Selection of oncology medicines in low- and middle-income countries

Bazargani, Y. T.; Boer, A. de; Schellens, J. H. M.; Leufkens, H.G.M.; Mantel‐Teeuwisse, Aukje K.

doi:10.1093/annonc/mdt514

Cited by 32 publications

(36 citation statements)

References 14 publications

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“…Secondly, the NEML has been including targeted drugs as part of the therapeutic options available in the public sector since 2004, when trastuzumab, rituximab and imatinib were selected for the first time. This contrasts favourably with the situation in many other low‐ and middle‐income countries were oncologic drugs and more specifically targeted drugs are often not included on national lists of essential medicines . Thirdly, selection and use of targeted drugs has not been complemented with any national policy guiding coverage decisions.…”

Section: Discussionmentioning

confidence: 93%

“…middle-income countries were oncologic drugs and more specifically targeted drugs are often not included on national lists of essential medicines. [29] Thirdly, selection and use of targeted drugs has not been complemented with any national policy guiding coverage decisions. In other words, once a cancer patient reaches the system, there is no guidance on when to start an oncologic treatment, which drug(s) must be used first or when to stop active treatments.…”

Section: Discussionmentioning

confidence: 99%

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Sharp rise in the expenditures of targeted drugs in Ecuador: five-year (2010-2014) consumption of oncologic drugs in public and private hospitals

Durán

Elseviers

Stichele

et al. 2018

J Pharm Health Serv Res

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Objective In Ecuador, a new constitutional mandate (2008) allowed the government to implement free universal access to health care, including oncologic drugs. As most Latin American countries, Ecuadorian healthcare system is fragmented between public and private providers, posing a special challenge to collect valid drug utilization data. Data from the public and the private healthcare sectors were collected to examine the utilization of oncologic drugs in Ecuador over a 5‐year period (2010–2014). Methods Oncologic drugs were extracted from individual dispensing data collected in the six largest Ecuadorian cancer hospitals. Drug utilization indicators include the yearly proportion of patients using selected therapeutic groups (targeted drugs, chemotherapy and hormonal drugs), and the mean and total expenditures, by healthcare sector. Key findings Total number of patients ranged from 12 060 in 2010 to 12 769 in 2014. Median age was 56 years; 60.3% were women. Twenty‐three drugs were classified as targeted (monoclonal antibodies, protein kinase inhibitor, vismodegib, vorinostat and abiraterone), 43 as chemotherapy and 11 as hormonal. Patients using chemotherapy decreased from 56% to 52%. Proportion of patients using chemotherapy drugs was 30% lower in the public than in the private sector. Total expenditures on cancer drugs showed a constant increase from USD 17 912 865 in 2010 to USD 40 514 947 in 2014. Patients using targeted drugs doubled from 8% to 14% in 5 years. Targeted drugs accounted for 76% of total expenditures in 2014. Conclusion Although only a small, but increasing proportion of patients used targeted drugs, it leads to a sharp rise in expenditures. In 2014, it represented three‐quarters of the total oncologic drugs expenditures. Differences in chemotherapy consumption between public and private sectors could reflect difficulties in public procurement, shortages and a faster, poorly controlled adoption of new drugs. If unmanaged, this is a possible threat to the health budget in the coming years.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Sharp rise in the expenditures of targeted drugs in Ecuador: five-year (2010-2014) consumption of oncologic drugs in public and private hospitals

Durán

Elseviers

Stichele

et al. 2018

J Pharm Health Serv Res

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“…[17] There was overall a statistically significant correlation between the listing of antineoplastic drugs and GNI per capita, as hypothesized, consistent with the findings of Bazargani et al on a selection of essential antineoplastic drugs in NEMLs from 76 countries. [18] However, the correlation with AGHE per capita was approximately zero. This is exemplified by Myanmar that, in an undated list, included all but Cytarabine 65 Cisplatin 73 Busulfan 42 Dactinomycin 50 Dacarbazine 54 Imatinib 28 Daunorubicin 41 Etoposide 62 Irinotecan 30 Doxorubicin 73 Hydroxyurea 64 Melphalan 48 Mercaptopurine 64 Ifosfamide 44 Topotecan 12 Methotrexate 95 Vinblastine 62 Vinorelbine 28 Thioguanine 27 Vincristine 82 one of the SIOP essential drugs yet had an AGHE per capita of US $4.7, calling into question the reality of access to drugs in that country, at least in the public sector.…”

Section: Discussionmentioning

confidence: 93%

“…[15] In the 47 Member States of the WHO African Region, the average density of physicians was about fivefold lower than the global average. [19] Bazargani et al [18] observed an association between the number and diversity of antineoplastic agents and the cancer burden in the countries that they studied, but noted also "Surprisingly, categories of antineoplastic agents frequently used as routine chemotherapy agents were not found among essential medicines in a notable fraction of all studied countries. This category includes medicines which have extensive indications in various types of malignancy."…”

Section: Discussionmentioning

confidence: 99%

Access to Cytotoxic Medicines by Children With Cancer: A Focus on Low and Middle Income Countries

Barr

Robertson

2015

Pediatric Blood & Cancer

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Background The Essential Medicines Working Group of the International Society of Pediatric Oncology (SIOP) has proposed a list of antineoplastic drugs that should be available in low and middle income countries. Procedure Data were extracted on the listing of 18 essential and 8 ancillary antineoplastic medicines in the national essential medicines lists (NEMLs) or national reimbursable medicines lists (NRMLs) of 135 countries with gross national income (GNI) per capita of less than US $25,000. Correlations between numbers of medicines listed and GNI per capita, annual government health expenditure (AGHE) per capita, and the number of physicians per million people were examined. Results Listing of the 18 essential antineoplastic drugs ranged from 27% (thioguanine) to 95% (methotrexate). The median number of medicines listed was 7 (0–18) in low income countries (n = 26) and 14 in lower‐middle (n = 42), upper‐middle (n = 44), and high income countries (n = 20). For the ancillary eight medicines, the median was one (0–8) across the 135 countries. Correlations with GNI per capita (r = 0.17, P = 0.0266) and physician density (r = 0.25, P = 0.0017) were statistically significant; not so for AGHE per capita (r = 0.00, P = 0.5000). Conclusions There was large variability within income groups in numbers of antineoplastic agents identified as essential in NEMLs and NRMLs. While not a direct measure of availability, listing is an important step, guiding procurement for the public sector. These results focus attention on deficits in NEMLs and NMRLs as a step to improving access to effective antineoplastic medicines for cancers in children in low and middle income countries. Pediatr Blood Cancer © 2015 Wiley Periodicals, Inc.

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“…3,4 Usually, newer technologies such as oral antineoplastics put pressure on health care budgets and are incorporated infrequently by health systems in middle-income countries because of their added direct cost. 5 …”

Section: Introductionmentioning

confidence: 99%

Increasing Access to Oral Anticancer Medicines in Middle-Income Countries: A Case Study of Private Health Insurance Coverage in Brazil

Fonseca

Bastos

Lopes

2016

JGO

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The World Health Organization estimates that approximately 60% of the world’s new annual cancer cases occur in Asia, Africa, and Central and South America, and that 70% of cancer deaths occur in these regions. Although oral chemotherapy is a promising intervention for cancer treatment, given its high cost, it is usually unavailable in middle-income countries. In 2013, after strong lobbying from civil society, Brazil's Congress passed legislation mandating that all private health insurance companies provide access to oral antineoplastic treatment. The decision to scale up the provision of oral chemotherapy was a watershed event in the regulation of private health insurance in Brazil. Until then, private insurers, which cover 25% of the population, were exempted from the provision of pharmaceutical drugs for home care treatments. This article explores the political process involved in regulating the provision of oral chemotherapy medicines by private health insurers. Elements of this successful advocacy case included investment in strategic communication, specialized knowledge of regulatory policy, and the ability to act via democratic channels of political representation. In turn, the receptiveness of government branches such as the Congress and regulating bodies, as well as the Cancer Awareness Month campaign, opened a window of opportunity. However, prospects for expanded access to such medicines in the public health system are bleak in the short term because of the ongoing political and economic crisis.

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Selection of oncology medicines in low- and middle-income countries

Cited by 32 publications

References 14 publications

Sharp rise in the expenditures of targeted drugs in Ecuador: five-year (2010-2014) consumption of oncologic drugs in public and private hospitals

Sharp rise in the expenditures of targeted drugs in Ecuador: five-year (2010-2014) consumption of oncologic drugs in public and private hospitals

Access to Cytotoxic Medicines by Children With Cancer: A Focus on Low and Middle Income Countries

Increasing Access to Oral Anticancer Medicines in Middle-Income Countries: A Case Study of Private Health Insurance Coverage in Brazil

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