The high cost of prescription drugs: causes and solutions

Rajkumar, S. Vincent

doi:10.1038/s41408-020-0338-x

Cited by 82 publications

(54 citation statements)

References 8 publications

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“…Moreover, with the recent approvals of cabozantinib and atezolizumab‐bevacizumab in treatment‐refractory and unresectable HCC, 13–15 better systemic therapy should positively impact SNH patients where metastatic disease is more prevalent. However, prohibitive new drug costs coupled with financial limitations associated with SNHs reimbursement could drive the increased utilization of these new therapies at AMCs but not SNHs, 16,17 further widening the treatment chasm.…”

Section: Discussionmentioning

confidence: 99%

Surgical resection of early stage hepatocellular carcinoma improves patient survival at safety net hospitals

Vitiello

Wang

Lee

et al. 2021

Journal of Surgical Oncology

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Background and Objectives Surgical resection is indicated for hepatocellular carcinoma (HCC) patients with Child A cirrhosis. We hypothesize that surgical intervention and survival are limited by advanced HCC presentation at safety net hospitals (SNHs) versus academic medical centers (AMCs). Methods Patients with HCC and Child A cirrhosis in the US Safety Net Collaborative (2012–2014) were evaluated. Demographics, clinicopathologic features, operative characteristics, and outcomes were compared between SNHs and AMCs. Liver transplantation was excluded. Kaplan–Meier and Cox proportional‐hazards models were used to identify the effect of surgery on overall (OS). Results A total of 689 Child A patients with HCC were identified. SNH patients frequently presented with T3/T4 stage (35% vs. 24%) and metastases (17% vs. 8%; p < .05). SNH patients were as likely to undergo surgery as AMC patients (17% vs. 18%); however, SNH patients were younger (56 vs. 64 years), underwent minor hepatectomy (65% vs. 38%), and frequently harbored well‐differentiated tumors (23% vs. 2%; p < .05). On multivariate analysis, surgical resection and stage, but not hospital type, were associated with improved OS. Conclusions Although SNH patients present with advanced HCC, survival outcomes for early stage HCC are similar at SNHs and AMCs. Identifying barriers to early diagnosis at SNH may increase surgical candidacy and improve outcomes.

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Section: Discussionmentioning

confidence: 99%

Surgical resection of early stage hepatocellular carcinoma improves patient survival at safety net hospitals

Vitiello

Wang

Lee

et al. 2021

Journal of Surgical Oncology

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“…Most clinical trials fail [ 294 , 295 , 296 ]; these failures result from a number of factors including deficient clinical trial design, poor proof of concept planning and insufficient administrative support and compliance [ 297 , 298 , 299 , 300 ]. Such failures have adverse consequences for both the clinical trial sponsors as well as the patients; failure has significant economic cost and results in lost therapeutic opportunity, in addition to potentially exposing the patient to harm from the investigational protocol and drugs [ 301 , 302 , 303 ]. These clinical trial-related matters may be more acute at CHCs given their more limited resources and the absence of experienced clinical trialists [ 304 , 305 , 306 , 307 ].…”

Section: The Community Oncology/academic Cancer Center Alliance Inmentioning

confidence: 99%

The Community Oncology and Academic Medical Center Alliance in the Age of Precision Medicine: Cancer Genetics and Genomics Considerations

Melas

Subbiah

Saadat

et al. 2020

JCM

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Recent public policy, governmental regulatory and economic trends have motivated the establishment and deepening of community health and academic medical center alliances. Accordingly, community oncology practices now deliver a significant portion of their oncology care in association with academic cancer centers. In the age of precision medicine, this alliance has acquired critical importance; novel advances in nucleic acid sequencing, the generation and analysis of immense data sets, the changing clinical landscape of hereditary cancer predisposition and ongoing discovery of novel, targeted therapies challenge community-based oncologists to deliver molecularly-informed health care. The active engagement of community oncology practices with academic partners helps with meeting these challenges; community/academic alliances result in improved cancer patient care and provider efficacy. Here, we review the community oncology and academic medical center alliance. We examine how practitioners may leverage academic center precision medicine-based cancer genetics and genomics programs to advance their patients’ needs. We highlight a number of project initiatives at the City of Hope Comprehensive Cancer Center that seek to optimize community oncology and academic cancer center precision medicine interactions.

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“…Generic medicines and the biosimilars that enter the system later can help to reduce the cost of the drugs for the consumer. 23 , 24 The Drug Price Competition and Patent Term Restoration Act (Hatch-Waxman Act, 1984) has led to accelerated methods for approving generic drugs. 25 However, in some cases, prices for cancer drugs are kept high by pharmaceutical company lobbying, which can also potentially delay the entry of generics into the market.…”

Section: Drug Pricing In the United Statesmentioning

confidence: 99%

Comparison of Access to Novel Drugs for Lymphoma and Chronic Lymphocytic Leukemia Between India and the United States

Sathyanarayanan

Flowers

Iyer

2020

JCO Global Oncology

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This review will compare and contrast the costs and access to novel drugs for treating chronic lymphocytic leukemia (CLL) and lymphoma in the United States and India during the last 5 years. Clinical outcomes for patients with hematologic malignancies have improved significantly since the approval of immunotherapeutic and targeted therapies. These new treatments have had an impact on overall outcomes and have helped determine the design for translational research and future trials. Although most of these novel drugs called “innovators” are initially approved and marketed in the United States, several have also become available in countries such as India. With the expiration of patents, generic versions of innovator drugs have increased and accessibility has improved for patients. The advent of biosimilars is another route for expanding access to biologic compounds. As a result, the development costs for developing these drugs are lower, and consequently, the costs for the patient are often lower. Although the delivery of cancer care is not the same in India as it is in the United States, the introduction of biosimilars and generics has helped bridge the gap. This has made treatment of CLL and lymphoma similar in both countries and has had the same impact on patient outcomes and quality of life. Compulsory licensing for essential medications, as stipulated by the Doha Declaration, and capping of drug prices could improve global access to treatments for CLL and lymphoma.

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The high cost of prescription drugs: causes and solutions

Cited by 82 publications

References 8 publications

Surgical resection of early stage hepatocellular carcinoma improves patient survival at safety net hospitals

Surgical resection of early stage hepatocellular carcinoma improves patient survival at safety net hospitals

The Community Oncology and Academic Medical Center Alliance in the Age of Precision Medicine: Cancer Genetics and Genomics Considerations

Comparison of Access to Novel Drugs for Lymphoma and Chronic Lymphocytic Leukemia Between India and the United States

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