Financial toxicity in cancer care in India: a systematic review

Boby, Jeffrey Mathew; Rajappa, Senthil; Mathew, Aju

doi:10.1016/s1470-2045(21)00468-x

Cited by 57 publications

(53 citation statements)

References 52 publications

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“…The process of procurement and sale of the drugs in the private sector remains largely unregulated and contributes to significant OOP and catastrophic expenditure. 27,28 Further work is needed to better understand the medicine supply chain and identify the steps leading to prices becoming unaffordable for patients. The priority list of oncologists from India had 85% concordance with that of other LMICs, highlighting the wide consensus on relevance of these drugs in similar settings.…”

Section: Discussionmentioning

confidence: 99%

Cancer Medicines: What Is Essential and Affordable in India?

Sengar

Fundytus

Hopman

et al. 2022

JCO Global Oncology

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PURPOSE The WHO essential medicines list (EML) guides selection of drugs for national formularies. Here, we evaluate which medicines are considered highest priority by Indian oncologists and the extent to which they are available in routine practice. METHODS This is a secondary analysis of an electronic survey developed by the WHO EML Cancer Medicine Working Group. The survey was distributed globally using a hierarchical snowball method to physicians who prescribe systemic anticancer therapy. The survey captured the 10 medicines oncologists considered highest priority for population health and their availability in routine practice. RESULTS The global study cohort included 948 respondents from 82 countries; 98 were from India and 67 were from other low- and middle-income countries. Compared with other low- and middle-income countries, the Indian cohort was more likely to be medical oncologist (70% v 31%, P < .001) and work exclusively in the private health system (52% v 17%, P < .001). 14/20 most commonly selected medicines were conventional cytotoxic drugs. Universal access to these medicines was reported by a minority of oncologists; risks of significant out-of-pocket expenditures for each medicine were reported by 19%-58% of oncologists. Risk of catastrophic expenditure was reported by 58%-67% of oncologists for rituximab and trastuzumab. Risks of financial toxicity were substantially higher within the private health system compared with the public system. CONCLUSION Most high-priority cancer medicines identified by Indian oncologists are generic chemotherapy agents that provide substantial improvements in survival and are already included in WHO EML. Access to these treatments remains limited by major financial burdens experienced by patients. This is particularly acute within the private health system. Strategies are urgently needed to ensure that high-quality cancer care is affordable and accessible to all patients in India.

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Section: Discussionmentioning

confidence: 99%

Cancer Medicines: What Is Essential and Affordable in India?

Sengar

Fundytus

Hopman

et al. 2022

JCO Global Oncology

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“…It is broadly defined as the adverse financial situation that arises as part of cancer therapy for the patient, and it directly impacts their financial security and well-being. The rising economic burden of cancer therapies is associated with an increased risk of financial insolvency and non-compliance to treatment in addition to negatively impacting the quality of life of the patient and family [ 2 ]. A study conducted among cancer patients in the USA reported that patients with cancer are 2.6 times more likely to go bankrupt compared to those without it [ 3 ].…”

Section: Rising Cost Of Cancer Carementioning

confidence: 99%

“…A study conducted among cancer patients in the USA reported that patients with cancer are 2.6 times more likely to go bankrupt compared to those without it [ 3 ]. The rising cost of cancer care is especially prominent in low-middle-income countries with low government expenditure on health care, dismal insurance coverage, and high out-of-pocket expenditures [ 2 ].…”

Section: Rising Cost Of Cancer Carementioning

confidence: 99%

Value-Based Care in Systemic Therapy: The Way Forward

et al. 2022

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The rising cost of cancer care has shed light on an important aspect of healthcare delivery. Financial toxicity of therapy must be considered in clinical practice and policy-making. One way to mitigate the impact of financial toxicity of cancer care is by focusing on an approach of healthcare delivery that aims to deliver value to the patient. Should value of therapy be one of the most important determinants of cancer care? If so, how do we measure it? How can we implement it in routine clinical practice? In this viewpoint, we discuss value-based care in systemic therapy in oncology. Strategies to improve the quality of care by incorporating value-based approaches are discussed: use of composite tools to assess the value of drugs, alternative dosing strategies, and the use of Health Technology Assessment in regulatory procedures. We propose that there must be a greater emphasis on value of therapy in determining its use and its cost.

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“…[3][4][5][6] The financial toxicity of cancer treatment is often a concern in resource-challenged settings like India, wherein high out-of-pocket expenditures for healthcare and noncompliance to treatment are major issues. [7][8][9] Although anti-emetic prophylaxis is standard during chemotherapy, drugs are often chosen based on the relative cost and effectiveness. Despite the acquisition cost of palonosetron being greater than ondansetron, palonosetron is often chosen over ondansetron in children because of superior emesis control with better cost-effectiveness.…”

Section: Introductionmentioning

confidence: 99%

“…The financial toxicity of cancer treatment is often a concern in resource‐challenged settings like India, wherein high out‐of‐pocket expenditures for healthcare and noncompliance to treatment are major issues 7–9 . Although anti‐emetic prophylaxis is standard during chemotherapy, drugs are often chosen based on the relative cost and effectiveness.…”

Section: Introductionmentioning

confidence: 99%

Cost‐effectiveness analysis of aprepitant‐based anti‐emetic regimen for children receiving highly emetogenic chemotherapy: Individual patient data analysis of a randomized trial

Singh

Ganguly

Sasi

et al. 2022

Pediatric Blood & Cancer

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Background: Aprepitant has been shown to reduce chemotherapy-induced nausea and vomiting in children receiving highly emetogenic chemotherapy (HEC). In this study, we assessed the cost-effectiveness of aprepitant for children receiving HEC in India, United Kingdom, and the United States. Procedure:We utilized individual patient-level outcome data from a pediatric randomized trial, which demonstrated the superiority of an aprepitant-based anti-emetic prophylaxis over standard ondansetron and dexamethasone for HEC. Health state for each day of follow-up was analyzed and quality-adjusted life years (QALYs) were estimated. The incremental cost-utility ratio (ICUR), incremental cost-effectiveness ratio (ICER), and net monetary benefit (NMB) for each country were estimated. Sensitivity analyses by varying cost of aprepitant, hospitalization, and health state utility values by ±25% were conducted.Results: Use of the aprepitant-based regimen resulted in gain of 0.

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Financial toxicity in cancer care in India: a systematic review

Cited by 57 publications

References 52 publications

Cancer Medicines: What Is Essential and Affordable in India?

Cancer Medicines: What Is Essential and Affordable in India?

Value-Based Care in Systemic Therapy: The Way Forward

Cost‐effectiveness analysis of aprepitant‐based anti‐emetic regimen for children receiving highly emetogenic chemotherapy: Individual patient data analysis of a randomized trial

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