Inferior progression-free survival for Thai patients with diffuse large B-cell lymphoma treated under Universal Coverage Scheme: the impact of rituximab inaccessability

Abstract

The impact of health insurance with inequitable rituximab coverage on the survival of patients with diffuse large B-cell lymphoma (DLBCL) has never been reported. We conducted a nationwide multicenter analysis on the outcome of 553 adult patients consecutively diagnosed with DLBCL between July 2003 and June 2006, in whom treatment cost was reimbursed under the Civil Servant Medical Benefit Scheme (CSMBS) (n =201) or the Universal Coverage Scheme (UCS) (n =352). The international prognostic index was comparable between the two payment groups. Rituximab-based therapy was administered in 45.3% and 3.1% of CSMBS and UCS patients, respectively (p <0.001). With a median follow-up of 24.6 months, the 6-year progression-free survival (PFS) was superior for CSMBS patients (34.2 vs. 23.2%, p =0.005). "Not treated with rituximab-based therapy" was the strongest adverse prognostic feature indicating a short PFS (hazard ratio 2.1, p <0.001). It is concluded that lack of access to rituximab is the principal factor accounting for the inferior PFS observed in Thai patients with DLBCL who are treated under the UCS.

Impact of Inadequate Doses of Rituximab in the Treatment of Diffuse Large B Cell Lymphoma in Malaysian Patients

“…The Asian population of this study was mainly from Japan, Korea and China. There is not many published data in South East Asia (SEA) region where the populations are generally more heterogenous and resources are often limited in certain countries within SEA region (Intragumthornchai et al, 2013). This study demonstrated that OR and CR rates were comparable to other studies, 88% and 73% respectively.…”

“…However, within the Asian countries, there are many which have limited health care resources in treating patients with lymphoma. There is limited published data on the survival of patients with DLBCL in these developing countries except for one report from Thailand where inferior progression free survival is documented when patients are not treated with rituximab (Intragumthornchai et al, 2013).…”

Sales of anti-cancer medicines; China, Indonesia, Kazakhstan, Malaysia, Philippines and Thailand

“…22 Disparities in survival were also found for lymphoma patients, and mainly attributed to limited access to rituximab for UHC-insured patients at the time of the study (2003–2006). 23 Two studies from China on patterns of prescribing for patients with breast cancer highlighted limited access to trastuzumab for patients overexpressing human epidermal growth factor receptor 2 (HER-2). 18 , 20 One of these two multicentre studies found that, between 2011 and 2014, only 31 (28.4%) of 109 patients overexpressing HER-2 were treated with trastuzumab.…”

“… 9 , 10 Multicountry studies on access to anti-cancer medicines in low- and middle-income countries have used the inclusion of medicines in national essential medicines or reimbursement lists and formularies 2 – 6 , 11 and their availability on the market and applicable copayments 11 as proximate indicators of access. Country-level studies have used national essential medicines lists and formularies, 12 , 13 sales data, 14 – 16 surveys 17 and patient-level data from medical records 18 – 23 to assess access to anti-cancer medicines in low- and middle-income countries. However, to our knowledge, few of the existing studies 15 or official statistics 24 have assessed the changes in use of anti-cancer medicines during the past decade of coverage expansion in low- and middle-income countries.…”

Characteristics, treatment patterns, prognostic determinants and outcome of peripheral T cell lymphoma and natural killer/T cell non-Hodgkin Lymphoma in older patients: The result of the nationwide multi-institutional registry Thai Lymphoma Study Group

“…Thai lymphoma study group (TLSG) is a multi-institutional collaborative panel of hematologists and hemato-pathologists from 13 major medical centers in Thailand. The detailed information of TLSG was described previously elsewhere [9,10]. The registry prospectively included newly diagnosed lymphoma patients aged older than 15 years old from all participating centers since September 2006.…”