Availability, Affordability, Access, and Pricing of Anti-cancer Medicines in Low- and Middle-Income Countries: A Systematic Review of Literature

Mattila, Phyllis Ocran; Ahmad, Rabbiya; Hasan, Syed Shahzad; Babar, Zaheer‐Ud‐Din

doi:10.3389/fpubh.2021.628744

Cited by 63 publications

(48 citation statements)

References 27 publications

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“…The high cost of immunotherapies in anti-cancer treatment has been a long-term issue globally, also and particularly in low-and middle-income countries (27). To bring down prices and thus improved affordability of medicines, the Chinese government has overhauled its policy toolbox by promoting universal health insurance (28), expanding investment on biosimilar medicines (29), and conducting medical centralized volume procurement (30).…”

Section: Discussionmentioning

confidence: 99%

Economic Evaluation of First-Line Camrelizumab for Advanced Non-small-cell Lung Cancer in China

Xiang

Chen

et al. 2021

Front. Public Health

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Background: As the first domestic PD-1 antibody approved for lung cancer in China, camrelizumab has exhibited proven effectiveness for non-small-cell lung cancer (NSCLC) patients. However, the cost-effectiveness of this new regimen remains to be investigated.Objective: To evaluate the cost-effectiveness of camrelizumab combination therapy vs. chemotherapy for previously untreated patients with advanced, non-squamous NSCLC without Alk or Egfr genomic aberrations from the perspective of China's healthcare system.Methods: Based on the CameL trial, the study developed a three-health state Markov model to evaluate the cost-effectiveness of adding camrelizumab to chemotherapy compared to chemotherapy alone in NSCLC patients. The analysis models were conducted for patients unselected by PD-L1 tumor expression (the base case) and the patient subgroup with PD-L1-expressing tumors (≥1%). Primary model outcomes included the costs in US dollars and health outcomes in quality-adjusted life-years (QALYs) as well as the incremental cost-effectiveness ratio (ICER) under a willingness-to-pay threshold of $31,500 per QALY. Additionally, a scenario analysis that adjusted within-trial crossover was employed to evaluate camrelizumab combination therapy compared to chemotherapy without subsequent use of PD1/PD-L1 antibodies.Results: Camrelizumab combination therapy was more costly and provided additional 0.11 QALYs over chemotherapy in the base case analysis (0.86 vs. 0.75 QALYs), 0.12 QALYs over chemotherapy in the subgroup analysis (0.99 vs. 0.88 QALYs), and 0.34 QALYs over chemotherapy in the scenario analysis (0.86 vs. 0.52 QALYs). Correspondingly, the ICER was $63,080 per QALY, $46,311 per QALY, and $30,591 per QALY, in the base case, the subgroup, and the scenario analysis, respectively. One-way sensitivity analyses revealed that ICERs of the base case and the subgroup analysis were most sensitive to the cost of camrelizumab, the cost of pemetrexed. Besides, the base case and subgroup analysis were more sensitive to the risk of neutrophil count decreased in the camrelizumab and the utility of stable disease, respectively.Conclusion: Although camrelizumab combination therapy is not cost-effective as first-line therapy for NSCLC patients in China in the base case, adjusting within-trial crossover would move the treatment regimen toward cost-effectiveness in the scenario analysis.

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Section: Discussionmentioning

confidence: 99%

Economic Evaluation of First-Line Camrelizumab for Advanced Non-small-cell Lung Cancer in China

Xiang

Chen

et al. 2021

Front. Public Health

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“…Countries have also responded to its evolving normative value over time, with the inclusion of comparatively expensive and patented antiretroviral medicines in 2002 marking a pivotal moment in WHO EML’s history [ 1 ]. In recent years, the inclusion of high-priced medicines, such as for cancer and hepatitis C [ 16 , 53 ], have seen WHO’s Expert Committee on essential medicines using WHO EML proactively to promote greater affordability and access [ 54 ]. Attention has also focused on the functioning of WHO EML within the larger goal of health systems strengthening [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Finally, the review identified the relationship between revisions to NMLs and the use of HTAs to be underdeveloped. Since 2015, successive versions of WHO EML have seen additions of patented high-cost medicines [ 16 , 53 ]. These drugs have provoked the access to medicines debate in HICs and reinforced the idea that high-cost drugs are a challenge for all health systems, regardless of a country’s economic status [ 16 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

National adaptation and implementation of WHO Model List of Essential Medicines: A qualitative evidence synthesis

et al. 2022

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Background The World Health Organization Model List of Essential Medicines (WHO EML) has played a critical role in guiding the country-level selection and financing of medicines for more than 4 decades. It continues to be a relevant evidence-based policy that can support universal health coverage (UHC) and access to essential medicines. The objective of this review was to identify factors affecting adaptation and implementation of WHO EML at the national level. Methods and findings We conducted a qualitative evidence synthesis by searching 10 databases (including CINAHL, Embase, Ovid MEDLINE, Scopus, and Web of Science) through October 2021. Primary qualitative studies focused on country-level implementation of WHO EML were included. The qualitative findings were populated in the Specialist Unit for Review Evidence (SURE) checklist, and key themes were identified through an iterative process. We appraised the papers using the Critical Appraisal Skills Programme (CASP) tool and assessed our confidence in the findings using the Grading of Recommendations Assessment, Development and Evaluation working group-Confidence in Evidence from Reviews of Qualitative research (GRADE-CERQual). We screened 1,567 unique citations, reviewed 183 full texts, and included 23 studies, from 30 settings. Non-English studies and experiences and perceptions of stakeholders published in gray literature were not collected. Our findings centered around 3 main ideas pertaining to national adaptation and implementation of WHO EML: (1) the importance of designing institutions, governance, and leadership for national medicines lists (NMLs), particularly the consideration of transparency, coordination capacity, legislative mechanisms, managing regional differences, and clinical guidance; (2) the capacity to manage evidence to inform NML updates, including processes for contextualizing global evidence, utilizing local data and expert knowledge, and assessing budget impact, to which locally relevant cost-effectiveness information plays an important role; and (3) the influence of NML on purchasing and prescribing by altering provider incentives, through linkages to systems for financing and procurement and donor influence. Conclusions This qualitative evidence synthesis underscores the complexity and interdependencies inherent to implementation of WHO EML. To maximize the value of NMLs, greater investments should be made in processes and institutions that are needed to support various stages of the implementation pathway from global norms to adjusting prescribed behavior. Moreover, further research on linkages between NMLs, procurement, and the availability of medicines will provide additional insight into optimal NML implementation. Protocol registry PROSPERO CRD42018104112

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“…The high cost of ICIs has always been a hindrance to the use of immunotherapy worldwide, especially where health resources are lacking or are unevenly distributed ( 29 ). In the CheckMate9ER study, the combination of immunotherapy and targeted therapy resulted in sustained clinical benefits of improving the QOL of patients with RCC ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

Economic evaluation of first-line nivolumab plus cabozantinib for advanced renal cell carcinoma in China

Wang

et al. 2022

Front. Public Health

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BackgroundIn the Checkmate9ER trial, first-line treatment with nivolumab combined with cabozantinib (NI + CA) has shown efficacy for advanced renal cell carcinoma. This study aims to evaluate the impact of the health and economic outcomes of NI + CA in China.MethodsClinical efficacy data were derived from pivotal phase III CheckMate 9ER trial. A three-state partitioned survival model was established based on disease progression. Progression-free survival and overall survival of NI + CA vs. sunitinib were fitted with log-logistic and log-normal distributions, respectively. Mixture cure, non-mixture cure, and Royston/Parmar spline models were used to evaluate model robustness. The results derived the computational cost from the Chinese healthcare system perspective. The primary outcomes were quality-adjusted life-years (QALYs), total cost in US dollars, as well as incremental cost-effectiveness ratios (ICERs) at the willingness-to-pay threshold in China. One-way and probabilistic sensitivity analysis were also used to assess the robustness of the model.ResultsIn the base-case analysis result, 0.86 additional QALYs could be obtained in the NI+CA (3.84 QALYs) versus the sunitinib strategy (2.97 QALYs). The ICER of NI+CA compared with the sunitinib strategy was US$292,945 per QALY. The ICER value in the NI+CA strategy was higher than the Chinese willingness-to-pay threshold of US$38,024 per QALY. Although NI+CA can improve long-term patient survival significantly over sunitinib in the treatment of advanced renal cell carcinoma, it is unlikely to be cost-effective due to high cost. The results of the one-way sensitivity analysis showed that drug cost, health utility value at the stage of disease progression, and subsequent treatment proportion had a greater impact on the stability of ICER values.ConclusionsNivolumab combined with cabozantinib can prolong the life of patients with advanced renal cell carcinoma and improve their quality of life, but there is a corresponding increase in medical cost. The NI + CA strategy is unlikely to be considered cost-effective in the treatment of advanced RCC from the perspective of Chinese healthcare system.

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Availability, Affordability, Access, and Pricing of Anti-cancer Medicines in Low- and Middle-Income Countries: A Systematic Review of Literature

Cited by 63 publications

References 27 publications

Economic Evaluation of First-Line Camrelizumab for Advanced Non-small-cell Lung Cancer in China

Economic Evaluation of First-Line Camrelizumab for Advanced Non-small-cell Lung Cancer in China

National adaptation and implementation of WHO Model List of Essential Medicines: A qualitative evidence synthesis

Economic evaluation of first-line nivolumab plus cabozantinib for advanced renal cell carcinoma in China

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