Chemotherapy Affordability on Basic and Enhanced Therapy Levels in Kyrgyzstan and Tajikistan

Abstract

Purpose Kyrgyzstan and Tajikistan are Central Asian low-income countries. Breast cancer is the most common cancer in the Kyrgyz Republic and in Tajikistan. Almost 40% of breast cancer cases are detected in advanced stages. The Kyrgyzstan and Tajikistan health care systems do not guarantee equal access to treatment to all people, and patients with breast cancer have to pay out of pocket for the entire course of chemotherapy treatment. Therefore, evaluation of the cost of a chemotherapy regimen represents a first step in the policy discussion and the creation of a government copayment system that would guarantee access to chemotherapy and ensure the effective and sustainable basic-level treatment of most patients. Methods Resource and Policy Exchange, Tajik, and Kyrgyz experts calculated the average drug dose per patient for adriamycin and cyclophosphamide; cyclophosphamide, methotrexate, and fluorouracil; and fluorouracil, adriamycin, and cyclophosphamide regimens recommended by the Breast Health Global Initiative as basic-level therapy and the taxanes average dose—docetaxel and paclitaxel—as enhanced-level therapy. The drug procurement cost per cycle was calculated for each chemotherapy regimen on the basis of on an average dose per patient (standard 1.75 m2), the average number of doses per cycle, and the average list price per milligram. Experts acquired cancer drug price lists from different pharmacies using the lowest generic prices available in Kyrgyzstan and Tajikistan. Results The cost of the basic chemotherapy regimen adriamycin and cyclophosphamide is $249 USD in Kyrgyzstan and $222 USD in Tajikistan. That of the cyclophosphamide, methotrexate, and fluorouracil regimen is $587 USD in Kyrgyzstan and $486 USD in Tajikistan. That of the fluorouracil, adriamycin, and cyclophosphamide regimen is $326 USD in Tajikistan and $526 USD in Kyrgyzstan. However, the cost of the taxanes regimen—enhanced level—is more expensive. The cost of a paclitaxel monotherapy regimen is $4896 USD in Kyrgyzstan and $4,695 USD in Tajikistan, and that of a docetaxel monotherapy regimen $1,411 USD in Kyrgyzstan and $1,086 USD in Tajikistan. Conclusion Chemotherapy regimen cost calculation is an integral part of advocacy and policy work. It helped to negotiate basic-level chemotherapy treatment insurance coverage for women with breast cancer. The cost of a monotherapy taxanes regimen is expensive and requires additional financial resources. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.