Barriers to access and use of high cost medicines: A review

Wahlster, Philip; Scahill, Shane; Lu, Christine Y.; Babar, Zaheer Ud Din

doi:10.1016/j.hlpt.2015.04.009

Cited by 23 publications

(20 citation statements)

References 63 publications

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“…Public health institutions and the government need to reflect on how resources can be allocated more equally and efficiently to ensure universal access to the most cost-effective level of care. Improving access and use of innovative treatments of which the effectiveness, safety and cost-effectiveness have been established, will provide better quality of cancer care, better health outcomes and fewer deaths due to cancer [ 49 , 51 ]. The government should monitor the needs for these medicines along with their actual use and access to guarantee the best level of care.…”

Section: Discussionmentioning

confidence: 99%

Access to innovative cancer medicines in a middle-income country - the case of Mexico

Moye-Holz

Saucedo

Dijk

et al. 2018

J of Pharm Policy and Pract

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BackgroundCancer has become the third cause of death in Mexico. Treatment for cancer is often complex and lengthy. New and better medicines enter the market at high prices, which may limit access. Like most Latin American countries, Mexico has an essential cancer medicines list that includes innovative medicines. Their accessibility and use in the public sector remains unknown. Therefore, we describe the use, as a proxy of access, of innovative and essential cancer medicines in the public sector in Mexico, by insurance institution, and by five regions between 2010 to 2016.MethodsWe used drug utilization research methods to assess the use of eight patented cancer medicines. Through the national transparency platform, we obtained data on the quantities of these medicines used in all public health facilities and social health insurance institutions and recalculated those figures into defined daily dose (DDD) per 1000 population per year.ResultsOverall, the use of all medicines increased over the years, especially for trastuzumab, rituximab and imatinib. The use of innovative medicines was higher per population covered in social health insurance institutions than in governmental facilities. Throughout the study period, the Central region (including Mexico City) has used more medicines per population than the other regions.ConclusionsThe use and access of some essential innovative cancer medicines has increased over the years, but remains unequal across insurance schemes and regions. Particularly, the Ministry of Health Insurance scheme and Northern and Western regions in the country would benefit from additional efforts to increase access to essential cancer medicines.

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Section: Discussionmentioning

confidence: 99%

Access to innovative cancer medicines in a middle-income country - the case of Mexico

Moye-Holz

Saucedo

Dijk

et al. 2018

J of Pharm Policy and Pract

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“…In Taiwan, similar to many other countries, health technology assessment to restrict coverage, prior authorization, and higher out-of-pocket costs by patients have been used to relief some economic burden for the national health system. The high cost of targeted therapies may continue to be a barrier to access for patients with cancer [ 45 , 46 ]. Increasing economic burden on cancer care overall due to growing use of high-cost targeted therapies challenges the sustainability of the universal insurance system because there might be ‘trade-offs’ to be made with reimbursements for non-cancer services and treatments.…”

Section: Discussionmentioning

confidence: 99%

Geographic Variations and Time Trends in Cancer Treatments in Taiwan

Hsu

Chang

2017

BMC Public Health

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BackgroundTargeted therapies have become important treatment options for cancer care in many countries. This study aimed to examine recent trends in utilization of antineoplastic drugs, particularly the use of targeted therapies for treatment of cancer, by geographic region in Taiwan (northern, midwestern, southern, and eastern regions and the outer islands).MethodsThis was a retrospective observational study of antineoplastic agents using 2009-2012 quarterly claims data from Taiwan’s National Health Insurance Research Database. Yearly market shares by prescription volume and costs for targeted therapies among total antineoplastic agents by region were estimated. We used multivariate regression model and ANOVA to examine variations in utilization of targeted therapies between geographic regions and used ARIMA models to estimate longitudinal trends.ResultsPopulation-adjusted use and costs of antineoplastic drugs (including targeted therapies) were highest in the southern region of Taiwan and lowest in the outer islands. We found a 4-fold difference in use of antineoplastic drugs and a 49-fold difference in use of targeted therapies between regions if the outer islands were included. There were minimal differences in use of antineoplastic drugs between other regions with about a 2-fold difference in use of targeted therapies. Without considering the outer islands, the market share by prescription volume and costs of targeted therapies increased almost 2-fold (1.84-1.90) and 1.5-fold (1.26-1.61) respectively between 2009 and 2012. Furthermore, region was not significantly associated with use of antineoplastic agents or use of targeted therapies after adjusting for confounders. Region was associated with costs of antineoplastic agents but it was not associated with costs of targeted therapies after confounding adjustments.ConclusionsUse of antineoplastic drugs overall and use of targeted therapies for treatment of cancer varied somewhat between regions in Taiwan; use was notably low in the outer islands. Strategies might be needed to ensure access to cancer care in each region as economic burden of cancer care increase due to growing use of targeted therapies.

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“… 29 43 44 The high cost of targeted therapies may continue to be a barrier to access for patients with eye cancer. 45 46 In Taiwan, prior authorisation and/or higher out-of-pocket costs by patients have been used for targeted therapies to relieve some economic burden for the national health system.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal trends in use of targeted therapies for treatment of malignant neoplasms of the eye: a population-based study in Taiwan

Hsu

González-González

et al. 2016

BMJ Open

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ObjectivesThis study examined the recent trend in use and costs of antineoplastic agents for treatment of eye malignancies in Taiwan from 2009 to 2012. We also forecasted use and costs of targeted therapies up to and including year 2016 based on the current patterns.DesignRetrospective observational study focusing on the usage of targeted therapies for treatment of eye malignancy.SettingThe monthly claims data for eye malignancy-related antineoplastic agents were retrieved from Taiwan's National Health Insurance Research Database (2009–2012).Main outcome measuresWe calculated the number of prescriptions and costs for each class of medications, and analysed their time trends. In addition, using a time series design with ARIMA models, we estimated the market share by prescription volume and the proportion of costs for targeted therapies for year 2016.ResultsThe market share by prescription volume of targeted therapies grew from 1.56% in 2009 to 9.98% in 2012 among all antineoplastic agents, and the proportion of costs for targeted therapies rose from 15.12% in 2009 to 58.88% in 2012. Especially, the proportion of costs for protein kinase inhibitors grew from 25.62% to 45.28% among all antineoplastic agents between 2010 and 2012. The market share by prescription volume and the proportion of costs for targeted therapies for treatment of eye malignancies were predicted to reach 27.33% and 91.39% by the fourth quarter in 2016, respectively.ConclusionsThis is the first study that examined and forecasted use and costs of targeted therapies for treatment of eye malignancies in Taiwan. Our findings indicate that, compared with other classes of drugs, targeted therapies are having a more and more relevant share among all treatment strategies for eye malignancies in Taiwan, and due to their high costs they are likely to cause great economic burden.

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Barriers to access and use of high cost medicines: A review

Cited by 23 publications

References 63 publications

Access to innovative cancer medicines in a middle-income country - the case of Mexico

Access to innovative cancer medicines in a middle-income country - the case of Mexico

Geographic Variations and Time Trends in Cancer Treatments in Taiwan

Longitudinal trends in use of targeted therapies for treatment of malignant neoplasms of the eye: a population-based study in Taiwan

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