History of the Baylor Charles A. Sammons Cancer Center

Variation of Cost among Anti-cancer Drugs Available in Indian Market

INTRODUCTION

Although cancer remains a major health problem all over the world, its treatment is limited by affordability of patients in a developing country like India. Information generated from cost analysis studies will be helpful for both the doctors in choosing the correct medicine for their patients and also for policy makers in successfully utilizing the meager resources that are available.

AIM

The aim of the present observational study was to analyse the price variations of anti-cancer drugs available in India.

MATERIALS AND METHODS

The cost of a particular anti-cancer drug being manufactured by different companies, in the same dose and dosage form, was obtained from latest issue of "Current Index of Medical Specialties" (CIMS) January-April, 2016. The difference between the maximum and minimum prices of various brands of the same drug was analysed and percentage variation in the prices was calculated. The results of the study were expressed as absolute numbers and percentages.

RESULTS

Overall, the price of a total of 23 drugs belonging to 6 different categories available in 52 different formulations were analysed. Among alkylating agents, oxaliplatin (50mg; injection) showed the maximum price variation of 125.02%. In anti-metabolites, methotrexate (2.5mg; tablet) showed the maximum price variation of 75.30%. The maximum price variation among natural products was seen with paclitaxel (260 mg; injection) of 146.98%, among hormonal drugs, was seen with flutamide (250mg; tablet) of 714.24%, among targeted drugs was seen with imatinib mesylate (100mg; film coated tablet) of 5.56% and among supportive drugs, granisetron (1mg; tablet) showed the maximum price variation of 388.68%.

CONCLUSION

The average percentage variations of different brands of the same anti-cancer drug in same dose and dosage form manufactured in India is very wide. The government and drug manufacturing companies must direct their efforts in reducing the cost of anti-cancer drugs and minimizing the economic burden on the patients.

Model for the cost-efficient delivery of continuous quality cancer care: a hospital and private-practice collaboration

Cancer care is expensive due to the high costs of treatment and preventable utilization of resources. Government, employer groups, and insurers are seeking cancer care delivery models that promote both cost-efficiency and quality care. Baylor University Medical Center at Dallas (BUMC), a large tertiary care hospital, in collaboration with Texas Oncology, a large private oncology practice, established two independent centers that function cooperatively within the Baylor Charles A. Sammons Cancer Center, the Oncology Evaluation and Treatment Center (OETC) and Infusion Center, to deliver urgent care and infusions after hours to oncology patients. Quality measures based on evidence-based care and cost-efficiency measures were implemented within these centers. Ability to meet predetermined goals for these measures will be a guide for implementing continuous quality and cost-efficiency interventions. During the first two quarters of operations, 2023 patients received care in the OETC (n = 423) and Infusion Center (n = 1600). The average time spent in the OETC was 48% less than the time spent in the BUMC emergency department (ED). Eighty-nine percent of the cancer center' patients who received urgent care at BUMC were referred to the OETC for this care, instead of the BUMC ED. The hospital admission rate in the OETC was 59% lower than it was in the BUMC ED, a high-volume level I trauma center. The addition of the OETC and Infusion Center to the cancer center holds promise for providing continuous quality cancer care that is cost-efficient.

The use of sensitive chemical antibodies for diagnosis: detection of low levels of EpCAM in breast cancer

EpCAM is expressed at low levels in a variety of normal human epithelial tissues, but is overexpressed in 70–90% of carcinomas. From a clinico-pathological point of view, this has both prognostic and therapeutic significance. EpCAM was first suggested as a therapeutic target for the treatment of epithelial cancers in the 1990s. However, following several immunotherapy trials, the results have been mixed. It has been suggested that this is due, at least in part, to an unknown level of EpCAM expression in the tumors being targeted. Thus, selection of patients who would benefit from EpCAM immunotherapy by determining EpCAM status in the tumor biopsies is currently undergoing vigorous evaluation. However, current EpCAM antibodies are not robust enough to be able to detect EpCAM expression in all pathological tissues. Here we report a newly developed EpCAM RNA aptamer, also known as a chemical antibody, which is not only specific but also more sensitive than current antibodies for the detection of EpCAM in formalin-fixed paraffin-embedded primary breast cancers. This new aptamer, together with our previously described aptamer, showed no non-specific staining or cross-reactivity with tissues that do not express EpCAM. They were able to reliably detect target proteins in breast cancer xenograft where an anti-EpCAM antibody (323/A3) showed limited or no reactivity. Our results demonstrated a more robust detection of EpCAM using RNA aptamers over antibodies in clinical samples with chromogenic staining. This shows the potential of aptamers in the future of histopathological diagnosis and as a tool to guide targeted immunotherapy.