the Union for International Cancer Control (UICC),
discussed the economic case for cancer control. The
estimated total annual economic cost of cancer globally was
approximately US$ 1.16 trillion in 2010 and broader
estimates of the costs of cancer, using a Value of Statistical
Life approach bring the annual global cost of cancer to US$
2.5 trillion. They also estimated that by implementing
resource-appropriate strategies for prevention, early
detection and treatment, between 2.4 and 3.7 million lives
could be saved each year, 80% of them in low- and middleincome
countries (LMICs). In economic terms, the value of
the healthy years of productive life that could be saved totals
between US$ 331 and US$ 451 billion, yielding an estimated
return on investments in prevention and treatment ranging
from US$ 10 billion to US$ 230 billion. The conclusion of the
250 high-level participants, including representatives from
UN agencies, ministries of health and finance, international
cancer organizations and private sector leaders was that
investing in cancer control saves lives and makes financial
sense (4).
Position of leading organizations
The American Society of Clinical Oncology (ASCO) also
raises cost concerns in its just-published The State of Cancer
Care in America 2014, stating that financial pressures and
instability are a "major threat to practices" and that the
quality of care throughout the United States is inconsistent.
Ann Steagall, Director of Clinical Policy at Biologics Inc., says
"the rising costs of cancer care are unsustainable for every
stakeholder." But ASCO remains shy about holding drug
makers responsible for the high cost of cancer care (5).
The World Health Organization (WHO) estimates that
nearly one third of the world's population does not have
access to full and effective treatment with the medicines
they need and this rises to over 50% in the poorest parts of
the world. Even in highly developed countries access to some
drugs and to the best available therapy is not guaranteed for
everyone.
Cancer therapies represent one of the great "missing
links" in cancer control efforts in LMICs. Access barriers to
cancer drugs are especially striking in light of the many
research advances of recent years, which have significantly
elevated the role of systemic therapy in the management of
many priority cancers. There is little or no international
funding for cancer treatment compared to the billions of
dollars that are used for other health-related purposes.
WHO has previously produced recommendations on the
essential drugs required for cancer therapy, and several new
anti-cancer drugs have been aggressively marketed. Most of
these are costly and produce only limited benefit (6).
WHO divided currently available anti-cancer drugs into
three priority groups (curable, increased curability-adjuvant
and prolong survival). Curable cancers and those cancers
where the cost-benefit ratio clearly favours drug treatment
can be managed appropriately with regimens based on only
17 drugs. All of these are available, at relatively low cost, as
generic preparations and the wide availability of these drugs
should be the first priority, especially for LMICs (6).
The WHO Model List of Essential Medicines for adults and
children presents a set of medicines that are considered to
be cost-effective and of critical public health importance in
all countries. In this sense, "Essential medicines" are defined
as those that "satisfy the priority health-care needs of the
population; they should therefore be available at all times in
adequate amounts and in appropriate dosage forms, at a
price the community can afford" (7).
The European Parliament recently debated the issue of
life-saving medicines and the excessively high pricing in
certain Member States. Speaking in the context of the
debate, health spokesperson Michele Rivasi, who initiated
the discussions, said: "The astronomical prices of some lifesaving
medicines is meaning those suffering from these
illnesses are unable to afford their treatment. This is a
scandal in itself but it is an even greater scandal that the
European Commission is refusing to address the issue,
notably by tackling the issue of monopolies and abuse of
market position" (8).
Barriers to access
Drugs costs, insufficient public funding of health, poor
infrastructure, the irrational use of cancer drugs,
bureaucratic policies and counterfeit medicines are the most
common obstacles in most of the countries of the developing
world. As an example, in developed countries sales of
counterfeit drugs represent less than 1% of the
pharmaceutical market; but this rises to 10-30% in parts of
Asia and Latin America and up to 70% in some African
countries.
Radiotherapy is a basic component of cancer treatment
and is recognized as an essential tool in the cure and
palliation of cancer, and recommended in 52% of new cancer
patients. In LMICs, the need for radiation therapy may in fact
be higher due to a more advanced stage of disease at
presentation. It has also been established that proximity and
timely access to radiotherapy facilities are known to affect
clinical outcomes. Unfortunately, access to radiation therapy
is limited in some countries and non-existent in others. Of
African nations, 29 of 52 have no radiotherapy facilities at
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