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in Europe each country has his own system for reimbursement and pricing of new agent and the system depends on the GDP of the country of the healthcare system and of course of the healthcare priorities so we are not speaking of the process of market access we are just speaking of the evaluation how can we assess the interest value of a new agent and of course each countrys as is own solution depending on these own resources but there are two main system the first one in based on clinical evaluation alone especially in Germany you compare a new agent to the existing drug and you define the added value and then there is a discussion with the pharmaceutical company to find the fair price on the other hand there are countries in which the assessment in base on health economic evaluation and especially on cost utility ratio this is usually a different ratio between the incremental cost and the incremental benefits and its in euro or pound per quali quali is a quality adjusted life here so
