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Shukar S, Anjum R, Zhang J, Babar ZUD, Mobeen I, Yang C. Anticancer medicines in Pakistan: An analysis of essential medicines lists. J Oncol Pharm Pract 2024; 30:46-54. [PMID: 37006130 DOI: 10.1177/10781552231167809] [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] [Indexed: 04/04/2023]
Abstract
OBJECTIVE The lack of anticancer drugs for curative and supportive purposes is the critical reason for the low survival rate in low-and-middle-income countries. This study aims to analyze whether the National Essential Medicines List (NEML) and Registered Essential Medicines List (REML) are in concordance with the World Health Organization (WHO) Essential Medicines List (EML) and whether the formularies prevalent in the country are parallel to each other and to the NEML. METHOD An observational study design was used in which antineoplastic drugs from the 2021 NEML and REML were compared with 2021 WHO EML to evaluate their availability in Pakistan. Market access was determined. Moreover, the formularies of six different hospital types were compared with each other and with the NEML, and REML to estimate the availability within hospitals. RESULTS There were 66 anticancer drugs in 2021 WHO EML and all were found in Pakistan's 2021 NEML but only 48 drugs (73%) were found in the REML. Hydroxycarbamide and dasatinib were two registered drugs absent in all hospitals' formularies. The market access for anticancer medicines was 73% (48 of 66). Semigovernment hospital (86%) has the highest availability, followed by the government hospital (80%). All the hospitals have unregistered drugs including bortezomib, lenalidomide, and mesna. CONCLUSION Pakistan's NEML adopts WHO EML abruptly but all medicines are not registered. The hospitals are trying their best to increase availability but optimum drug regulations to revise NEML based on the country's requirements and emphasizing registration of anticancer medicines are needed to improve the country's availability of antineoplastic agents.
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Affiliation(s)
- Sundus Shukar
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Rehan Anjum
- Department of Pharmacy, Shifa International Hospitals, Islamabad, Pakistan
| | - Jinwei Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, West Yorkshire, UK
| | - Iqra Mobeen
- Department of Pharmacy, Samaa Fertilization Center Jumeriah, Dubai, United Arab Emirates
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi'an, Shaanxi, China
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Joosse IR, Mantel-Teeuwisse AK, Suleman F, van den Ham HA. Sustainable Development Goal indicator for measuring availability and affordability of medicines for children: a proof-of-concept study. BMJ Open 2023; 13:e065929. [PMID: 37041064 PMCID: PMC10106062 DOI: 10.1136/bmjopen-2022-065929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVES To complement Sustainable Development Goal (SDG) indicator 3.b.3 that monitors access to medicines for all, a corresponding child-specific methodology was developed tailored to the health needs of children. This methodology could aid countries in monitoring accessibility to paediatric medicines in a validated manner and on a longitudinal basis. We aimed to provide proof of concept of this adapted methodology by applying the method to historical datasets. METHOD A core set of child-appropriate medicines was selected for two groups of children: children aged 1-59 months and children aged 5-12 years. To enable calculation of affordability of medicines for children, the number of units needed for treatment was created, incorporating the recommended dosage and duration of treatment for the specific age group. The adapted methodology was applied to health facility survey data from Burundi (2013), China (2012) and Haiti (2011) for one age group. SDG indicator 3.b.3 scores and (mean) individual facility scores were calculated per country and sector. RESULTS We were able to calculate SDG indicator 3.b.3 based on historical data from Burundi, China and Haiti with the adapted methodology. In this case study, all individual facilities failed to reach the 80% benchmark of accessible medicines, resulting in SDG indicator 3.b.3 scores of 0% for all 3 countries. Mean facility scores ranged from 22.2% in Haiti to 40.3% in Burundi for lowest-price generic medicines. Mean facility scores for originator brands were 0%, 16.5% and 9.9% for Burundi, China and Haiti, respectively. The low scores seemed to stem from the low availability of medicines. CONCLUSION The child-specific methodology was successfully applied to historical data from Burundi, China and Haiti, providing proof of concept of this methodology. The proposed validation steps and sensitivity analyses will help determine its robustness and could lead to further improvements.
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Affiliation(s)
- Iris R Joosse
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Aukje K Mantel-Teeuwisse
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Fatima Suleman
- WHO Collaborating Centre for Pharmaceutical Policy and Evidence Based Practice, Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Hendrika A van den Ham
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
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Otth M, Brack E, Kearns PR, Kozhaeva O, Ocokoljic M, Schoot RA, Vassal G, Balduzzi A, Beck Popovic M, Beishuizen A, Bergamaschi L, Biondi A, Bourdeaut F, Braicu E, Brok J, Brugières L, Burke A, Calaminus G, Casanova M, Choucair ML, Cleirec M, Corbaciouglu S, Correa Llano MG, De Rojas T, Domínguez Pinilla N, Elmaraghi C, Ferrari A, Fossa A, Gaspar N, Herold N, Karapiperi K, Karu M, Kjærsgaar M, Knörr F, Koenig C, Kranjcec I, Krawczyk M, Lehmberg K, Lehrnbecher T, Lunesink M, Massano D, Matijasic N, Merks H, Metzler M, Michalski A, Minkov M, Morland B, Niktoreh N, Oltenau E, Orbach D, Owens C, Papachristidou S, Pasqualini C, Pavlovic M, Perez Albert P, Poyer F, Radulovic I, Reinhardt D, Rebelo J, Roser E, Russo I, Scheinemann K, Schindera C, Schrappe M, Sehested A, Sehouli J, Spreafico F, Strauss SJ, Stutterheim J, Svojgr K, Tzotzola V, Van Ewijk R, Verschuur A, Vora A, Woessmann W, Zajac-Spychala O, Zwaan M. Essential medicines for childhood cancer in Europe: a pan-European, systematic analysis by SIOPE. Lancet Oncol 2022; 23:1537-1546. [PMID: 36332647 DOI: 10.1016/s1470-2045(22)00623-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Shortages and unequal access to anticancer medicines for children and adolescents are a reality in Europe. The aim of the European Society for Paediatric Oncology (SIOPE) Essential Anticancer Medicines Project was to provide a list of anticancer medicines that are considered essential in the treatment of paediatric cancers to help ensure their continuous access to all children and adolescents with cancer across Europe. METHODS This pan-European project, done between Jan 20, 2020, and Feb 18, 2022, was designed to be a systematic collection and review of treatment protocols and strategies that are used to treat childhood cancer in Europe. We formed 16 working groups on the basis of paediatric cancer types, and which were based on the existing SIOPE Clinical Trial Groups. Workings groups consisted of representatives from the SIOPE Clinical Trial Groups, Young SIOPE members, and senior paediatric oncology experts. Each group collected existing treatment protocols that are used to treat the respective cancer types in Europe. Medicines from the standard group of each protocol were extracted. For medicines not on the WHO Essential Medicines List for children (EMLc) 2017, working groups did a literature search to determine whether the medicines should be defined as essential, promising, or neither essential nor promising. Each group provided an individual summary, and all medicines that were considered essential by at least one group were combined in a joint list. FINDINGS The working groups identified 73 treatment protocols used in Europe and defined 66 medicines as essential. For several newer medicines, such as kinase inhibitors or tisagenlecleucel, the supporting evidence was insufficient to consider them essential, so these medicines were defined as promising. 25 medicines were considered promising by at least one working group. 22 (33%) of the 66 essential and none of the promising medicines were included in the WHO EMLc 2017. The WHO EMLc 2021 included two new medicines (everolimus and vinorelbine) following applications we made as a result of this project. INTERPRETATION Medicines that were defined as essential within this project should be available for the treatment of childhood and adolescent cancer continuously and across Europe. This list can be used to support and guide stakeholders and policy makers in negotiations on a national and European level regarding shortages, accessibility, and affordability of these medicines. FUNDING None.
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Affiliation(s)
- Maria Otth
- Division of Oncology-Hematology, Department of Pediatrics, Kantonsspital Aarau, Aarau, Switzerland; Department of Oncology, Haematology, Immunology, Stem Cell Transplantation and Somatic Gene Therapy, University Children's Hospital Zurich, Zurich, Switzerland.
| | - Eva Brack
- Division of Pediatric Hematology and Oncology, University Children's Hospital Bern, Bern, Switzerland
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit, National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Olga Kozhaeva
- Policy Department, European Society for Paediatric Oncology, SIOP Europe, Brussels, Belgium
| | - Marko Ocokoljic
- Policy Department, European Society for Paediatric Oncology, SIOP Europe, Brussels, Belgium
| | - Reineke A Schoot
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Gilles Vassal
- Department of Children and Adolescent Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
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Hovhannisyan S, Hoveyan J, Aghabekyan T, Tamamyan G. Update on the Availability of Essential Medications for Pediatric Cancer Patients in Armenia: How to Solve the Problem? Hematol Oncol Stem Cell Ther 2022; 15:74-76. [PMID: 32533930 DOI: 10.1016/j.hemonc.2020.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/11/2020] [Indexed: 01/27/2023] Open
Affiliation(s)
- Saten Hovhannisyan
- Yerevan State Medical University, Department of Pediatric Oncology and Hematology, Yerevan, Armenia.,Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R.H. Yeolyan, Yerevan, Armenia.,Armenian Pediatric Hematology and Oncology Group, Yerevan, Armenia
| | - Julieta Hoveyan
- Yerevan State Medical University, Department of Pediatric Oncology and Hematology, Yerevan, Armenia.,Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R.H. Yeolyan, Yerevan, Armenia.,Armenian Pediatric Hematology and Oncology Group, Yerevan, Armenia
| | - Tigran Aghabekyan
- Armenian Pediatric Hematology and Oncology Group, Yerevan, Armenia.,Yerevan State Medical University, Faculty of General Medicine, Yerevan, Armenia
| | - Gevorg Tamamyan
- Yerevan State Medical University, Department of Pediatric Oncology and Hematology, Yerevan, Armenia.,Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R.H. Yeolyan, Yerevan, Armenia.,Armenian Pediatric Hematology and Oncology Group, Yerevan, Armenia
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Bedirian K, Aghabekyan T, Mesrobian A, Shekherdimian S, Zohrabyan D, Safaryan L, Sargsyan L, Avagyan A, Harutyunyan L, Voskanyan A, Tadevosyan A, Melik-Nubaryan D, Khachatryan P, Saghatelyan T, Kostanyan M, Vardevanyan H, Hovhannisyan M, Sarkisian T, Sargsyan K, Babikyan D, Tananyan A, Danielyan S, Muradyan A, Tamamyan G, Bardakhchyan S. Overview of Cancer Control in Armenia and Policy Implications. Front Oncol 2022; 11:782581. [PMID: 35087754 PMCID: PMC8787108 DOI: 10.3389/fonc.2021.782581] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
Cancer is the second leading cause of death in Armenia. Over the past two decades, the country has seen a significant rise in cancer morbidity and mortality. This review aims to provide up-to-date info about the state of cancer control in Armenia and identify priority areas of research. The paper analyzes published literature and local and international statistical reports on Armenia and similar countries to put numbers into context. While cancer detection, diagnosis, and treatment are improving, the prevalence of risk factors is still quite high and smoking is widespread. Early detection rates are low and several important screening programs are absent. Diagnosis and treatment methods are not standardized; there is a lack of treatment accessibility due to insufficient government coverage and limited availability of essential medicines. Overall, there is room for improvement in this sector, as research is limited and multidisciplinary approaches to the topic are rare.
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Affiliation(s)
- Karen Bedirian
- Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center After Prof. R. Yeolyan, Yerevan, Armenia
| | - Tigran Aghabekyan
- Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center After Prof. R. Yeolyan, Yerevan, Armenia
- Faculty of Medicine, Yerevan State Medical University, Yerevan, Armenia
| | - Arianna Mesrobian
- Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center After Prof. R. Yeolyan, Yerevan, Armenia
| | - Shant Shekherdimian
- Department of Pediatric Surgery, Yerevan State Medical University, Yerevan, Armenia
- Department of Public Health, Yerevan State Medical University, Yerevan, Armenia
- Ministry of Health of the Republic of Armenia, Yerevan, Armenia
- Department of Pediatric Surgery, University of California Los Angeles, Los Angeles, CA, United States
| | - Davit Zohrabyan
- Department of Oncology, Yerevan State Medical University, Yerevan, Armenia
- Clinic of Adults’ Solid Tumors, Hematology Center After Prof. R. Yeolyan, Yerevan, Armenia
| | - Liana Safaryan
- Department of Oncology, Yerevan State Medical University, Yerevan, Armenia
- Clinic of Adults’ Solid Tumors, Hematology Center After Prof. R. Yeolyan, Yerevan, Armenia
| | - Lilit Sargsyan
- Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center After Prof. R. Yeolyan, Yerevan, Armenia
- Department of Pediatric Oncology and Hematology, Yerevan State Medical University, Yerevan, Armenia
- Armenian Pediatric Hematology and Oncology Group, Yerevan, Armenia
| | - Armen Avagyan
- Department of Oncology, Yerevan State Medical University, Yerevan, Armenia
- Clinic of Chemotherapy, Mikayelyan Institute of Surgery, Yerevan State Medical University, Yerevan, Armenia
- Armenian Association of Hematology and Oncology, Yerevan, Armenia
| | - Lilit Harutyunyan
- Department of Oncology, Yerevan State Medical University, Yerevan, Armenia
- Clinic of Chemotherapy, Mikayelyan Institute of Surgery, Yerevan State Medical University, Yerevan, Armenia
- Young Oncologists Group of Armenia, Yerevan, Armenia
| | - Astghik Voskanyan
- Clinic of Adults’ Hematology, Hematology Center After Prof. R. Yeolyan, Yerevan, Armenia
| | - Artashes Tadevosyan
- Department of Public Health and Healthcare Organization, Yerevan State Medical University, Yerevan, Armenia
| | - Davit Melik-Nubaryan
- Department of Public Health and Healthcare Organization, Yerevan State Medical University, Yerevan, Armenia
- Division of Clinical Affairs, Yerevan State Medical University, Yerevan, Armenia
| | - Parandzem Khachatryan
- Department of Clinical Pathology, Yerevan State Medical University, Yerevan, Armenia
- “Histogen” Armenian-German Scientific Center of Pathology, Yerevan, Armenia
| | - Tatul Saghatelyan
- Department of Oncology, Yerevan State Medical University, Yerevan, Armenia
- Department of Radiation Oncology, National Center of Oncology, Yerevan, Armenia
| | - Mher Kostanyan
- Department of Oncology, Yerevan State Medical University, Yerevan, Armenia
- Department of Oncology, National Center of Oncology, Yerevan, Armenia
| | | | - Marine Hovhannisyan
- Faculty of Public Health, Yerevan State Medical University, Yerevan, Armenia
| | - Tamara Sarkisian
- Department of Medical Genetics, Yerevan State Medical University, Yerevan, Armenia
- Center of Medical Genetics and Primary Health Care, Yerevan, Armenia
| | - Karine Sargsyan
- Department of Medical Genetics, Yerevan State Medical University, Yerevan, Armenia
- International Biobanking and Education, Medical University of Graz, Graz, Austria
- National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Davit Babikyan
- Faculty of Public Health, Yerevan State Medical University, Yerevan, Armenia
- Laboratory of Molecular Genetic, Center of Medical Genetics and Primary Health Care, Yerevan, Armenia
| | - Armen Tananyan
- Department of Oncology, Yerevan State Medical University, Yerevan, Armenia
| | - Samvel Danielyan
- Armenian Association of Hematology and Oncology, Yerevan, Armenia
- Hematology Center after Prof. R. Yeolyan, Yerevan, Armenia
| | - Armen Muradyan
- Department of Urology, Yerevan State Medical University, Yerevan, Armenia
| | - Gevorg Tamamyan
- Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center After Prof. R. Yeolyan, Yerevan, Armenia
- Department of Pediatric Oncology and Hematology, Yerevan State Medical University, Yerevan, Armenia
- Armenian Pediatric Hematology and Oncology Group, Yerevan, Armenia
- Institute of Cancer and Crisis, Yerevan, Armenia
| | - Samvel Bardakhchyan
- Department of Oncology, Yerevan State Medical University, Yerevan, Armenia
- Clinic of Adults’ Solid Tumors, Hematology Center After Prof. R. Yeolyan, Yerevan, Armenia
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