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Mexico-the five regions of study. Region 1 (North): Baja California, Baja California Sur, Chihuahua, Coahuila, Durango, Nuevo León, Sinaloa, Sonora, Tamaulipas. Region 2 (Center): Mexico City, Mexico State, Guanajuato, Morelos, Querétaro, San Luis Potosí, Zacatecas. Region 3 (West): Aguascalientes, Colima, Guerrero, Jalisco, Michoacan, Nayarit. Region 4 (East): Hidalgo, Puebla, Tlaxcala, Veracruz. Region 5 (South): Campeche, Chiapas, Oaxaca, Quintana Roo, Tabasco, Yucatan.

Mexico-the five regions of study. Region 1 (North): Baja California, Baja California Sur, Chihuahua, Coahuila, Durango, Nuevo León, Sinaloa, Sonora, Tamaulipas. Region 2 (Center): Mexico City, Mexico State, Guanajuato, Morelos, Querétaro, San Luis Potosí, Zacatecas. Region 3 (West): Aguascalientes, Colima, Guerrero, Jalisco, Michoacan, Nayarit. Region 4 (East): Hidalgo, Puebla, Tlaxcala, Veracruz. Region 5 (South): Campeche, Chiapas, Oaxaca, Quintana Roo, Tabasco, Yucatan.

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Background:Cancer 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...

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... SP's reimbursement guidelines were set to cover medicines for basic cancer care and define reference prices, which are similar to international reference prices. Eight percent of SP's resources were allocated to "Fondo de Protrección contra Gastos Catastróficos" (FPGC), of which 28% finances cancer care [88]. Unfortunately, with the new government taking office in 2018, SP was supposed to be replaced by the new Institute of Health for Wellness (Instituto de Salud para el Bienestar or INSABI), which has faced enormous complications in its proper operation, leading, among other calamities, to the crisis of scarcity of medicines to treat infantile cancers in particular, and of oncology treatments for the entire population in general. ...
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Tackling cancer is a major challenge right on the global level. Europe is only the tip of an iceberg of cancer around the world. Prosperous developed countries share the same problems besetting Europe–and the countries and regions with fewer resources and less propitious conditions are in many cases struggling often heroically against a growing tide of disease. This paper offers a view on these geographically wider, but essentially similar, challenges, and on the prospects for and barriers to better results in this ceaseless battle. A series of panels have been organized by the European Alliance for Personalised Medicine (EAPM) to identify different aspects of cancer care around the globe. There is significant diversity in key issues such as NGS, RWE, molecular diagnostics, and reimbursement in different regions. In all, it leads to disparities in access and diagnostics, patients’ engagement, and efforts for a better understanding of cancer.
... Therefore, the cost and affordability should be taken into consideration when negotiating medicine procurement terms. Consistent with other previous findings, the barriers to the accessibility of negotiated targeted anti-cancer drugs include high prices, limited coverage of public insurance schemes (62), inequality across insurance schemes, regional variations (59), non-availability of the medicine at the facilities, and updated clinical diagnosis and treatment standards (63). This in turn could be due to the differences in the high cost of anti-cancer drugs, the burden of disease, disease priorities, the capacity of the health insurance system, government budget management, regional economic development, and unequal diagnosis and treatment capacities of medical institutions (64, 65). ...
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Background In order to establish a long-term strategy for bearing the costs of anti-cancer drugs, the state had organized five rounds of national-level pricing negotiations and introduced the National Health Insurance Coverage (NHIC) policy since 2016. In addition, the National Healthcare Security Administration (NHSA) introduced the volume-based purchasing (VBP) pilot program to Nanjing in September 2019. Taking non-small cell lung cancer as an example, the aim of the study was to verify whether national pricing negotiations, the NHIC policy and the VBP pilot program had a positive impact on the accessibility of three targeted anti-cancer drugs.Methods Based on the hospital procurement data, interrupted time series (ITS) design was used to analyze the effect of the health policy on the accessibility and affordability of gefitinib, bevacizumab and recombinant human endostatin from January 2013 to December 2020 in Nanjing, China.ResultsThe DDDs of the three drugs increased significantly after the policy implementation (P < 0.001, P < 0.001, P = 0.008). The trend of DDDc showed a significant decrease (P < 0.001, P < 0.001, P < 0.001). The mean availability of these drugs before the national pricing negotiation was <30% in the surveyed hospitals, and increased significantly to 60.33% after 2020 (P < 0.001, P = 0.001, P < 0.001). The affordability of these drugs has also increased every year after the implementation of the insurance coverage policy. The financial burden is higher for the rural patients compared with the urban patients, although the gap is narrowing.Conclusion The accessibility of targeted anti-cancer drugs has increased significantly after the implementation of centralized prices, the NHIC policy and the VBP pilot program, and has shown sustained long-term growth. Multi-pronged supplementary measures and policy approaches by multiple stakeholders will facilitate equitable access to effective and affordable anti-cancer drugs.
... A survey about the barriers of access to the study medicines in the United States and several emerging markets showed that doctors in a considerable number of countries reported that insurance coverage, availability of medicines, and cost to the patients were the common barriers [32]. After the novel medicines were included in Mexico's public insurance system, medicines utilization in remote or less developed areas was much lower than that in the areas which were closer to the capital city [33,34].. ...
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Background China started to cover novel medicines for the treatment of major cancers, such as trastuzumab for breast cancer by the government health insurance programs since 2016. Limited data have been published on the use of cancer medications and little is known about how government health insurance coverage of novel anti-cancer medicines benefited patients in the real world. This study aimed to generate evidence to inform the health security authorities to optimize the government health insurance coverage of novel anti-cancer medicines as a more inclusive and equal policy, through which each of the needed patient can get access to the novel anti-cancer medicines regardless of the ability to pay. Methods The study targeted one of the government health insurance newly covered novel medicines for breast cancer and the breast cancer patients. The analyses were based on the data collected from one tertiary public hospital in Fujian province of China. We conducted interrupted time series analysis with a segmented regression model and multivariate analyses with a binary logistic regression model to analyze the impact of the government health insurance coverage on medicines utilization and the determinants of patient’s medication choice. Results The average proportion of patients who initiated medication with novel medicines increased from 37.4% before the government health insurance coverage to 69.2% afterwards. Such an increase was observed in all patient sub-groups. The monthly proportion of patients who initiated medication with novel medicines increased sharply by 18.3 % (95 %CI,10.4-34.0 %, p = 0.01) in September 2017, the afterwards trend continuously increased (95 %CI,1.03–3.60, p = 0.02). The critical determinants of patient's medication choice were mostly connected with the patient's health insurance benefits packages. Conclusions The government health insurance coverage of novel anti-breast-cancer medicines benefited the patients generally. The utilization of novel medicines such as trastuzumab continuously increased. The insurance coverage benefited well the patients in the high-risk age groups. However, rural patients, patients enrolled in the “resident program”, and patients from low-income residential areas and non-local patients benefited less from this policy. Improving the benefits package of the low-income patients and the “resident program” beneficiary would be of considerable significance for a more inclusive and equal health insurance coverage of novel anti-cancer medicines.
... The BCR-ABL inhibitors, due to the high consumption of imatinib, was the group of PKIs most used in Norway. This is in line with studies from other countries (8,9). Imatinib is a first line treatment for patients with chronic myeloid leukemia and gastrointestinal stromal tumor (GIST) in Norway (10,11). ...
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Background: Antineoplastic agents (ATC group L01) have not been assigned DDDs due to highly interindividual variation in dosages. Consumption data has therefore been presented in other measurement units such as grams of active ingredient. However, the protein kinase inhibitors (PKIs) are a rapidly growing drug group that was introduced to the market recently and are administered orally in a fixed dose. DDDs were therefore established for the PKIs in 2020. In this study we aim to assess whether the newly assigned DDDs would better express drug utilisation patterns in Norway than the current units of measurement. Methods: Sales data for PKIs (ATC level L01E) by grams, cost, units and packages for 2019 were collected from the Norwegian Drug Wholesales Statistics and data on number of prescriptions and prevalence for 2019 were collected from the Norwegian Prescription Database (NorPD). DDDs were calculated by applying the values of the new DDDs. Results: The proportions of the different substances varied according to the unit of measurement. DDDs and packages had the highest similarity and correlated better than grams with the prevalence of use in the Norwegian population. BCR-ABL tyrosine kinase inhibitors was the largest group accounting for 31% of the total consumption (DDD/1000 inhabitants/day) and imatinib was the most sold PKI in all units of measurement except cost. Conclusions: Using an international agreed unit of measurement gives reliability to the study result. Assignment of DDDs to PKIs will improve the quality of drug utilisation studies in this area.
... For the United States, we use the U.S. Census Bureau's fourregion classification scheme. For Mexico, we adopt the five-region classifications used by Moye-Holz et al. (2018). States in the South region of each country are the excluded reference category in all models. ...
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Why do COVID-19 social distancing policies vary so widely across states in federal countries? This mixed-methods study of Brazil, Mexico, and the United States finds that state-level variation in the stringency of social distancing policies is driven not by the epidemiological, demographic, or socioeconomic factors commonly emphasized in previous research, but largely by political factors. Introducing a novel framework for explaining pandemic policymaking, the study shows the central importance of political parties, presidential power, and governors’ coalitions in determining state-level policy stringency. In the United States and Mexico, statistical and qualitative evidence indicates that interstate collaboration among governors, combined with top-down pressures from national party elites and presidents, led to greater policy alignment among coordinated states. In Brazil, in contrast, where there is little evidence of either policy coordination or alignment, state-level policies resulted instead from intrastate factors and diffusion. Together, these findings highlight how a multilevel framework attuned to varied combinations of intra-unit, cross-unit, and cross-level causal factors strengthens our understanding of pandemic policymaking.
... Overall, 13 studies were included in the review with some having multiple outcomes: five studies (16)(17)(18)(19)(20) were on the pricing of anticancer medicines, four studies (4,18,21,22) addressed affordability of anti-cancer medicines, and five studies reported (8,18,20,22,23) on the availability of anticancer medicines and overall four studies (8,(24)(25)(26) was on access to anti-cancer medicines. ...
... Studies on access showed large variability within income groups of what was identified as essential in NEMLs and National Reimbursable Medicine List (NRMLs) (24,26). A study (24) explored access in 135 LMICs, to the 18 essential and 8 ancillary antineoplastic medicines proposed by the International Society of Pediatric Oncology (SIOP) to be essential in the supportive care of children with cancer. ...
... In studies (24,26), there are certainly highlighted inequalities in access to cancer care. Barriers to access and use of innovative Pricing, Availability. ...
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Background: Cancer is the second leading cause of death globally accounting for more than half of deaths in Low- and Middle-Income Countries (LMICs). Cancer treatment is expensive and the high prices of cancer medicines have a huge impact on access in LMICs. Scarcity of pricing or affordability data is one of the major barriers in the development of effective and transparent pricing policies in LMICs. This study aimed to conduct a systematic review of the literature regarding pricing, availability, affordability, and access to anti-cancer medicines in LMICs. Method: A systematic search was conducted across six electronic databases: PubMed, Medline/CINAHL (EBSCO), Web of Science, Springer Links, Scopus, and Google Scholar. The literature (from 2015 to 2020) was reviewed to identify original research articles published in English. Results: A total of 13 studies were included in the review with some having multiple outcomes: five studies on pricing, four studies addressed affordability, five studies reported on availability, and four studies on access to anti-cancer medicines. The studies showed that in LMICs, there are wide variations in cancer prices and availability amongst the medicine brands and across different countries, with less affordability by patients with low-income levels, sometimes leading to treatment abandonment. Conclusion: Given the importance of medicine availability and prices in patient access and medicine buying capacity of governments, multi-pronged policy and program approaches by multiple stakeholders are needed to ensure access to cancer medicines.
Article
Low- and middle-income countries (LMICs) represent a diverse group of regions with varied cancer presentation. Drug development and accessibility across these regions have primarily been dependent on the trials initiated and conducted across high-income countries. Representation of LMIC regions in these trials in terms of study population has been minimal, leading to inequitable distribution of optimal and affordable cancer care. In spite of many challenges, LMICs have now increasingly been able to contribute to anticancer drug development. The opportunities present in LMICs must be explored and used in conjunction with due collaborative efforts from high-income countries, health care planners, and regulatory agencies. Global drug development trials should not only factor in suitable representation of LMICs but also design studies with pragmatic objectives and endpoints so that the trial results lead to equitable and affordable cancer care. Strengthening collaboration between cancer researchers from LMICs and high-income countries and empowering the local investigator with adequate resources will help remove current disparities.
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Introduction Little is known about the impact of the government’s efforts in having novel anticancer medicines covered by the public health insurance system in China. This study targeted the above policy implemented in Fujian province in 2017, analysed the policy impact on the medical expenditure of cancer treatment and patient affordability based on the clinical data of Fujian provincial medical centre. Methods The study included 253 human epidermal growth factor receptor 2-positive patients with breast cancer who completed at least one course of trastuzumab treatment extracted from the hospital health information system of the provincial medical centre of Fujian. We adopted the propensity score-matching method to mimic a quasi-experimental design to estimate the impact of the public health insurance coverage policy on all the indicated patients with a before–after comparison of the total breast cancer-associated direct medical expenditures for a standard course of treatment or maintenance treatment and the proportionate patient out-of-pocket (OOP) expenditure based on the real clinical data. Results We found evidence of an association between the public health insurance coverage of novel breast cancer medication and the reductions of the medical expenditure by US$18661.02 (95% CI 13 836.57 to 28 201.45), and the proportionate patient OOP expenditure by 24% (95% CI0.20 to 0.27). The medical expenditure and the proportionate patient OOP expenditure might be generally reduced. Conclusions The coverage of innovative antibreast cancer medicines by the public health insurance was found to be associated with a reduction of the medical expenditure and share of patient OOP expenditure for cancer treatment of the indicated patients. Patients with lower ability-to-pay did not benefit well from the coverage policy. To maximise the welfare of the public health insurance coverage of novel anticancer medication, the study called for strengthened health insurance benefit packages of the rural patient and the patient enrolled in the urban and rural resident health insurance programme, who might have lower ability-to-pay and need more support from the public security system.
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Objectives: This study took Fuzhou city as a case, described how the public health insurance coverage policy in 2016 of novel anti-lung cancer medicines benefited patients, and who benefited the most from the policy in China. Methods: This was a retrospective study based on health insurance claim data with a longitudinal analysis of the level and trend changes of the monthly number of patients to initiate treatment with the novel targeted anti-lung cancer medicines gefitinib and icotinib before and after health insurance coverage. The study also conducted a multivariate linear regression analysis to predict the potential determinants of the share of patient out-of-pocket (OOP) expenditure for lung cancer treatment with the study medicines. Results: The monthly number of the insured patients in Fuzhou who initiated the treatment with the studied novel targeted anti-lung cancer medication abruptly increased by 26 in the month of the health insurance coverage (95% CI: 14–37, p < 0.01) and kept at an increasing level afterward (p < 0.01). By controlling the other factors, the shares of OOP expenditure for lung cancer treatment of the patients who were formal employee program enrollees not entitled to government-funded supplementary health insurance coverage and resident program enrollees were 18.3% (95% CI: 14.1–22.6) and 26.7% (95% CI: 21.0–32.4) higher than that of the patients who were formal employee program enrollees with government-funded supplementary health insurance coverage. Conclusion: The public health insurance coverage of novel anti-lung cancer medicines benefited patients generally. To enable that patients benefit from this policy more equally and thoroughly, in order to achieve the policy goal of not to leave anyone behind, it is necessary to strengthen the benefits package of the resident program and to optimize the current financing mechanism of the public health insurance system.
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Background There are concerns that high prices of cancer medicines may limit patient access. Since information on prices for cancer medicines and their impact on affordability is lacking for several countries, particularly for lower income countries, this study surveys prices of originator cancer medicines in Europe and Latin America and assesses their affordability.Methods For 19 cancer medicines, public procurement and ex-factory prices, as of 2017, were surveyed in five Latin American (LATAM) countries (Brazil, Chile, Colombia, Mexico, and Peru) and 11 European countries (Austria, France, Germany, Greece, Hungary, the Netherlands, Poland, Romania, Spain, Sweden, and the UK). Price data (public procurement prices in LATAM and ex-factory prices in Europe) in US dollar purchasing power parities (PPP) were analyzed per defined daily dose. Affordability was measured by setting medicines prices in relation to national minimum wages.ResultsThe prices of cancer medicines varied considerably between countries. In European countries with higher levels of income, PPP-adjusted prices tended to be lower than in European countries of lower income and LATAM countries. Except for one medicine, all surveyed medicines were considered unaffordable in most countries. In European countries of lower income and LATAM countries, more than 15 days’ worth of minimum wages would be required by a worker to purchase one defined daily dose of several of the studied medicines.Conclusions The high prices and large unaffordability of cancer medicines call for strengthening pricing policies with the aim of ensuring affordable treatment in cancer care.