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Lazar Neto F, de Melo MAZ, Hidalgo Filho CMT, Mathias-Machado MC, Testa L, Campolina AG. Global representativeness and impact of funding sources in cost-effectiveness research on systemic therapies for advanced breast cancer: A systematic review. Breast 2024; 75:103727. [PMID: 38603837 PMCID: PMC11017040 DOI: 10.1016/j.breast.2024.103727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Breast cancer (BC) is the most incident tumor and, consequently, any new intervention can potentially promote a considerable budget impact if incorporated. Cost-effectiveness (CE) studies assist in the decision-making process but may be influenced by the country's perspective of analysis and pharmaceutical industry funding. METHODS A systematic review of Medline, Scopus, and Web of Science from January 1st, 2012 to July 8th, 2022 was conducted to identify CE studies of tumor-targeted systemic-therapies for advanced BC. Articles without incremental cost-effectiveness ratio calculations were excluded. We extracted information on the country and class of drug studied, comparator type, authors' conflicts of interest (COI), pharmaceutical industry funding, and authors' conclusions. RESULTS 71 studies comprising 204 CE assessments were included. The majority of studies were from the United States and Canada (44%), Asia (32%) and Europe (20%). Only 8% were from Latin America and none from Africa. 31% had pharmaceutical industry funding. The most studied drug classes were cyclin-dependent-kinase inhibitors (29%), anti-HER2 therapy (23%), anti-PD(L)1 (11%) and hormone therapy (11%). Overall, 34% of CE assessments had favorable conclusions. Pharmaceutical industry-funded articles had a higher proportion of at least one favorable conclusion (82% vs. 24%, p-value<0.001), European countries analyzed (45% vs. 9%, p-value = 0.003), and CE assessments with same class drug comparators (56% vs. 33%, p-value = 0.004). CONCLUSIONS Breast cancer CE literature scarcely represents low-and-middle-income countries' perspectives and is influenced by pharmaceutical industry funding which targets European countries', frequently utilizes comparisons within same-drug class, and is more likely to have favorable conclusions.
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Affiliation(s)
- Felippe Lazar Neto
- Instituto do Câncer do Estado de São Paulo, ICESP, Universidade de São Paulo, São Paulo, Brazil.
| | | | | | - Maria Cecília Mathias-Machado
- Instituto do Câncer do Estado de São Paulo, ICESP, Universidade de São Paulo, São Paulo, Brazil; Oncoclinicas, São Paulo, Brazil
| | - Laura Testa
- Instituto do Câncer do Estado de São Paulo, ICESP, Universidade de São Paulo, São Paulo, Brazil
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Carapinha JL. Market Transparency in Medicine Pricing: Pathways to Fair Pricing. PHARMACOECONOMICS 2024; 42:611-614. [PMID: 38722539 DOI: 10.1007/s40273-024-01390-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/25/2024]
Affiliation(s)
- João L Carapinha
- Syenza, Anaheim, CA, USA.
- School of Pharmacy and Pharmaceutical Sciences, Northeastern University, Boston, MA, 02115, USA.
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da Silva Machado FL, Cañás M, Urtasun MA, Marín GH, Albuquerque FC, Pont L, Convertino I, Bonaso M, Tuccori M, Kirchmayer U, Lopes LC. A Cross-National Comparison of Biosimilars Pricing in Argentina, Australia, Brazil, and Italy. Ther Innov Regul Sci 2024; 58:549-556. [PMID: 38436905 DOI: 10.1007/s43441-024-00623-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/19/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Biosimilar medicines are defined as biological products highly similar to an already licensed biological product (RP). The market entry of biosimilars is expected to reduce the costs of biological treatments. OBJECTIVE This study aims to evaluate the range of differences between the prices of biosimilars and the corresponding RP for biologicals approved in four countries. METHOD This is a cross-national comparison of pricing of biosimilars in Argentina, Australia, Brazil, and Italy. The study examined online price databases provided by the national authorities of the investigated countries. Biosimilar price difference was calculated by subtracting the unit price of the biosimilar by the unit price of the RP, and then dividing it by the unit price of the RP. The results were presented as percentage. RESULTS Brazil had the highest median price reduction (- 36.3%) in biosimilars price, followed by Italy (- 20.0%) and Argentina (- 18.6%). All the biosimilars in Italy were priced below the RP presenting a minimum reduction of 6.3%, while in Australia, most of the prices of biosimilars were equal to the RP. In Argentina, one infliximab-biosimilar displayed price above the RP (40.7%) while the lower priced brand had a reduction of 14.4%. Brazil had four biosimilars with prices above the respective RP, including isophane insulin (1), insulin glargine (1) and somatropin (2). CONCLUSION The study revealed a marked dispersion in the price's differences between biosimilars and RP across the studied countries. Governments should evaluate whether their policies have been successful in improving affordability of biological therapies.
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Affiliation(s)
- Fernanda Lacerda da Silva Machado
- Instituto de Ciências Farmacêuticas, Universidade Federal Do Rio de Janeiro, Macaé, Rio de Janeiro, Brazil
- Sorocaba University, Sorocaba, São Paulo, Brazil
| | - Martín Cañás
- Universidad Nacional Arturo Jauretche-FEMEBA, La Plata, Argentina
| | - Martín A Urtasun
- Universidad Nacional Arturo Jauretche-FEMEBA, La Plata, Argentina
| | - Gustavo H Marín
- Universidad Nacional de La Plata-CONICET, La Plata, Argentina
| | | | - Lisa Pont
- University of Technology Sydney, Sydney, Australia
| | - Irma Convertino
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Bonaso
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Tuccori
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ursula Kirchmayer
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
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Babar ZUD, Dulal S, Dhakal NP, Upadhyaya MK, Trap B. Developing Nepal's medicines pricing policy: evidence synthesis and stakeholders' consultation. J Pharm Policy Pract 2024; 17:2346222. [PMID: 38690551 PMCID: PMC11060005 DOI: 10.1080/20523211.2024.2346222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Objectives The objectives of this paper are to (a) explore stakeholders' opinions regarding Nepal's existing medicines pricing practices/situation and (b) build and present a set of medicines pricing policies for Nepal. Methods A review of the literature and field visits to community retail pharmacies, hospital pharmacies, wholesalers, and distributor outlets in Kathmandu were conducted to assess the medicines pricing situation. Following the literature review, preliminary meetings with stakeholders and field visits were held and a draft interview guide was prepared. Consultative sessions subsequently were undertaken in Kathmandu, Nepal, in January 2023 with representatives from the Department of Drug Administration, Ministry of Health and Population, Association of Pharmaceutical Producers of Nepal, consumer groups, Transparency International, Medicines Importers Association of Nepal/ Pharmaceutical Distributors Association of Nepal, Nepal Chemist and Druggist Association, and Nepal Pharmaceutical Association. Notes were taken during these meetings regarding issues and concerns raised as well as experiences and recommendations for the future, as outlined in the interview guide. Results The stakeholders in general stated that they do not have any objection to price regulation; however, they believe such regulation should be subject to periodic review. Both the importers and the Ministry of Health and Population have the view that an independent body/authority should be charged with regulating the prices of medicines. A set of policy options to be considered for use in Nepal include cost-plus pricing, external price referencing, internal reference pricing, and mark-up regulations. Conclusion Key issues related to pricing were identified and suggest that a set of pricing policies and updated regulations need to be considered to establish changes that are transparent, rational, and acceptable to the related stakeholders. Hence, suggestions made in this paper could be useful to inform a rational and fair pricing structure and to improve access to medicines.
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Affiliation(s)
| | - Santosh Dulal
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kathmandu, Nepal
| | - Narayan Prasad Dhakal
- Department of Drug Administration, Ministry of Health and Population, Kathmandu, Nepal
| | - Madan Kumar Upadhyaya
- Quality Standard and Regulation Division, Ministry of Health and Population, Kathmandu, Nepal
| | - Birna Trap
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kathmandu, Nepal
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Del Paggio JC, Naipaul R, Gavura S, Mercer RE, Koven R, Gyawali B, Wilson BE, Booth CM. Cost and value of cancer medicines in a single-payer public health system in Ontario, Canada: a cross-sectional study. Lancet Oncol 2024; 25:431-438. [PMID: 38547890 DOI: 10.1016/s1470-2045(24)00072-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND The financial impact of cancer medicines on health systems is not well known. We describe temporal trends in expenditure on cancer medicines within the single-payer health system of Ontario, Canada, and the extent of clinical benefit these treatments offer. METHODS In this cross-sectional study, we identified cancer medicines and expenditures from formularies and costing databases (the New Drug Funding Program, Ontario Drug Benefit Program, and The High-Cost Therapy Funding Program) during 10 consecutive years (April 1, 2012, to March 31, 2022) in Ontario, Canada. For intravenous medicines, we applied the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) to identify expenditures associated with substantial clinical benefit. We also identified treatments associated with improved overall survival or quality of life. FINDINGS 69 intravenous and 98 oral or injectable medicines were funded during 2012-22. Annual expenditure on cancer medicines increased by approximately 15% per year during 2012-22; the increase was more rapid in the most recent 4 years. Total expenditure on cancer medicines in the 2021-22 financial year was CA$1·7 billion. Immune checkpoint inhibitors were the single biggest expense by class ($284 million), representing 17% of the entire cancer medicine annual budget. Drugs with the highest individual costs were lenalidomide ($178 million) and pembrolizumab ($163 million), each accounting for around 10% of the entire budget. 29 (76%) of 38 indications eligible for ESMO-MCBS scoring met the threshold for substantial clinical benefit. Eight (21%) indications had no randomised trial evidence of improved overall survival, and only four (11%) were associated with improved QOL. $346 million (67% of the expenditure on intravenous cancer medicines) was spent on drugs that improved median overall survival by more than 6 months, $82 million (16%) was spent on medicines with overall survival gains of 3-6 months, and $32 million (6%) was spent on medicines with overall survival gains of less than 3 months. $53 million (10%) was spent on medicines with no established improvement in overall survival. INTERPRETATION Costs of cancer medicines to the Canadian health system are increasing rapidly. Most funded indications met thresholds for substantial clinical benefit and two-thirds of the expenditure were for medicines that improve survival by more than 6 months. Whether this cost trajectory can be maintained in a sustainable, equitable, high-quality health system is unclear. Efforts are needed to ensure the price of medicines with substantial benefit is affordable and funding of treatments with very modest benefit might need to be re-assessed, particularly when alternative supportive and palliative therapies are available. FUNDING None.
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Affiliation(s)
- Joseph C Del Paggio
- Department of Oncology, Thunder Bay Regional Health Sciences Centre and Northern Ontario School of Medicine University, Thunder Bay, ON, Canada
| | - Rohini Naipaul
- Ontario Health (Cancer Care Ontario), Provincial Drug Reimbursement Programs, Toronto, ON, Canada
| | - Scott Gavura
- Ontario Health (Cancer Care Ontario), Provincial Drug Reimbursement Programs, Toronto, ON, Canada
| | - Rebecca E Mercer
- Ontario Health (Cancer Care Ontario), Provincial Drug Reimbursement Programs, Toronto, ON, Canada; Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada
| | - Rachel Koven
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
| | - Bishal Gyawali
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada; Department of Oncology, Queen's University, Kingston, ON, Canada; Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Brooke E Wilson
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada; Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada; Department of Oncology, Queen's University, Kingston, ON, Canada; Public Health Sciences, Queen's University, Kingston, ON, Canada.
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Gaudette É, Rizzardo S, Zhang Y, Pothier KR, Tadrous M. Cost-effectiveness of the top 100 drugs by public spending in Canada, 2015-2021: a repeated cross-sectional study. BMJ Open 2024; 14:e082568. [PMID: 38485176 PMCID: PMC10941152 DOI: 10.1136/bmjopen-2023-082568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/21/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES To assess the distribution and spending by cost-effectiveness category among those drugs with the highest public spending levels in Canada. DESIGN Repeated cross-sectional study. SETTING The Canadian provinces of Manitoba, Ontario, New Brunswick, Nova Scotia, Prince Edward Island and Newfoundland. MAIN OUTCOMES AND MEASURES Cost-effectiveness assessments by the Canadian Agency for Drugs and Technologies in Health (CADTH) for top-100 brand-name outpatient drugs by gross public plan spending in any year between 2015 and 2021 in Canada Institute for Health Information's National Prescription Drug Utilization Information System data. Gross public plan spending by cost-effectiveness category. RESULTS From 2015 to 2021, 152 brand-name drugs occupied a top-100 rank and were included in the analysis. Of those, 117 had been assessed by CADTH. During the 7-year period, there was an increase in both top-100 drugs with cost-effective (from 18 to 24) and cost-ineffective (from 29 to 41) assessments, while drugs not assessed or with an unclear assessment declined (from 31 to 19 and from 22 to 16, respectively). As a share of spending on top-100 drugs with an assessment, spending on cost-effective drugs was mostly stable at 40%-46% from 2015 to 2021, while spending on cost-ineffective drugs increased from 30% to 45%. CONCLUSION A large and growing share of public drug spending has been allocated to cost-ineffective drugs in Canada. Dedicating large budgets to such treatments prevents spending with greater health impact elsewhere in the healthcare system and could restrain the capacity to pay for groundbreaking pharmaceutical innovation in the future.
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Affiliation(s)
- Étienne Gaudette
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Policy and Economics Analysis Branch, Patented Medicine Prices Review Board, Ottawa, Ontario, Canada
| | - Shirin Rizzardo
- Policy and Economics Analysis Branch, Patented Medicine Prices Review Board, Ottawa, Ontario, Canada
| | - Yvonne Zhang
- Policy and Economics Analysis Branch, Patented Medicine Prices Review Board, Ottawa, Ontario, Canada
| | - Kevin R Pothier
- Policy and Economics Analysis Branch, Patented Medicine Prices Review Board, Ottawa, Ontario, Canada
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto - St George Campus, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
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Pontes MA, Ribeiro AA, Albuquerque FC, Leite Cotenzini SN. Comparative price analysis of biological medicines: disparities generated by different pricing policies. Front Pharmacol 2024; 14:1256542. [PMID: 38273835 PMCID: PMC10808539 DOI: 10.3389/fphar.2023.1256542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/13/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction: Biological medicines have been assuming an important role among the therapeutic options for several diseases, however, due to their complex production process, the products obtained from this technology have a high added value and do not reach the purchasing power of most patients, which overwhelms the budget of health systems. With the development of biosimilars, which have reduced production costs, it is expected that access to biological medicines will become broader. However, in Brazil, the criteria for determining the price of biosimilars, unlike the generic policy in the country, do not foresee a price reduction due to the reduction of development costs. Objective: To understand the impact of the current model of economic regulation on the availability and access of these products in the country, based on a comparative analysis in selected countries, and identify trends that can help to expand the availability and access to biological medicines. Method: Quantitative and qualitative study, to identify the variation between the entry prices of biological medicines in Brazil and in selected countries, as well as the differences in the economic regulation policies established in these countries. Results: The results demonstrate that the current pricing model in Brazil has generated distortions in the prices of biosimilars in the market, which, consequently, makes it difficult for the population to access this category of products, in addition to allowing unsustainable market practices for the systems of public and private health in Brazil. It was also found that most of the analyzed countries, unlike Brazil, seek to harmonize the prices of different brands of the same molecule marketed in the country and with the international market, in addition to establishing incentive policies for indication and replacement by biosimilars, which expands the participation of biosimilars in the market significantly. Conclusion: Based on the data presented, it is concluded that it is essential to build a broader political and regulatory debate on the market for biologicals and biosimilars in the country to guarantee the access of the Brazilian population to more cost-effective technologies, generate a more competitive market and consequently contribute to the financial sustainability of health systems.
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de Castilla EMR, Mayrides M, González H, Vidangossy F, Corbeaux T, Ortiz N, Amaya C, Nuñez A, Jimbo DFJ, Ayensa A, Galindo M, Ruiz K, Pérez JM. Implementing precision oncology in Latin America to improve patient outcomes: the status quo and a call to action for key stakeholders and decision-makers. Ecancermedicalscience 2024; 18:1653. [PMID: 38425763 PMCID: PMC10901631 DOI: 10.3332/ecancer.2024.1653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Indexed: 03/02/2024] Open
Abstract
Background The advent of precision oncology (PO) has revolutionised diagnostic and follow up strategies and improved clinical outcomes for cancer patients. However, socio-economic inequalities in the level of implementation of PO in different countries is a prevailing issue. To improve this situation, the Latin America Patients Academy has gathered the recommendations of healthcare professionals and social civil members experienced in cancer management from Mexico, Guatemala, Costa Rica, Dominican Republic, Panama, Colombia, Chile, Ecuador, Peru and Argentina regarding the areas that need to be prioritised to improve the access to PO in Latin American (LATAM) countries. Methods This manuscript is the culmination of a series of educational campaigns and panel discussion aimed at improving the implementations of PO in LATAM that took place from June 2021 to January 2022. The status of PO in Latin America the level of PO implementation is generally low with some exceptions. The number of clinical trials and articles published with keywords related to PO from LATAM countries is drastically lower than in Europe and the United States. Despite sharing many complex challenges, progress is taking place in some countries in the region. Focus areas defined by the expert panel The expert panel determined the areas of PO that should be improved by LATAM countries to improve its implementation through cancer care plans, educational programs and collaborative strategies. These initiatives should increase awareness about PO in the region and eventually improve cancer control in the region.
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Affiliation(s)
| | | | - Haydée González
- Linfomas Argentinas, Tucumán 731, Buenos Aires 1049, Argentina
| | | | | | - Nancy Ortiz
- Foro Nacional de Cancer Chile, Santiago 755000, Chile
| | - Claudia Amaya
- Fundacion SENOSama Bucaramanga, Santander 680002, Colombia
| | - Alexandra Nuñez
- Asociación Unidos Contra el Cáncer, San Jose 10103, Costa Rica
| | | | - Adela Ayensa
- Salvati, Calle Eugenia No 13 – 102, Col Nápoles, Benito Juarez, Ciudad de México 03810, México
| | - Mayra Galindo
- Asociación Mexicana de Lucha contra el Cáncer, Zacatecas No 24-4to piso, interior 404, Roma Nte, Cuauhtémoc, Ciudad de México 06700, México
| | - Karla Ruiz
- Calle Conde de la Monclova 363 of 306, San Isidro, Lima 15073, Peru
| | - Juan Manuel Pérez
- Fundación Un Amigo como Tu, Ave Correa y Cidrón Esq Abraham Lincoln, Edif Profesionales Unidos, Suite 303, Santo Domingo, DN, Santo Domingo 10102, Dominican Republic
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Silva W, Rego E. How to Manage Philadelphia-Positive Acute Lymphoblastic Leukemia in Resource-Constrained Settings. Cancers (Basel) 2023; 15:5783. [PMID: 38136329 PMCID: PMC10741425 DOI: 10.3390/cancers15245783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 12/24/2023] Open
Abstract
Recent studies have indicated that more than half of adult patients newly diagnosed with Ph+ ALL can now achieve a cure. However, determining the most suitable protocol for less-resourced settings can be challenging. In these situations, we must consider the potential for treatment toxicity and limited access to newer agents and alloSCT facilities. Currently, it is advisable to use less intensive induction regimens for Ph+ ALL. These regimens can achieve high rates of complete remission while causing fewer induction deaths. For consolidation therapy, chemotherapy should remain relatively intensive, with careful monitoring of the BCR-ABL1 molecular transcript and minimal residual disease. AlloSCT may be considered, especially for patients who do not achieve complete molecular remission or have high-risk genetic abnormalities, such as IKZF1-plus. If there is a loss of molecular response, it is essential to screen patients for ABL mutations and, ideally, change the TKI therapy. The T315I mutation is the most common mechanism for disease resistance, being targetable to ponatinib. Blinatumomab, a bispecific antibody, has shown significant synergy with TKIs in treating this disease. It serves as an excellent salvage therapy, aside from achieving outstanding results when incorporated into the frontline.
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Affiliation(s)
- Wellington Silva
- Discipline of Hematology, Hospital das Clínicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-010, Brazil;
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Lv X, Ren W, Ran S, Zhao Y, Zhang J, Chen J, Zhang N. Trends and prescribing patterns of oral anti-neoplastic drugs: a retrospective longitudinal study. Front Public Health 2023; 11:1294126. [PMID: 38074729 PMCID: PMC10701268 DOI: 10.3389/fpubh.2023.1294126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
Background Cancer as a global public health problem, imposes a heavy disease burden. With the rapid development of oral anti-neoplastic drugs, there has been a paradigm shift in the treatment of cancer from intravenous to oral administration. Objective This study was conducted to investigate the trends and prescribing patterns of oral anti-neoplastic drugs in an academic tertiary hospital in China. Methods A single-center and retrospective analysis was performed based on the prescriptions of outpatients treated with oral anti-neoplastic drugs from 2017 to 2022. Yearly prescriptions and expenditure were calculated according to their pharmacological classes, and trends were further analyzed. Defined daily doses (DDDs) and defined daily cost (DDC) of oral targeted anti-neoplastic drugs were also determined. Results Both the number of prescriptions and expenditure of oral anti-neoplastic drugs increased progressively. There was a significant upward trend in the number and proportion of prescriptions for the older adult group, male group, and patients with gynecologic/genitourinary and respiratory cancer. Hormonal therapy agents accounted for the highest proportion of prescriptions, and letrozole was initially the most frequently prescribed drug. The number of DDDs of total oral targeted anti-neoplastic drugs showed a continuously ascending trend, primarily driven by the usage of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) and BCR-ABL TKIs. Conclusion The prescriptions and expenditure of oral anti-neoplastic drugs, and the number of DDDs of oral targeted anti-neoplastic drugs all showed a progressively ascending trend. Further studies are needed to evaluate the long-term health and financial outcomes, and the factors influencing these prescribing patterns.
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Affiliation(s)
- Xiaoqun Lv
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Weifang Ren
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Shan Ran
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Yuhan Zhao
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Jihong Zhang
- Research Center for Clinical Medicine, Jinshan Hospital, Fudan University, Shanghai, China
| | - Jun Chen
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Ning Zhang
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
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Ivama-Brummell AM, Marciniuk FL, Wagner AK, Osorio-de-Castro CG, Vogler S, Mossialos E, Tavares-de-Andrade CL, Naci H. Marketing authorisation and pricing of FDA-approved cancer drugs in Brazil: a retrospective analysis. LANCET REGIONAL HEALTH. AMERICAS 2023; 22:100506. [PMID: 37235087 PMCID: PMC10206192 DOI: 10.1016/j.lana.2023.100506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023]
Abstract
Background Most cancer drugs enter the US market first. US Food and Drug Administration (FDA) approvals of new cancer drugs may influence regulatory decisions in other settings. The study examined whether characteristics of available evidence at FDA approval influenced time-to-marketing authorisation (MA) in Brazil, and price differences between the two countries. Methods All new FDA-approved cancer drugs from 2010 to 2019 were matched to drugs with MA and prices approved in Brazil by December 2020. Characteristics of main studies, availability of randomised controlled trials (RCTs), overall survival (OS) benefit, added therapeutic benefit, and prices were compared. Findings Fifty-six FDA-approved cancer drugs with matching indications received a MA at the Brazilian Health Regulatory Agency (Anvisa) after a median of 522 days following US approval (IQR: 351-932). Earlier authorisation in Brazil was associated with availability of RCT (median: 506 vs 760 days, p = 0.031) and evidence of OS benefit (390 vs 543 days, p = 0.019) at FDA approval. At Brazilian marketing authorisation, a greater proportion of cancer drugs had main RCTs (75% vs 60.7%) and OS benefit (42.9% vs 21.4%) than that in the US. Twenty-eight (50%) drugs did not demonstrate added therapeutic benefit over drugs for the same indication in Brazil. Median approved prices of new cancer drugs were 12.9% lower in Brazil compared to the US (adjusted by Purchasing Power Parity). However, for drugs with added therapeutic benefit median prices were 5.9% higher in Brazil compared to the US, while 17.9% lower for those without added benefit. Interpretation High-quality clinical evidence accelerated the availability of cancer medicines in Brazil. The combination of marketing and pricing authorisation in Brazil may favour the approval of cancer drugs with better supporting evidence, and more meaningful clinical benefit albeit with variable degree of success in achieving lower prices compared to the US. Funding None.
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Affiliation(s)
- Adriana M. Ivama-Brummell
- Department of Health Policy, London School of Economics and Political Science, Cowdray House, Houghton Street, London, WC2A 2AE, United Kingdom
- Office of Assessment of Safety and Efficacy, General Office of Medicines, Brazilian Health Regulatory Agency, SIA, Trecho 05, Área Especial 57, Brasília-DF CEP 71.205-050, Brazil
| | - Fernanda L. Marciniuk
- Executive Secretariat of the Drug Market Regulation Chamber, Brazilian Health Regulatory Agency, SIA, Trecho 05, Área Especial 57, Brasília-DF CEP 71.205-050, Brazil
| | - Anita K. Wagner
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - Claudia G.S. Osorio-de-Castro
- Department of Medicines Policy and Pharmaceutical Services, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, sala 632, Manguinhos, Rio de Janeiro, RJ, 21041-210, Brazil
| | - Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Austrian National Public Health Institute, Stubenring 6, Vienna, 1010, Austria
- Department of Health Care Management, Technical University of Berlin, Berlin, 10623, Germany
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, Cowdray House, Houghton Street, London, WC2A 2AE, United Kingdom
| | - Carla L. Tavares-de-Andrade
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, sala 727A, Manguinhos, Rio de Janeiro, RJ, 21041-210, Brazil
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, Cowdray House, Houghton Street, London, WC2A 2AE, United Kingdom
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Varmaghani M, Elyasi S, Mojahedian MM, Ghavami V, Borhani B, Javan-Noughabi J, Sarafraz S. Availability and affordability of anticancer medicines in Iran based on WHO/HAI standard survey methods. Support Care Cancer 2022; 31:89. [PMID: 36574075 DOI: 10.1007/s00520-022-07546-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/13/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Cancer is the second leading cause of death in the world after cardiovascular disease. The present study aimed to investigate the affordability and physical access to chemotherapy drugs among patients with one of the three common cancers of the breast, stomach, and colon in the city of Mashhad, Iran, in 2021. METHODS This was a descriptive cross-sectional study. Twenty drug stores including two public and 18 privates in Mashhad were evaluated. Data was collected by consistent stay in the drug stores or pharmacies. For each oncology medicine, selling price, lowest general price, and availability were investigated. Three approaches have been experimented to calculate the affordability of anticancer medicines in this study. RESULTS Out of 28 studied medicines from public and private drug stores, 15 (53.5%) received very low, 8 (28.5%) relatively high, and 2 (7%) high access scores. The generic docetaxel brand's ultra-drug and trastuzumab (AryoTrust) were the most available drugs, but the doxorubicin (Ebewe), oxaliplatin (Mylan), and trastuzumab (Herceptin) were not available to the individuals with cancer. Also, the first approach (based on income decile) indicated that insured patients from all income deciles were able to pay the costs of the lowest price drugs of the DCF drug regimen, and if the patients were insured and belonged to the ninth income decile, they had the financial ability to buy drugs at the lowest price of the FLO drug regimen. CONCLUSION Unaffordability of cancer medicines can lead to treatment abandonment and increase inequality in access to healthcare services. Therefore, this requires immediate attention of policy makers to be planned in order to ensure to reducing the costs of medicines for patients and increasing patient access to anticancer medicines.
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Affiliation(s)
- Mehdi Varmaghani
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sepideh Elyasi
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad M Mojahedian
- Department of Clinical Pharmacy and Pharmacoeconomics, School of Pharmacy, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Ghavami
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behnam Borhani
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Javan-Noughabi
- Department of Health Economics and Management Sciences, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Shirin Sarafraz
- Department of Health Economics and Management Sciences, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
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Vogler S. Prices of new medicines: International analysis and policy options. ZEITSCHRIFT FÜR EVIDENZ, FORTBILDUNG UND QUALITÄT IM GESUNDHEITSWESEN 2022; 175:96-102. [DOI: 10.1016/j.zefq.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/16/2022] [Indexed: 11/12/2022]
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Siegmeier F, Büssgen M. Indication-wide drug pricing: Insights from the pharma market. J Pharm Policy Pract 2022; 15:53. [PMID: 36038951 PMCID: PMC9422096 DOI: 10.1186/s40545-022-00451-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/19/2022] [Indexed: 12/04/2022] Open
Abstract
Background Pharmaceutical spending has been increasing rapidly for years and is higher than ever before. To control the rising costs, countries are implementing regulatory frameworks such as (internal) reference pricing, price cuts or generics substitution. Internal reference pricing establishes a reference price within a country which serves as the maximum level of reimbursement for a group of pharmaceuticals. Price setting in the German market is especially relevant for many European countries, which use Germany as a reference country for their own price setting. Methods We evaluate pharmaceutical price dynamics for not reference priced pharmaceuticals (NRPs) as well as for reference priced pharmaceuticals (RPs) in Germany—referring to the internal reference price system. 64,862 medication packs have been extracted from the German pharmaceutical pricing register Lauer-Taxe. For each pack, we extracted detailed data on the company, manufacturer rebates, pharmacy retail prices, reference prices, co-payments, import quotas, and discount agreements. We then investigated price setting and dynamics of NRPs vs. RPs for all 14 indication areas by ATC code level 1. Results The average manufacturer price per pack was 604.84€ for NRPs and 112.11€ for RPs. Similar differences were found for the wholesale price and the pharmacy retail price. The reference price was—as expected—0.00€ for NRPs, and 154.40€ for RPs. NRP packs were imported in 42.38%, while RP packs were imported only in 24.62%. Highest average pharmacy retail prices could be found in the therapeutic areas ‘antineoplastic and immunomodulating agents’ (1711.47€), ‘systemic hormonal preparations’ (1331.95€), and ‘blood and blood forming organs’ (1260.58€). We detected high fluctuations in pharmacy retail prices per indication, as well as for reference prices per indication. The indications with the highest number of reference price regulated medical packs are ‘cardiovascular system’, ‘musculo-skeletal system’, and ‘nervous system’. Highest co-payments were found in the indications ‘antineoplastic and immunomodulating agents’, ‘blood and blood forming organs’, and ‘antiinfectives for systemic use’. Conclusion Price setting and price dynamics vary substantially between NRP and RP medication packs. Further, we saw major differences across all indication areas as well as when comparing medication packs launched by top 20 pharma companies vs. the rest. Supplementary Information The online version contains supplementary material available at 10.1186/s40545-022-00451-x.
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Affiliation(s)
- Florian Siegmeier
- Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany
| | - Melanie Büssgen
- Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany.
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15
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Liver Diseases in Latin America: Current Status, Unmet Needs, and Opportunities for Improvement. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2022; 20:261-278. [PMID: 35729970 PMCID: PMC9202671 DOI: 10.1007/s11938-022-00382-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 02/07/2023]
Abstract
Purpose of review
To assess the current challenges regarding liver diseases, including the burden of disease, access to care, screening, and treatment needs in Latin America. Recent findings Latin America is a region with a rich multicultural heritage and important socioeconomic differences. The burden of liver diseases is high and mainly determined by a high level of alcohol intake and the surge of risk factors associated with NAFLD (i.e., sedentary lifestyles, broader access to highly processed foods, obesity, and type 2 diabetes mellitus). Hepatotropic viruses also play a role in the development of chronic liver diseases, although their comparative frequency has been decreasing over the last decades. There are important disparities in access to screening and treatment for liver diseases in Latin America, which are reflected in low access to critical treatments such as direct-acting antiviral agents and drugs to treat hepatocellular carcinoma. Also, important barriers to liver transplantation are present in multiple countries, including a low deceased donors’ rate and a lack of availability in several countries (especially in Central America). Our region also has disadvantages in research and education in liver diseases, which limits regional academic development and improvement in quality of care of liver diseases. Summary In order to tackle an increasing health burden due to liver diseases, Latin America urgently needs tailored interventions aiming to control the main risk factors for these disorders through the establishment of effective public health policies. Also, development of liver transplantation programs and improvement of medical education and research capabilities as well as extensive collaboration between all stakeholders are keys to address the liver disease agenda in the region.
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Garattini L, Finazzi B, Mannucci PM. Pharmaceutical pricing in Europe: time to take the right direction. Intern Emerg Med 2022; 17:945-948. [PMID: 35303264 DOI: 10.1007/s11739-022-02960-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/24/2022] [Indexed: 11/05/2022]
Abstract
A price stems from the intersection between supply and demand curves in any common market. However, there are special markets where consumers do not pay for goods directly, and prescription drugs are a well-known example in healthcare. Drugs are mainly funded by public expenditure in well-established welfare systems like those of the Western European countries. However, the present era of austerity in public funding has made financial resources scarce in most European nations. Currently, the leading tendency for pharmaceutical pricing in Europe is direct negotiation with pharma companies. However, these negotiations are administratively burdensome, with costs not necessarily offsetting savings. Moreover, since any trade negotiation implies some degree of confidentiality to be effective these strategies are scantily transparent. When prices are set for many products through unavoidably arbitrary decisions, the final consequence is an irrational allocation of financial resources. Here, we raise a proposal to restore a reasonable balance between public equity objectives of health authorities and private profit incentives of the pharma industry in Europe, switching from pricing to budgeting. The underlying rationale of our proposal is to stop setting arbitrary prices in a context of market failure.
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Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy
| | - Bruno Finazzi
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy
| | - Pier Mannuccio Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Aggregate Online Brand Name Pharmacy Price Dynamics for the United States and Mexico. ECONOMIES 2022. [DOI: 10.3390/economies10050112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Virtual cross-border medical tourism allows many residents in the United States to purchase brand name medicines from companies in Mexico without travelling there. Monthly economic reports indicate that the online brand name pharmaceutical product prices in Mexico are noticeably lower than the corresponding internet prices in the United States. There have been very few econometric studies on how these prices are linked and the dynamic nature of those relationships. Results in this study indicate that online medicine prices in Mexico respond very rapidly to online prices changes in the high-price market.
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Shin G, Kwon HY, Bae S. For Whom the Price Escalates: High Price and Uncertain Value of Cancer Drugs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074204. [PMID: 35409887 PMCID: PMC8998346 DOI: 10.3390/ijerph19074204] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 02/01/2023]
Abstract
The price of cancer drugs has skyrocketed, yet it is not clear whether their value is commensurate with their price. More cancer drugs are approved under expedited review, which considers less rigorous clinical evidence, yet only 20% of them show an overall survival gain in the confirmatory trial. Moreover, clinical data are often generated based on small, single-arm studies with surrogate outcomes, challenging economic evaluation. With their high price and uncertain (marginal) clinical value, cancer drugs are frequently rejected by health technology assessment (HTA) bodies. Therefore, agencies, including the UK's National Institute for Health and Care Excellence (NICE), have adopted cancer drug funds (CDF) or risk-sharing schemes to provide extra access for expensive cancer drugs which fail to meet NICE's cost effectiveness threshold. With rising pricing and fewer new cancer medications with novel mechanisms of action, it is unclear if newly marketed cancer therapies address unmet clinical needs or whether we are paying too much. Transparency, equity, innovativeness, and sustainability are all harmed by a "special" approach for cancer medications. If early access is allowed, confirmatory trials within a certain time frame and economic evaluation should be conducted, and label changes or disinvestment should be carried out based on those evaluations.
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Affiliation(s)
- Gyeongseon Shin
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea;
| | - Hye-Young Kwon
- Division of Biology and Public Health, Mokwon University, Deajeon 35349, Korea;
| | - SeungJin Bae
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea;
- Correspondence:
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