SPONSORED FEATURE: JOHNS HOPKINS MEDICINE
ISSUES IN ACCESS TO CANCER MEDICATIONS IN
LOW- AND MIDDLE-INCOME COUNTRIES
GILBERTO DE LIMA LOPES, JR, MD, MBA, FAMS, THE JOHNS HOPKINS SINGAPORE INTERNATIONAL MEDICAL CENTRE,
SINGAPORE AND THE JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE, BALTIMORE, MD, USA
In the last five decades major breakthroughs have been realized in the treatment of cancer
but, mainly due to the high cost of new drugs, for those of us who practice in low- and middle-
income countries (LMIC) many of these advances are but an aspiration and hope for the
future. LMIC account for about 60% of new cancer cases and nearly two thirds of related
deaths, demonstrating the lower ability these nations have to address the disease; yet
emerging economies incur a paltry 6.2% of the global cancer cost and are responsible for a
whopping 89% of the global cancer expenditure gap.
Cost of cancer in low- and middle-income countries expressing breast cancer. This contrasted to 55% of patients in
We have calculated the economic burden of cancer per patient, Singapore, a high-income country in south-east Asia. Moreover,
including direct medical costs, non-medical costs and we validated these results using sales data from IMS Health and
productivity losses, in South America, China and India to be calculated the expenditure per capita on the same index of drugs
US$7.92, US$4.32 and US$0.54, respectively, which is little to be US$0.49 in Thailand, US$0.48 in Malaysia, US$0.12 in the
when compared to US$183, US$244 and US$460 in the United Philippines, US$0.11 in Vietnam and US$0.04 in Indonesia as
Kingdom, Japan and the United States, in that order. Adjusting compared to US$6 in Singapore and US$20 in the United
by income at current exchange rates, the cost of cancer care States. Not surprisingly, access correlated strongly with GNI per
represents 0.12% of gross national income per capita (GNI) in capita (R2=0.99) and, interestingly, with cost-effectiveness
South America, 0.05% in India and 0.11% in China. In the United (R2=0.7), even though only Thailand routinely uses health
Kingdom, Japan and United States the corresponding cost was economics evaluations when deciding on therapeutic coverage
0.51%, 0.6% and 1.02% of GNI per capita, respectively. in the region.
This paper is a summary version of a more comprehensive and
Access to cancer medications in low- and middle- detailed manuscript which will be published in an upcoming
income countries issue of Nature Reviews Clinical Oncology.
Little data has been presented or published on the prevalence of
use of cancer medications in emerging markets. In a survey and Universal coverage for health care in emerging
focus group of medical oncologists and health care policy economies
experts from six South-east Asian nations at the first Southeast With the goal of improving access to health care, universal
Asian Cancer Care Access Network (SEACCAN) meeting in insurance coverage, the fundamental element of functional
2011, we estimated that approximately 15% of patients in low- health care systems as it pools resources and provides
and middle-income countries in the region had access to an financial protection from the costs of illness, is increasingly
index of medications which included oxaliplatin in the adjuvant common in emerging Asian and Latin American countries.
treatment of colon cancer, bevacizumab and cetuximab in the However, the majority of countries, many of which are in
palliative treatment of colorectal cancer; gefitinib or erlotinib in Africa, still lack universal coverage. Encouragingly, large
the treatment of patients with metastatic lung cancer who middle-income countries which still lack universal coverage
harbour epidermal growth factor receptor mutations; sorafenib are working towards it. Indonesia recently passed legislation
in the management of advanced hepatocellular carcinoma; and establishing the first steps towards comprehensive coverage
trastuzumab in the adjuvant therapy of early HER2/neu over- and China’s efforts are well under way and on target to cover
24 CANCER CONTROL 2013