Assessing the prices and affordability of oncology medicines for three common cancers within the private sector of South Africa

Mattila, Phyllis Ocran; Babar, Zaheer‐Ud‐Din; Suleman, Fátima

doi:10.1186/s12913-021-06627-6

Cited by 18 publications

(21 citation statements)

References 21 publications

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“…Our findings on the high costs of reaching a diagnosis complement qualitative evidence from elsewhere in the region on OOP costs of accessing cancer care [ 36 – 39 ]. We add sharper evidence on the highly regressive impact of the OOP spending, including examples of impoverishment through sale of assets, and the impact of delays on costs, self-referral and travel in search of care.…”

Section: Discussionsupporting

confidence: 71%

Patients’ pathways to cancer care in Tanzania: documenting and addressing social inequalities in reaching a cancer diagnosis

Makene

Ngilangwa

Santos

et al. 2022

BMC Health Serv Res

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Background This article investigates the extent and sources of late diagnosis of cancer in Tanzania, demonstrating how delayed diagnosis was patterned by inequities rooted in patients’ socio-economic background and by health system responses. It provides evidence to guide equity-focused policies to accelerate cancer diagnosis. Methods Tanzanian cancer patients (62) were interviewed in 2019. Using a structured questionnaire, respondents were encouraged to recount their pathways from first symptoms to diagnosis, treatment, and in some cases check-ups as survivors. Patients described their recalled sequence of events and actions, including dates, experiences and expenditures at each event. Socio-demographic data were also collected, alongside patients’ perspectives on their experience. Analysis employed descriptive statistics and qualitative thematic analysis. Results Median delay, between first symptoms that were later identified as indicating cancer and a cancer diagnosis, was almost 1 year (358 days). Delays were strongly patterned by socio-economic disadvantage: those with low education, low income and non-professional occupations experienced longer delays before diagnosis. Health system experiences contributed to these socially inequitable delays. Many patients had moved around the health system extensively, mainly through self-referral as symptoms worsened. This “churning” required out-of-pocket payments that imposed a severely regressive burden on these largely low-income patients. Causes of delay identified in patients’ narratives included slow recognition of symptoms by facilities, delays in diagnostic testing, delays while raising funds, and recourse to traditional healing often in response to health system barriers. Patients with higher incomes and holding health insurance that facilitated access to the private sector had moved more rapidly to diagnosis at lower out-of-pocket cost. Conclusions Late diagnosis is a root cause, in Tanzania as in many low- and middle-income countries, of cancer treatment starting at advanced stages, undermining treatment efficacy and survival rates. While Tanzania’s policy of free public sector cancer treatment has made it accessible to patients on low incomes and without insurance, reaching a diagnosis is shown to have been for these respondents slower and more expensive the greater their socio-economic disadvantage. Policy implications are drawn for moving towards greater social justice in access to cancer care.

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Section: Discussionsupporting

confidence: 71%

Patients’ pathways to cancer care in Tanzania: documenting and addressing social inequalities in reaching a cancer diagnosis

Makene

Ngilangwa

Santos

et al. 2022

BMC Health Serv Res

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“…However, the prices of a number of standard oncology treatments are decreasing with the increasing availability of lower-cost oral generics and biosimilars [ 42 , 44 – 46 ]. We are also aware of considerable price differences for oncology medicines in the private sector in South Africa, which may further impact the availability of certain brands even though they are licensed [ 47 ]. The increasing unaffordability of oncology medicines could contribute to their lower than expected utilisation in the private sector.…”

Section: Discussionmentioning

confidence: 99%

Trends in the utilization of medicines sold in the private sector post- registration in South Africa and the implications for similar countries

et al. 2023

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Background Regulatory authorities register medicines for patients to access them within a reasonable period of time. There is a paucity of available data regarding the extent to which registered medicines reach the public after market authorisation is granted by the South African Health Products Regulatory Authority (SAHPRA). This is important since time spent by SAHPRA assessing medicines that are subsequently not launched onto the South African market means time wasted, which could be spent on assessing new medicines that address an unmet need in the country. Consequently, we initially analysed the time taken for registered medicines to reach patients and the relationship between medicines registered at SAHPRA and those subsequently dispensed in private pharmacies. The extent of registration of multiple sourced versus new patented medicines was also explored. Methods A retrospective, descriptive and quantitative investigation was conducted for medicines registered between 2014 and 2019. Registered and dispensed medicines were compared to establish accessibility post registration. Data sources included SAHPRA and IQVIA datasets. Microsoft Excel and SAS were used for data storage, analysis, and computation of descriptive statistical analysis. Results Of (N = 2175) registered medicines, only 358 (16.5%; 95% CI 15.0%—18.1%) were dispensed to patients, and out of 1735 medicines registered between 2015 and 2019, only 57 (3.3%; 95% CI 2.5%—4.2%) were dispensed during the study period. Medicines acting on the central nervous system were registered and dispensed the most at 21.0% and 18.0%, respectively, whereas antineoplastic and immunomodulation agents were registered and dispensed only 11% and 5%, respectively. A concern was that only 13.0% of registered medicines were originators, with most either as generics, including branded generics, or pseudo-generics. Conclusion Regulatory measures should be implemented to ensure increased medicine access post-registration for new originators, especially for priority disease areas that benefit patients. Mental health diseases and improved access to oncology medicines require special attention and further investigation in South Africa.

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“…However, the prices of a number of standard oncology treatments are decreasing with the increasing availability of lower-cost oral generics and biosimilars [42,44,46]. We are also aware of considerable price differences for oncology medicines in the private sector in South Africa, which may further impact the availability of certain brands even though they are licensed [47]. The increasing unaffordability of oncology medicines could contribute to their lower than expected utilisation in the private sector.…”

Section: Discussionmentioning

confidence: 99%

Trends in the Utilization of Medicines Sold in the Private Sector Post- Registration in South Africa and the Implications for Similar Countries

Mpanza

Godman

Keele

et al. 2022

Preprint

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Background: Regulatory authorities register medicines for patients to access within a reasonable time. There is a paucity of available data regarding the extent to which registered medicines reach the public after market authorisation by the South African Health Products Regulatory Authority (SAHPRA). This is important since time spent by SAHPRA assessing medicines that are subsequently not launched onto the South African market means time wasted, which could be spent on assessing new medicines that address an unmet need in the country. Consequently, we initially analysed the time taken for registered medicines to reach patients and the relationship between medicines registered at SAHPRA and those subsequently dispensed in private pharmacies. The extent of registration of multiple sourced versus new patented medicines was also explored. Methods: A retrospective, descriptive and quantitative investigation was conducted for medicines registered between 2014 -2019. Registered and dispensed medicines were compared to establish accessibility post registration. Data sources included SAHPRA and IQVIA datasets. Microsoft Excel and SAS (SAS Institute Inc, Carey, NC, USA), Release 9.4.was used for data storage, analysis, and computation of descriptive statistical analysis. Results: Of (N=2175) registered medicines, only 358 (16.5%; 95% CI 15.0% - 18.1%)were dispensed to patients, andout of 1735 medicines registered during 2015 – 2019 only 57 (3.3%; 95% CI 2.5% - 4.2%) were dispensed during the study period. Medicines acting on the central nervous system were registered and dispensed the most at 21.0% and 18.0%, respectively, whereas antineoplastic, and immunomodulation agents were registered and dispensed at only 11% and 5%, respectively. A concern was that only 13.0% of registered medicines were originators, with most either as generics, including branded generics, or pseudo-generics. Conclusion: Regulatory measures should be implemented to ensure increased medicine access post-registration for new originators, especially for priority disease areas that benefit patients. Mental health diseases and improved access to oncology medicines require special attention and further investigation in South Africa.

show abstract

Assessing the prices and affordability of oncology medicines for three common cancers within the private sector of South Africa

Cited by 18 publications

References 21 publications

Patients’ pathways to cancer care in Tanzania: documenting and addressing social inequalities in reaching a cancer diagnosis

Patients’ pathways to cancer care in Tanzania: documenting and addressing social inequalities in reaching a cancer diagnosis

Trends in the utilization of medicines sold in the private sector post- registration in South Africa and the implications for similar countries

Trends in the Utilization of Medicines Sold in the Private Sector Post- Registration in South Africa and the Implications for Similar Countries

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