Are essential medicines available, reliable and affordable in low-middle income countries?

Eden, Tim; Burns, Elizabeth; Freccero, Piera; Renner, Lorna; Paintsil, Vivian; Dolendo, Mae; Scanlan, Trisha; Khaing, Aye Aye; Piña, Martha Zentella de; Islam, Asma; Chunda‐Liyoka, Catherine; Kouya, Francine; Molyneux, Elizabeth

doi:10.1016/j.jcpo.2018.12.001

Cited by 17 publications

(21 citation statements)

References 29 publications

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“…However, paediatric cancer survival rates in LMICs range from 10% to 50% 11. Reasons for this survival gap include delayed presentation, lack of efficient referral pathways, treatment abandonment, increased treatment toxicities, and poor access to chemotherapy 4 11 12. A recent survey of lead clinicians from nine LMICs noted poor access to chemotherapy for leukaemias, lymphomas, Wilms tumour and retinoblastoma 12.…”

Section: Introductionmentioning

confidence: 99%

“…Reasons for this survival gap include delayed presentation, lack of efficient referral pathways, treatment abandonment, increased treatment toxicities, and poor access to chemotherapy 4 11 12. A recent survey of lead clinicians from nine LMICs noted poor access to chemotherapy for leukaemias, lymphomas, Wilms tumour and retinoblastoma 12. In addition to medical treatments, over 90% of the population of low-income countries (LICs) lack access to radiation therapy 13.…”

Section: Introductionmentioning

confidence: 99%

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Cost and cost-effectiveness of childhood cancer treatment in low-income and middle-income countries: a systematic review

et al. 2019

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IntroductionA major barrier to improving childhood cancer survival is the perception that paediatric oncology services are too costly for low-income and middle-income country (LMIC) health systems. We conducted a systematic review to synthesise existing evidence on the costs and cost-effectiveness of treating childhood cancers in LMICs.MethodsWe searched multiple databases from their inception to March 2019. All studies reporting costs or cost-effectiveness of treating any childhood cancer in an LMIC were included. We appraised included articles using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Where possible, we extracted or calculated the cost per disability-adjusted life year (DALY) averted using reported survival and country-specific life expectancy. Cost/DALY averted was compared with per capita gross domestic product (GDP) as per WHO-Choosing Interventions that are Cost-Effective guidelines to determine cost-effectiveness.ResultsOf 2802 studies identified, 30 met inclusion criteria. Studies represented 22 countries and nine different malignancies. The most commonly studied cancers were acute lymphoblastic leukaemia (n=10), Burkitt lymphoma (n=4) and Wilms tumour (n=3). The median CHEERS checklist score was 18 of 24. Many studies omitted key cost inputs. Notably, only 11 studies included healthcare worker salaries. Cost/DALY averted was extracted or calculated for 12 studies and ranged from US$22 to US$4475, although the lower-end costs were primarily from studies that omitted key cost components. In all 12, cost/DALY averted through treatment was substantially less than country per capita GDP, and therefore considered very cost-effective.ConclusionMany included studies did not account for key cost inputs, thus underestimating true treatment costs. Costs/DALY averted were nonetheless substantially lower than per capita GDP, suggesting that even if all relevant inputs are included, LMIC childhood cancer treatment is consistently very cost-effective. While additional rigorous economic evaluations are required, our results can inform the development of LMIC national childhood cancer strategies.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cost and cost-effectiveness of childhood cancer treatment in low-income and middle-income countries: a systematic review

et al. 2019

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“…As a result, health professionals may not return home, creating a “brain drain” that damages the LMIC center (G. Chantada personal communication 5 May 2020). Regional training, such as fellowship programs in UNOP Guatemala serving candidates from Latin America, the National University Hospital Singapore, serving South East Asia, or the Red Cross Children's Hospital in Cape Town serving Africa, are of much greater value and can even cover specialized needs, such as bone marrow transplantation or neuro‐oncology 17,18 . Web‐based tumor boards 19 and adapted protocols also benefit patient care in the LMICs 20 …”

Section: Physician Educationmentioning

confidence: 99%

The role of twinning in sustainable care for children with cancer: A TIPPing point? SIOP PODC Working Group on Twinning, Collaboration, and Support

Kanwar

Schwartz

Salifu

et al. 2020

Pediatric Blood & Cancer

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With the World Health Organization (WHO) Global Initiative for Childhood Cancer, there is renewed interest in sustainable interventions to improve childhood cancer care in low-/middle-income countries (LMICs). Practitioners in LMICs have traditionally practiced "twinning," i.e., targeted international pediatric oncology partnerships (TIPPs) between one or more institutions in a high-income country (HIC) and an LMIC, to improve care for children with cancer in the latter. The International Society of Paediatric Oncology Committee for Paediatric Oncology in Developing Countries Working Group on Twinning, Collaboration, and Support reviewed guidelines from https: //cancerpointe.com and the current literature, gathered input from practitioners in LMICs, and in this article discuss the role of TIPPs in the WHO initiative.

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“…They stated that the treatment of CVDs with 21 selected lowest-price generic equivalent medicines was generally affordable, but the poorest households in Iran would be at risk of pushing under the poverty line because of the price of these CVD medicines [40,41]. Due to this fact that the CVD patients can still encounter a considerable expense, particularly with regards to multi-drug utilization [39,42], there is an interest to evaluate the impacts of health costs on households with the specific consideration of CVDs by multinational studies or single countries studies [38,[43][44][45][46][47][48][49][50][51][52][53][54].…”

Section: The Rationale Of the Studymentioning

confidence: 99%

Affordability Assessment from a Static to Dynamic Concept: A Scenario-Based Assessment of Cardiovascular Medicines

Zarei

Karimzadeh

Moradi

et al. 2020

IJERPH

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The out-of-pocket payments for prescription medications can impose a financial burden on patients from low- and middle- incomes and who suffer from chronic diseases. The present study aims at evaluating the affordability of cardiovascular disease (CVD) medication in Iran. This includes measuring affordability through World Health Organization/Health Action International (WHO/HAI) methodology. In this method, affordability is characterized as the number of days’ wages of the lowest-paid unskilled government worker. The different medication therapy scenarios are defined in mono-and combination therapy approaches. This method adds on to WHO/HAI methodology to discover new approaches to affordability assessments. The results show the differences in the medicines affordability when different approaches are used in mono-and combination therapy between 6 main sub-therapeutic groups of CVD. It indicates the medicine affordability is not a static concept and it changes dynamically between CVD therapeutic subgroups when it used alone or in combination with other medicines regarding patients’ characteristics and medical conditions. Hypertension and anti-arrhythmia therapeutic groups had the most non-affordability and hyperlipidemia had the most affordable medicines. Therefore, affordability can be considered as a dynamic concept, which not only affected by the medicine price but significantly affected by a patient’s characteristics, the number of medical conditions, and insurance coverage.

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Are essential medicines available, reliable and affordable in low-middle income countries?

Cited by 17 publications

References 29 publications

Cost and cost-effectiveness of childhood cancer treatment in low-income and middle-income countries: a systematic review

Cost and cost-effectiveness of childhood cancer treatment in low-income and middle-income countries: a systematic review

The role of twinning in sustainable care for children with cancer: A TIPPing point? SIOP PODC Working Group on Twinning, Collaboration, and Support

Affordability Assessment from a Static to Dynamic Concept: A Scenario-Based Assessment of Cardiovascular Medicines

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