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Drug Pricing: Cancer drugs cost the most in US, but most unaffordable in India, China - Study

Published on 07/06/16 at 01:24pm

Cancer drugs are less affordable in low-income countries, despite the lower retail prices, according to a study released at the annual meeting of American Society of Clinical Oncology (ASCO).

Lead study author Daniel Goldstein, said: “This study provides a glimpse into prices and affordability of cancer drugs around the world and sets the stage for further research.”

The study found that the US has the highest prices for cancer drugs in the world, with the lower income countries having access to cheaper drugs. However, even though the treatments are less expensive in low-income nations, they also are less affordable to the populations.

The study analyses cancer drug prices in seven countries including the US, China and India.  While the study found the lowest prices for cancer drugs are prevalent in India and South Africa, but when calculating the price as a percentage of wealth adjusted for the cost of living, people in India and China were found to be least able to afford the drugs.

The researchers calculated monthly drug doses for 15 generic and 8 patented cancer drugs used to treat a wide range of cancer types and stages including Roche's Herceptin and Avastin, as well as treatments by Eli Lilly, Novartis, Bristol-Myers Squibb and Takeda. Retail drug prices in Australia, China, India, South Africa, the UK, Israel, and the US were obtained predominantly from government websites.

The Price Difference

Researchers found that the median monthly price of branded cancer medicines was nearly $8700 in the US, compared with roughly $3200 in China, $2700 in Australia, $2600 in the UK, $1700 in South Africa and $1500 in India. Median prices for generic cancer drugs were also highest in the US, at $654, and lowest in India and South Africa, at $159 and $120, respectively.

“Cost of drugs remains a critical issue, one that the WHO has no control over,” Lawrence Shulman, Abramson Cancer Center at the University of Pennsylvania said at the ASCO.

“The inability to procure certain medication will have a substantial effect on mortality. If you can’t get trastuzumab (Herceptin) for women who have HER2-positive breast cancer, mortality rates will be twice of what they are, in countries where trastuzumab is available,” Shulman said.   

However, after accounting for affordability, the research found that cancer drugs were most affordable in Australia and the UK, where the average monthly price of patented therapies was 71% and 78% of their respective gross domestic product per capita at purchasing power parity (GDPcapPPP) values.

In the US, branded cancer drugs were 192% of its GDPcapPPP, while generics were found to be priced at 14% of wealth adjusted for the cost of living. Meanwhile, the same measure applied to branded treatments in China and India amounted to 288% and 313% of their GDPcapPPP values, respectively, and was 48% and 33% for generics.

“Poverty should not be an obstacle for receiving potentially curative cancer care,” Shulman says.   

The study did not take into account the health insurance systems in different countries. 

“The implications of our findings are limited because we were not able to take discounts and rebates into account, which would better predict drug affordability,” Goldstein said.

GDPcapPPP is a measure of national wealth that takes into consideration the cost of living. The GDPcapPPP data for each country was obtained from the International Monetary Fund and researchers used it to estimate the affordability of drugs.

 

Global sales of cancer drugs rose 11.5% to $107 billion in 2015, according to report by the IMS. The growth was driven by a record number of new launches, with 70 new oncology drugs entering the market over the past five years. However, many of the recently launched medicines are not yet available to patients in most countries, and even when registered they may not be reimbursed under public insurance programs.

The pharmaceutical industry has come under severe scrutiny lately over the pricing issue. US presidential hopefuls Donald Trump and Hilary Clinton have both pledged action to lower prescription drug costs if elected to office.

Economic Crisis and Cancer Deaths

The 2008 global economic crisis and the resulting fallout in the form of unemployment and cutting of public-sector health spending have been associated with increased cancer mortality, according to a new study published in The Lancet.

Lead author Mahiben Maruthappu from Imperial College London, UK, said: “Cancer is a leading cause of death worldwide so understanding how economic changes affect cancer survival is crucial. We found that increased unemployment was associated with increased cancer mortality, but that universal health coverage protected against these effects. This was especially the case for treatable cancers including breast, prostate and colorectal cancer.” 

The economic crisis was associated with over 260,000 additional cancer deaths in countries within the Organisation for Economic Development (OECD) by 2010, of which 160,000 were in the European Union, according to the research. 

“We also found that public healthcare spending was tightly associated with cancer mortality – suggesting healthcare cuts could cost lives. If health systems experience funding constraints, this must be matched by efficiency improvements to ensure patients are offered the same level of care, regardless of economic environment or employment status,” Maruthappu says. 

Cancer accounted for 8.2 million deaths in 2012, and the number of cases is expected to increase from 14 million in 2012 to 22 million in 2030. The economic crisis beginning in 2008 saw a substantial rise in unemployment, and caused many countries to cut public-sector health care spending. Several studies have shown the impact of these changes on mental and physical health – for instance increases in suicide or cardiovascular disease. 

Anjali Shukla 

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