What Factors Hindered the Access to Essential Anticancer Medicine in Public Hospitals for the Local Population in Hubei Province, China

Abstract

Background:Cancer poses a serious threat to one’s health, which caused significant economic burden on the family and society. Poor availability and affordability resulted in some essential medicines failing to meet the basic health needs of this group of patients. The objective of this study was to evaluate the availability, prices and affordability of 32 anticancer essential medicines in Hubei Province, China.Methods: Data on the availability and price related information of 32 essential anticancer medicines in the capital and five other cities of Hubei Province were collected. A total of 28 hospitals were sampled, which included 13 tertiary hospitals and 15 secondary hospitals. We used the standard methods developed by the World Health Organization and Health Action International to compare the differences in drug price, availability and affordability between secondary hospitals and tertiary hospitals.Results: Overall, the availability of medicine was higher in tertiary hospitals. The average availability of originator brand (OBs) was 13.70% (tertiary hospitals) VS 6.67% (secondary hospitals), and lowest-priced generic (LPGs) was 62.83% (tertiary hospitals) VS 42.92% (secondary hospitals). The MPR value of most sampled medicines in secondary hospitals were less than 1. In contrast, the MPR of Cytarabine (17.15), Oxaliplatin (12.73) were significantly higher than the international reference price. The top three OBs’ total expenses for 30-days treatment were Irinotecan, Oxaliplatin, Bicalutamide. Further, their affordability was relative low, as the costs for one course using these medicines were much higher than 20% of the minimum family monthly income.Conclusion: Though the “Zero Mark-Up” and “Centralized procurement policy of anti-tumor drugs” policies have been implemented in China, the availability issue yet to be addressed. High price and low affordability were the major barriers to the access of essential anticancer medicines. Measures should be taken to provide sufficient, available and affordable medicines to patients in need.

The impact of national centralized drug procurement on health expenditures for lung cancer inpatients: A difference-in-differences analysis in a large tertiary hospital in China

“…Although previous studies have reported the potential impact of the NCDP policy on drug expenditures, none of them focused on anticancer drugs. Most studies found that the volume of policy-related drugs increased, while the purchase spending declined after the implementation of NCDP (4, 16,17). The policy effects on antihypertensive drugs, antibiotic drugs, and nucleoside analogs were consistent with the overall policy effects (18)(19)(20).…”

Access to Essential and Innovative Anti-cancer Medicines: A Longitudinal Study in Nanjing, China

“…The results of this analysis are similar to those of a previous longitudinal tracking study on the availability of EAMs [13] . A cross-sectional study Hubei Province, China showed that the availability of EAMs (LPGs) was 40.88%, while that of OBs was only 7.57% [9] . In this study, the mean availability of OBs was higher than that of the two studies above, which may be due to the exclusion of some essential medicines in the evaluation of the mean availability of OBs, such as Methotrexate, Tamoxifen, Hydroxyurea, etc, which do not have the approval of the original manufacturer in China, that is, they are not listed or have been withdrawn from the market in China.…”

“…However, only a few studies have focused on the accessibility of anti-cancer medicines, especially for innovative medicines in China. A previous study surveyed the availability of 32 EAMs in the Hubei Province of China and found that on average availability of OBs in tertiary and secondary hospitals was 13.7% and 6.67%, respectively, whereas that of LPGs was relatively higher, at 62.83% and 42.92%, respectively [9] . In addition, a study aimed to evaluate the change in accessibility of EAMs from 2015 to 2018 in Anhui, China, all IAMs are unaffordable, but their affordability is on the rise [10] .Another national study focusing on procurement data found that the procurement of three out of 10 EAMs decreased, whereas the procurement of 10 targeted cancer medicines increased between 2015-2020 [11] .…”

Overall survival benefits of cancer drugs in the WHO Model List of Essential Medicines, 2015–2021

“…Of concern are potential barriers to access to and affordability of essential cancer drugs recommended in the WHO EML. [29][30][31][32][33][34][35] Arguably, access and affordability are only relevant considerations for WHO EML cancer drugs with established clinical benefit, and most importantly, OS benefit. In recent years, the WHO has put greater emphasis on the development and use of explicit clinical benefit criteria to inform the selection of cancer drugs for the EML.…”