discuss Structure and
Activities• Present Outcomes for 2005
JPG 05/14/0512
POLICY ISSUESPOLICY ISSUES• BOARD APPROVED
BRIDGING THE HEALTH MEASUREMENT GAP: MISSION IMPOSSIBLE: Lead – George Torrance -
ROLE OF OUTCOMES RESEARCH IN EVIDENCE-BASED HEALTH CARE DECISION-MAKING: Lead – Bryan Luce, Founder & Senior Research Leader, the
MEDTAP Institute at UBCCONTINUOUS QUALITY IMPROVEMENT FOR
COST EFFECTIVE HEALTH CARE RESEARCH AND GLOBAL POLICY: Leads – Bill McGhan, Professor, University of the Sciences
JPG 05/14/0513
POLICY ISSUESPOLICY ISSUES•BOARD APPROVED
DEVELOPING STANDARDS FOR DRUG COSTS IN PHARMACOECONOMIC STUDIES:
Lead – Michael Drummond, Director, University of York, Centre for Health Economics, Heslington, York
TRANSFERABILITY OF ECONOMIC DATA: WHEN DOES A DIFFERENCE MAKE A DIFFERENCE
Lead – Michael Drummond, Director, University of York, Centre for Health Economics, Heslington, York, Jim Smeeding, President JestaRx Group
• COUNCIL DISCUSSION ACCELRATING USE OF COST EFFECTIVENESS AND OUTCOMES
DATA BY HEALTH CARE DECISION MAKERS Leads – Rob Epstein, Vice President of Medical Affairs, Medco, John
Clouse, Director, Pharmacoeconomic Evaluations, United Health Care, Jean Paul Gagnon, Director Public Policy, Sanofi-Aventis Pharmaceuticals
JPG 05/14/0514
NEW ISSUESNEW ISSUES• Anyone can submit issue to Science
Policy Council for development and discussion
• Members are open to ideas• Each issue will be discussed and debated • Issue author will be recognized and
informed of issue status• Send issues to Jean Paul Gagnon at
JPG 05/14/0515
Bridging the Health Bridging the Health Measurement Gap: Mission Measurement Gap: Mission
Impossible?Impossible?Donald Patrick, University of Washington
Eva Lydick, New Mexico George Torrance, McMaster University,
Innovus Research Inc., and Health Utilities Inc.
JPG 05/14/0516
The IssueThe Issue• There is no standard measurement of health• Different agencies use different methods
• WHO, Statistical Agencies, NICE, etc.• QALYs are not necessarily comparable
• SG, TTO, VAS • Public, Patients• EQ5D, HUI, QWB, etc.
• Should ISPOR propose a “reference case” method?
JPG 05/14/0517
AnalysisAnalysis• Is lack of comparability across studies a
problem?• Reference case does not preclude other
methods• How broadly to define the problem?
• QALY• QALY, WTP• QALY, WTP, HRQOL, PRO
JPG 05/14/0518
Tentative RecommendationsTentative Recommendations• ISPOR should take this on• Organize a special
workshop(s), consensus, publish
• Maintain and update over time
JPG 05/14/0519
Where Does Outcomes Research Where Does Outcomes Research fit into Evidence-Based Health fit into Evidence-Based Health Care Decision-Making?Care Decision-Making?
Bryan Luce
JPG 05/14/0520
Selected Organizations Selected Organizations Using EBMUsing EBM
• BCBS’s Technology Evaluation Center • US Preventive Services Task Force • Clinical Practice Guidelines• CMS Medicare Coverage Advisory
Committee (MCAC)• AHRQ’s Evidence-Based Practice
Centers
JPG 05/14/0521
Organizations Using EBM Organizations Using EBM (Cont.)(Cont.)
• UK’s National Institute for Clinical Excellence (NICE)
• AMCP’s Format for Formulary Submission • Multiple MCOs
• OHSU Drug Effectiveness Review Project • 13 Medicaid Agencies • Consumers’ Union BestBuyDrugs website• AARP’s ResearchRx website
JPG 05/14/0522
Organizations Using EBM Organizations Using EBM (Cont.)(Cont.)
• CMS’s MMA: Comparative Effectiveness
• CMS Interim Coverage: PCT/Registries
• Institute of Medicine: EBM/Comparative Effectiveness Private-Public Initiative
JPG 05/14/0523
EBG in Practice: Three EBG in Practice: Three GroupsGroups
• The “efficacy” group
• The “effectiveness” group
• The “cost-effectiveness” group
JPG 05/14/0524
The EBG “Efficacy” The EBG “Efficacy” GroupGroup
• Mantra is “minimize bias”• Opt for maximizing internal validity of
studies at expense of generalizability• Examples of organizations:
• Cochrane Collaboration• OHSU’s Drug Effectiveness Review
Project Medicaid agencies (?), Consumers Union, AARP
JPG 05/14/0525
The EBG “Effectiveness” The EBG “Effectiveness” GroupGroup
• Mantra: “Is it effective in the real world?”• Opt for generalizability to populations and clinical
settings of interest (incl non-experimental evidence)• Examples of organizations:
• CMS (MCAC, MMA, PCT/Registry Interim Coverage Policy)
• AHRQ’s EPCs• BCBS TEC• Clinical Practice Guidelines• IOM’s Effectiveness Initiative
JPG 05/14/0526
The EBG Cost-The EBG Cost-Effectiveness GroupEffectiveness Group
• Mantra is “real world effectiveness and real world value for money”• Opt for generalizability often over long
haul and accuracy over precision• Examples of organizations:
• Academy of Managed Care Pharmacy• U.K.’s National Institute for Clinical
Excellence (NICE)• AHRQ’s EPCs
JPG 05/14/0527
• Specific Tasks: • 1. Recruit a senior advisory panel to
consist of both traditional clinical EBM experts (e.g. Cochrane participants) and HEOR researchers to recommend the objective to be achieved, to help define the problem and approach and to oversee the work plan and work products
JPG 05/14/0528
2. Review, describe and report on existing EBM applications by key organizations in US and the rest of the westernized world
3. Review and report on the EBM methods literature including how various parties define the of the words “evidence-based medicine”, “best evidence”, “systematic review” with the intention of defining these words for different contexts.
JPG 05/14/0529
4. Develop a consensus for the definitions of words and phrases above
5. Review and report on methods for combining disparate sets of evidence that include RCT evidence and outcomes evidence
JPG 05/14/0530
6. Convene a 2 day workshop of key opinion leaders who have different concepts of the EBM application and charge the group with engaging the issues and developing a consensus concerning the role that HEOR (including observational data, modeling, patient-reported outcomes, including patient preference) should play in different applications of EBM and the methodological and reporting solutions.
JPG 05/14/0531
Presenter:
William McGhan, PharmD, PhDUniversity of the Sciences
Philadelphia, Pennsylvania USA
ISPOR Health Science Policy Council
Continuous Quality Improvement for Continuous Quality Improvement for Cost-Effective Cost-Effective
HealthCare Research HealthCare Research and Global Policyand Global Policy
JPG 05/14/0532
• While most ISPOR members and practitioners are able to follow major economic indicators and the release of major economic papers, it has been suggested that a process be developed whereby ISPOR would systematically report on trends in the overall quality of cost-effectiveness studies and global policy.
Issue DescriptionIssue Description
JPG 05/14/0533
Issue Description (cont’d)Issue Description (cont’d)• Recommendations and reports from
ISPOR would be intended to advance international health care efficiency and quality and become a mainstay of our global effort to improve the economic and quality-of-life research and practice in various health care sectors.
JPG 05/14/0534
Analyzing the OptionsAnalyzing the Options• Reports should be continually fostered inside and outside
ISPOR that quantify the adequacy in the quality of publications and regional CEA analyses.
• ISPOR needs to monitor what qualitative, quantitative and statistical methods require modification, improvement or further development.
• It is important to monitor the quality of CEA guidelines being used by various journals, organizations and nations for analyzing new therapies and allocation of resources.
• Educational materials and forums need to be provided to improve CEA quality.
JPG 05/14/0535
Options for ActionOptions for Action• Commission a white paper on the state of CEA science & policy.• Generate report card system on the overall state of CEA science and
practice. • Issue periodic assessment reports on the overall quality of papers,
abstracts, journal guidelines, government guidelines. • Examine ISPOR awards program to assure that excellent reports and
research advances are recognized and encouraged (ranging from researchers, policy makers, to clinical practitioners?).
• Organize a special workshop on the topic bringing together representatives of the various stakeholders (e.g., Statistical Agencies, technology assessors, health economists, clinical researchers, health policy researchers, payers and regulators). Publish the results.
• Organize a special session on the topic at an upcoming ISPOR annual meeting.
• In relationship to improving economic modeling and transparency, it has been suggested that ISPOR become an online repository for published and “reference case” CEA models and perhaps databases for which print journals have inadequate space.
JPG 05/14/0536
A List of ISPOR Initiatives:A List of ISPOR Initiatives:How Well Are These Linked to Overall How Well Are These Linked to Overall Continuous Improvement?Continuous Improvement?
• Research Practices • · ISPOR Research Initiatives • - ISPOR Health Science
Initiatives • - ISPOR Quality of Life Initiatives • - Pharmacoeconomic Guidelines • • · ISPOR Good Research Practices • - ISPOR Code of Ethics • - Modeling Studies • - Retrospective Database
Studies • - CEA with Clinical Trials • - Real World Data Task Force • - Budget Impact Analysis Task
Force
• Research & Communication Issues
• · General Pharmacoeconomics Research and Use Issues
• · Quality of Life Regulatory Issues
• · Health Science Research Use Issues/General
• · Use of Research in Decision Making
• · ISPOR Communications Task Force
• · ISPOR Abstract Quality Assurance Task Force
JPG 05/14/0537
65%
23%
43%
83%
89%
57%
65%
30%
50%
80%
93%
64%
84%**
46%**
68%**
73%**
52%**
74%**
69%**
82%**
82%**
73%**
0% 20% 40% 60% 80% 100%
Disclosed funding source
Presented study perspective
Societal perspective
Discounted both costs and QALYs
Identified modeling software
Calculated net costs
Stated year of currency
Reported incremental ratios
Performed sensitivity analyses
Compared to results of relatedCEAs
Discussed limitations
1976-1997 1998-2001
N = 305 N = 228* p<0.1 ** p<0.05
Source: P. Neumann, N..V. Olchanski; A.B. Rosen; D. Greenberg; R. Chapman; P.W. Stone; J. Nadai. ARE PUBLISHED COST-UTILITY ANALYSES IMPROVING? (Poster) ISPOR: Arlington, VA, May 18-21, 2003.
Changes in CEA Report Quality Over Time
JPG 05/14/0538
METHODS INDICATORS
0100200300400
1998 1999 2000 2001 2002 2003 2004
Abs
tract
s
Markov
Bootstrap
Sensitivity
Bayes
ConfidenceIntervalsDiscounting
CONTENT ANALYSIS ISPOR ABSTRACTSCONTENT ANALYSIS ISPOR ABSTRACTS
Source: 1. Smith MD and McGhan WF. ISPOR 10th International Meeting(Poster) Washington, DC. May 15-18, 2005. 2. www.ispor.org/research_study_digest/index.asp (N=4605 abstracts)
JPG 05/14/0539
CONTINUOUS QUALITY IMPROVEMENT
Guidelines
Design
InterventionMeasurement
Analysis
Feedback
EconomicsPRO/QOLOutcomes
Guideline
InterventionMeasure
Analysis
Feedback
DesignCEA / CUAPRO / QOLOutcomes
McGhan WF and Briesacher B. Implementing Pharmacoeconomic Outcomes Management. PharmacoEconomics. Vol 6 (5): 412-416.
JPG 05/14/0540
REFERENCESREFERENCESReed SD et al. Conducting economic evaluations alongside multinational
clinical trials: Toward a research consensus. American Heart Journal. March 2005;149:434-43.
Neumann PJ, Stone PW, Chapman RH, Sandberg EA, Bell CM. The Quality of Reporting in Published Cost-Utility Analyses, 1976-1997. Annals of Internal Medicine. 2000; 132(12):964-72.
Neumann PJ, Greenberg D, Olchanski NV, Stone PW, Rosen AB. Growth and quality of the cost-utility literature, 1976-2001. Value in Health. 2005;8(1):3-9.
Rosen AB, Greenberg D, Stone PW, Olchanski NV, Neumann PJ. Quality of Abstracts of Papers Reporting Original Cost-Effectiveness Analyses. Medical Decision Making. In press.
Neumann PJ, Greenberg D, Olchanski NV, Stone PW, Rosen AB. Growth and quality of the cost-utility literature, 1976-2001. Value in Health. 2005;8(1):3-9.
Neumann PJ, Stone PW, Chapman RH, Sandberg EA, Bell CM. The Quality of Reporting in Published Cost-Utility Analyses, 1976-1997. Annals of Internal Medicine. 2000; 132(12):964-72.
Rosen AB, Greenberg D, Olchanski NV, Chapman RH, Neumann PJ. Reporting of Key Data in Abstracts of Cost-Utility Analyses. Abstract SMDM, Chicago, IL, October 19-22, 2003.
McGhan WF and Briesacher B. Implementing Pharmacoeconomic Outcomes Management. PharmacoEconomics. Vol 6 (5): 412-416, 1994.
JPG 05/14/0541
TRANSFERABILITY OF TRANSFERABILITY OF ECONOMIC DATA:ECONOMIC DATA:
WHEN DOES A DIFFERENCEWHEN DOES A DIFFERENCEMAKE A DIFFERENCE?MAKE A DIFFERENCE?
Michael Drummond Centre for Health
Economics University of York
United Kingdom
JPG 05/14/0542
OUTLINE OF THE ISSUESOUTLINE OF THE ISSUES• Several factors, varying from location to
location, are thought to limit the transferability (generalisability) of economic data.
• These factors include differences in relative prices, practice patterns, availability of healthcare resources, community values for health states.
JPG 05/14/0543
OUTLINE OF THE ISSUESOUTLINE OF THE ISSUES(Continued)(Continued)• Existing guidelines for economic
evaluation (formal and voluntary) take differing positions on the relevance and admissibility of data from outside the country of interest.
• Too much flexibility could lead to misleading cost-effectiveness estimates; too much restriction could lead to unnecessary duplication of research.
JPG 05/14/0544
OUTLINE OF THE ISSUESOUTLINE OF THE ISSUES(Continued)(Continued)• A recent review of economic evaluations of
drugs conducted in Western Europe has shown that: there are variations in cost-effectiveness from
country to country; the differences are not systematic; they depend on the methods employed by the
analyst; the implications of these variations for
decision-making are not clear.Barbieri et al. Value in Health 2005; 8(1): 10-23.
JPG 05/14/0545
ISPOR’s PLANSISPOR’s PLANS• To tackle the following issues:
Which elements of economic data vary most from setting to setting?
Given the known variability, what would be reasonable guidelines for accepting (or not accepting) data from outside the country of interest?
JPG 05/14/0546
ISPOR’s PLANS ISPOR’s PLANS (Continued)(Continued)• Review existing national guidelines to
extract more detail on transferability recommendations.
• Analyse the studies in the Barbieri et al review in more detail, to identify more precisely the variation (from place to place) in the key parameters.
• Organise an issues panel at a future meeting, involving researchers and decision-makers, to discuss these findings.
JPG 05/14/0547
DEVELOPING STANDARDS DEVELOPING STANDARDS FOR DRUG COSTS IN FOR DRUG COSTS IN
PHARMACOECONOMIC PHARMACOECONOMIC STUDIESSTUDIES
Michael Drummond University of York
Jim Smeeding University of Texas &
JestaRx Group
JPG 05/14/0548
OUTLINE OF THE ISSUESOUTLINE OF THE ISSUES• Drug costs (of the study drug and
comparator) are major cost drivers in pharmacoeconomic studies.
• The cost of the drug regimen involves not only the price but also the impact of wholesale discounts, pharmacy on-costs and assumptions about wastage.
• In the USA, the Center for Medicare and Medicaid Services (CMS) is proposing to base reimbursement on Average Sales Price (ASP).
JPG 05/14/0549
OUTLINE OF THE ISSUES OUTLINE OF THE ISSUES (Continued)(Continued)• Until recently most cost studies in the USA
have quoted Average Wholesale Price. ASP factors in discounts and rebates.
• In addition, there is a growing theoretical literature, often linked to discussions about patent protection, that suggests that the market prices for drugs are not good approximations to the social opportunity costs.
JPG 05/14/0550
JANUARY 1, 2005 – ASP PLUS 6%JANUARY 1, 2005 – ASP PLUS 6%• Policy:
- Average Sales Price plus 6% (ASP plus 6%) shall apply to payment(s) for drugs and biologicals (under Medicare Part B – HCPCS) that are furnished on or after January 1, 2005. No Grace Period
JPG 05/14/0551
ASP METHODOLOGY:ASP METHODOLOGY:PHARMACEUTICAL SALES DATAPHARMACEUTICAL SALES DATA
Calculated Quarterly (calendar):3rd Quarter 2004 ASP for January 1, 2005
implementation;4th Quarter 2004 ASP for April 1, 2005 Implementation.
Average Sales Price for each NDC, along with the number of units sold (Weighted Average).
Average Sales Price shall include: volume discounts, prompt pay discounts, cash discounts, charge backs, and rebates to the first point of sale.
JPG 05/14/0552
PROS & CONSPROS & CONSPros:• Market driven (not set by manufacturer or other
source).• Factors in discounts, rebates.Cons:• Very difficult to establish an ASP which is fair to all
providers.• Very difficult to maintain – contracts are continually
changing with status of product.• Variation from quarter to quarter.• Difficult to capture all discounts (early payment, etc).• ASP data – One Quarter Lag at beginning of New
Quarter.
JPG 05/14/0553
ISPOR’s PLANSISPOR’s PLANS• To establish a Task Force or Working Group
to develop standards for drug costs in pharmacoeconomic studies.
• To review current practice for estimating drug costs in pharmacoeconomic studies undertaken in major markets.
• To review the conceptual and methodologic literature on drug prices, patent protection and social opportunity costs.
JPG 05/14/0554
ACCELRATING USE OF COST ACCELRATING USE OF COST EFFECTIVENESS AND OUTCOMES EFFECTIVENESS AND OUTCOMES DATA BY HEALTH CARE DECISION DATA BY HEALTH CARE DECISION
MAKERSMAKERS
Rob Epstein, Vice President of Medical Affairs,Medco
John Clouse, Director, Pharmacoeconomic b, United Health Care
Jean Paul Gagnon, Director Public Policy, Sanofi-Aventis Pharmaceuticals
JPG 05/14/0555
ISSUE DESCRIPTIONISSUE DESCRIPTION• Health care decision makers not incorporating
CEA in decision-making• Inferior translation process, few decision
makers understand how to use CEA information
• Decision makers not getting information, e.g., don’t read “Value in Health”
• ISPOR not demonstrating value to decision makers
JPG 05/14/0556
REDEFINING COMPETITION IN REDEFINING COMPETITION IN US HEALTH CARE*US HEALTH CARE*•Healthcare competition today works on the
wrong level, players engage in zero-sum competition (dividing value rather than creating it)
•Players transfer costs onto one another, limit access to care, hoard information and stifle innovation
•Competition should occur at the level of preventing, identifying and treating patients’ conditions and disease
*Porter M, Olmsted Weisberg, E., June 2004
JPG 05/14/0557
FIXING HEALTH CARE COMPETITION*FIXING HEALTH CARE COMPETITION*•Increase transparency in pricing to reduce cost
shifting, discrimination and other inefficiencies •Improving quality often substantially reduces
costs•Use information to support value-based
competition•Focus on value for patients, not just cost
*Porter M, Olmsted Weisberg, E., June 2004
JPG 05/14/0558
PORTER SUGGESTS THREE WAYS TO PORTER SUGGESTS THREE WAYS TO DEMONSTRATE VALUEDEMONSTRATE VALUE•“Compete on it”, e.g., plug into, become part of
decision making systems used by decision makers, i.e., work with PDPs, MAs, physicians, pharmacists, patients and others
• ISPOR should proactively design decision making system that includes all stakeholders and demonstrates value
• ISPOR should direct its promotional activities at insuring patients correctly use products and services
JPG 05/14/0559
ANALYSISANALYSIS• Movement to accelerate availability of
CEA, e.g., FMCP FORMAT program for collecting PE data
• However, no movement to translate data or show decision makers how to contrast and compare drugs or devices
JPG 05/14/0560
ALTERNATIVE RESPONSESALTERNATIVE RESPONSES• Develop training courses or Internet modules
that show decision makers using cases how to translate CEA data and together with other variables make decisions
• Develop model procedure with steps decision makers can follow to synthesize, understand and use CEA and outcomes data to select drugs and devices
JPG 05/14/0561
ALTERNATIVE RESPONSESALTERNATIVE RESPONSES
• Start process by using focus groups of stakeholders to: Describe and discuss how they arrive at
formulary or drug product decisions Suggest programs and tools needed to
effectively use CEA and other variables to make decisions
Use later as advisory panel to provide feedback on prototype translating tools and procedures
JPG 05/14/0562
RECOMMENDATIONSRECOMMENDATIONS• Build a solid set of procedures and tools that equip decision
makers with the skills to use CEA and other variables to make decisions
• Use focus group to build and then evaluate the prototype procedures, tools and educational program for using CEA with other variables to make decisions
• Offer tested program of procedures and tools to decision makers• Once launched develop newsletter for users of ISPOR’s decision
making procedure and tools program that shares tips for better decision making
• Work with AARP and CU to implement patient based procedures and tools for using CEA and other data to make decisions
JPG 05/14/0563
JPG 05/14/0564
JPG 05/14/0565
SummarySummary•Described Mission and
Membership•Discussed Structure and
Activities•Presented Outcomes for 2005
JPG 05/14/0566
REACTION & REACTION & DISCUSSIONDISCUSSION
JPG 05/14/0567
Contact InformationContact Information
Jean Paul GagnonJean Paul [email protected] 800-648-9499 Ext 6379 [email protected] 800-648-9499 Ext 6379
sanofi-aventissanofi-aventis
JPG 05/14/0568