Regulatory and logistical issues influencing access to antineoplastic and supportive care medications for children with cancer in developing countries

Abstract

Globally there are numerous impediments, both logistical, regulatory and more recently global drug shortages, hindering pediatric access to therapeutic drugs of all types. Efforts to reduce barriers are ongoing and are especially important in low and middle income countries and for children requiring treatment of conditions such as those encountered in pediatric oncology characterized by the risk of life threatening treatment failures. Progress has been made through the efforts of the World Health Organization and regulators in the US and Europe to encourage the development of therapeutic agents for use in pediatrics and measures taken have fostered the availability of stronger pediatric data to guide therapeutic decisions. Nonetheless, pharmaceuticals remain a global commodity, subject to regulation by the World Trade Organization and this has often had detrimental effects in low and middle income countries. This article emphasizes the need for closer international collaboration to address the barriers currently impeding access to antineoplastic and supportive care medicines for children.

Sharp rise in the expenditures of targeted drugs in Ecuador: five-year (2010-2014) consumption of oncologic drugs in public and private hospitals

“…Shortages of oncologic drugs must be explored when analysing the low level and downwards trend of chemotherapy exposure in the public sector. Shortages of essential chemotherapy drugs are a rising problem worldwide . Oncologists in the United States have reported being unable to prescribe the preferred drug because of shortages in 74% to 82.7% of cases during the previous 6 months of the survey, and up to 59% of them substituted with a more expensive drug, leading to an important increase in cancer‐related expenditures.…”

“…Shortages of essential chemotherapy drugs are a rising problem worldwide. [32,33] Oncologists in the United States have reported being unable to prescribe the preferred drug because of shortages in 74% to 82.7% of cases during the previous 6 months of the survey, [34,35] and up to 59% of them substituted with a more expensive drug, [35] leading to an important increase in cancer-related expenditures. Recently, Unguru et al have published an ethical framework to better deal with this menace.…”

Challenges in managing infections among pediatric cancer patients: Suboptimal national essential medicines lists for low and middle income countries

“…Although pooled procurement has been effectively used to manage medication cost for some institutions, the quality of medication supplied by manufacturers and distributors are questionable . Many LMICs must import medicines because of a lack of domestic pharmaceutical manufacturing capacity but do not have the infrastructure to monitor the quality of these imported medicines . Low‐quality or counterfeit medicines may be particularly harmful for immunosuppressed cancer patients .…”

Strategies for Managing the Costs of Chronic Illness in the Context of Limited Financial Resources: A Qualitative Study in Dominican Persons With Arthritis

“…There is limited research on the manner in which individuals living in resource‐limited settings manage the costs of chronic illness given scant personal resources . In particular, only a few qualitative studies have addressed this topic .…”