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Languages: English
Types: Article

Classified by OpenAIRE into

mesheuropmc: health care economics and organizations
Background: Differential pricing, based on countries’ purchasing power, is recommended by the WHO to secure affordable medicines. However, in developing countries innovative drugs often have similar or even higher prices than in high-income countries. We evaluated the potential implications of trastuzumab global pricing policies in terms of cost-effectiveness (CE), coverage and accessibility for patients with breast cancer in Latin America (LA). Methods: A Markov model was designed to estimate life years (LYs), quality-adjusted life years (QALYs) and costs from a health care perspective. To better fit local cancer prognosis, a base case scenario using transition probabilities from clinical trials was complemented with two alternative scenarios with transition probabilities adjusted to reflect breast cancer epidemiology in each country. Findings: Incremental discounted benefits ranged from 0.87 to 1.00 LY and 0.51 to 0.60 QALY and incremental CE ratios from USD 42,104 to USD 110,283 per QALY (2012 US dollars), equivalent to 3.6 gross domestic product per capita (GDPPC) per QALY in Uruguay and to 35.5 GDPPC in Bolivia. Probabilistic sensitivity analysis showed 0% probability that trastuzumab is CE if the willingness-to-pay (WTP) threshold is one GDPPC per QALY, and remained so at three GDPPC threshold except for Chile and Uruguay (4.3% and 26.6% respectively). Trastuzumab price would need to decrease between 69.6% to 94.9% to became CE in LA. Interpretation: Although CE in other settings, trastuzumab was not CE in LA. The use of health technology assessment to prioritize resource allocation and support price negotiations is critical to making innovative drugs available and affordable in developing countries.
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    • 1. United Nations. General Assembly. Prevention and control of noncommunicable. Report of the Secretary-General 2011 [cited 2013 March 15]; Available from: http://www.un.org/ga/search/view_doc.asp?symbol=A/66/83&Lang=E
    • 2. World Health Organization. Preventing chronic diseases : a vital investment : WHO global report. WHO Library Cataloguing-in-Publication Data 2005 [cited 2013 March 15]; Available from: http://www.who.int/chp/chronic_disease_report/contents/foreword.pdf
    • 3. Howitt P, Darzi A, Yang GZ, Ashrafian H, Atun R, Barlow J, et al. Technologies for global health. Lancet. 2012; 380(9840): 507-35.
    • 4. World Health Organization. Research and development to meet health needs in developing countries: strengthening global financing and coordination: report of the consultative expert working group on research and development: financing and coordination. 2012 [cited 2013 March 15]; Available from: http://www.who.int/phi/CEWG_Report_5_April_2012.pdf
    • 5. World Health Organization. Report of the Workshop on Differential Pricing & Financing of Essential Drugs. 2001 [cited 2013 March 15]; Available from: http://apps.who.int/medicinedocs/en/d/Jh2951e/
    • 6. Morel CM, McGuire A, Mossialos E. The level of income appears to have no consistent bearing on pharmaceutical prices across countries. Health Aff (Millwood). 2011; 30(8): 1545-52.
    • 7. Susanne Gelders, Margaret Ewen, Nakae Noguchi, Laing R. Price, availability and affordability. An international comparison of chronic disease medicines. Background report prepared for the WHO Planning Meeting on the Global Initiative for Treatment of Chronic Diseases held in Cairo in December 2005 2006 [cited; Available from: http://apps.who.int/medicinedocs/index/assoc/s14135e/s14135e.pdf
    • 8. Federico Tobar, Charreau J. Comparación internacional del precio de los medicamentos de alto costo. Argentina, Países del Cono sur, España e Inglaterra. 2011 [cited 2013 March 15]; Available from: http://www.fsg.org.ar/publicaciones/Precio%20de%20los%20medicamentos%20de%2 0alto%20costo.pdf
    • 9. World Health Organization. The World Health Report Health Systems Financing: the Path to Universal Coverage. 2010 [cited 2013 March 15]; Available from: http://www.who.int/entity/whr/2010/whr10_en.pdf
    • 10. Parkin DM, Bray F, Ferlay J, Pisani P. Estimating the world cancer burden: Globocan 2000. Int J Cancer. 2001; 94(2): 153-6.
    • 11. Lozano-Ascencio R, Gomez-Dantes H, Lewis S, Torres-Sanchez L, Lopez-Carrillo L. [Breast cancer trends in Latin America and the Caribbean]. Salud Publica Mex. 2009; 51 Suppl 2(2): s147-56.
    • 12. Plosker GL, Keam SJ. Trastuzumab: a review of its use in the management of HER2-positive metastatic and early-stage breast cancer. Drugs. 2006; 66(4): 449-75.
    • 13. Liao N, Zhang GC, Li XR, Yao M, Wang K. [A meta-analysis of neoadjuvant chemotherapy combined with trastuzumab for HER2-positive breast cancers]. Nan Fang Yi Ke Da Xue Xue Bao. 2009; 29(5): 943-5.
    • 14. Chan AL, Leung HW, Lu CL, Lin SJ. Cost-effectiveness of trastuzumab as adjuvant therapy for early breast cancer: a systematic review. Ann Pharmacother. 2009; 43(2): 296-303.
    • 15. Skedgel C, Rayson D, Younis T. The cost-utility of sequential adjuvant trastuzumab in women with Her2/Neu-positive breast cancer: an analysis based on updated results from the HERA Trial. Value Health. 2009; 12(5): 641-8.
    • 16. Lidgren M, Jonsson B, Rehnberg C, Willking N, Bergh J. Cost-effectiveness of HER2 testing and 1-year adjuvant trastuzumab therapy for early breast cancer. Ann Oncol. 2008; 19(3): 487-95.
    • 17. Liberato NL, Marchetti M, Barosi G. Cost effectiveness of adjuvant trastuzumab in human epidermal growth factor receptor 2-positive breast cancer. J Clin Oncol. 2007; 25(6): 625-33.
    • 18. Garrison LP, Jr., Lubeck D, Lalla D, Paton V, Dueck A, Perez EA. Costeffectiveness analysis of trastuzumab in the adjuvant setting for treatment of HER2- positive breast cancer. Cancer. 2007; 110(3): 489-98.
    • 19. Shiroiwa T, Fukuda T, Shimozuma K, Ohashi Y, Tsutani K. The model-based costeffectiveness analysis of 1-year adjuvant trastuzumab treatment: based on 2-year follow-up HERA trial data. Breast Cancer Res Treat. 2008; 109(3): 559-66.
    • 20. Norum J, Olsen JA, Wist EA, Lonning PE. Trastuzumab in adjuvant breast cancer therapy. A model based cost-effectiveness analysis. Acta Oncol. 2007; 46(2): 153-64.
    • 21. Fagnani F, Colin X, Arveux P, Coudert B, Misset JL. [Cost/effectiveness analysis of adjuvant therapy with trastuzumab in patients with HER2 positive early breast cancer]. Bull Cancer. 2007; 94(7): 711-20.
    • 22. Hedden L, O'Reilly S, Lohrisch C, Chia S, Speers C, Kovacic L, et al. Assessing the real-world cost-effectiveness of adjuvant trastuzumab in HER-2/neu positive breast cancer. Oncologist. 2012; 17(2): 164-71.
    • 23. Purmonen TT, Pankalainen E, Turunen JH, Asseburg C, Martikainen JA. Shortcourse adjuvant trastuzumab therapy in early stage breast cancer in Finland: costeffectiveness and value of information analysis based on the 5-year follow-up results of the FinHer Trial. Acta Oncol. 2011; 50(3): 344-52.
    • 24. Hall PS, Hulme C, McCabe C, Oluboyede Y, Round J, Cameron DA. Updated costeffectiveness analysis of trastuzumab for early breast cancer: a UK perspective considering duration of benefit, long-term toxicity and pattern of recurrence. Pharmacoeconomics. 2011; 29(5): 415-32.
    • 25. Sullivan R, Peppercorn J, Sikora K, Zalcberg J, Meropol NJ, Amir E, et al. Delivering affordable cancer care in high-income countries. Lancet Oncol. 2011; 12(10): 933-80.
    • 26. Banta D. Health technology assessment in Latin America and the Caribbean. Int J Technol Assess Health Care. 2009; 25 Suppl 1: 253-4.
    • 27. Pichon-Riviere A, Augustovski F, Rubinstein A, Marti SG, Sullivan SD, Drummond MF. Health technology assessment for resource allocation decisions: are key principles relevant for Latin America? Int J Technol Assess Health Care. 2010; 26(4): 421-7.
    • 28. Di Ruggiero E, Zarowsky C, Frank J, Mhatre S, Aslanyan G, Perry A, et al. Coordinating Canada's research response to global health challenges: the Global Health Research Initiative. Can J Public Health. 2006; 97(1): 29-31.
    • 29. Caro JJ, Briggs AH, Siebert U, Kuntz KM. Modeling good research practices-- overview: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force-- 1. Value Health. 2012; 15(6): 796-803.
    • 30. Jeffrey D. Sachs. Macroeconomics and health: Investing in health for economic development. Report of the Commission on Macroeconomics and Health. WHO Library Cataloguing-in-Publication Data 2001 [cited; Available from: http://whqlibdoc.who.int/publications/2001/924154550x.pdf
    • 31. Enrique Ruelas Barajas, Pedro Rizo Ríos. Guía de Evaluación de Insumos para la Salud. In: Dirección General Adjunta de Priorización Comisión Interinstitucional del Cuadro Básico y Catálogo de Insumos del Sector Salud, editor. Mexico; 2011. p. Available at: http://www.csg.salud.gob.mx/descargas/pdfs/cuadro_basico/guia_eval_insumos1105 2011.pdf.
    • 32. Ministerio de Salud de Chile. Guía Metodológica para la Evaluación Económica de Intervenciones en Salud en Chile. In: Departamento de Economía de la Salud Subsecretaría de Salud Pública, editor. Santiago de Chile; 2013. p. Available at: http://desal.minsal.cl/wp-content/uploads/2013/09/EE_FINAL_web.pdf (October 4).
    • 33. Instituto de Evaluación Tecnológica en Salud (IETS). Manual para la elaboración de evaluaciones económicas en salud. Bogotá 2014. p. Available at: http://www.iets.org.co/manuales/Manuales/Manual%20evaluacio%CC%81n%20econo %CC%81mica%20web%2030%20sep.pdf (October 14).
    • 34. George B, Harris A, Mitchell A. Cost-effectiveness analysis and the consistency of decision making: evidence from pharmaceutical reimbursement in australia (1991 to 1996). Pharmacoeconomics. 2001; 19(11): 1103-9.
    • 35. Augustovski F, Garay OU, Pichon-Riviere A, Rubinstein A, Caporale JE. Economic evaluation guidelines in Latin America: a current snapshot. Expert Rev Pharmacoecon Outcomes Res. 2010; 10(5): 525-37.
    • 36. Gianni L, Dafni U, Gelber RD, Azambuja E, Muehlbauer S, Goldhirsch A, et al. Treatment with trastuzumab for 1 year after adjuvant chemotherapy in patients with HER2-positive early breast cancer: a 4-year follow-up of a randomised controlled trial. Lancet Oncol. 2011; 12(3): 236-44.
    • 37. Smith I, Procter M, Gelber RD, Guillaume S, Feyereislova A, Dowsett M, et al. 2- year follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer: a randomised controlled trial. Lancet. 2007; 369(9555): 29-36.
    • 38. Piccart-Gebhart MJ, Procter M, Leyland-Jones B, Goldhirsch A, Untch M, Smith I, et al. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med. 2005; 353(16): 1659-72.
    • 39. Paul Kind, Richard Brooks, Rabin R, editors. EQ-5D concepts and methods: a developmental history: Springer; 2005.
    • 40. Calvert MJ, Freemantle N, Cleland JG. The impact of chronic heart failure on health-related quality of life data acquired in the baseline phase of the CARE-HF study. Eur J Heart Fail. 2005; 7(2): 243-51.
    • 41. International Agency for Research on Cancer. Globocan 2008 Cancer Incidence, Mortality and Prevalence Worldwide in 2008. 2008 [cited 2012; Available from: http://globocan.iarc.fr/
    • 42. Bland KI, Menck HR, Scott-Conner CE, Morrow M, Winchester DJ, Winchester DP. The National Cancer Data Base 10-year survey of breast carcinoma treatment at hospitals in the United States. Cancer. 1998; 83(6): 1262-73.
    • 43. Paik S, Bryant J, Tan-Chiu E, Yothers G, Park C, Wickerham DL, et al. HER2 and choice of adjuvant chemotherapy for invasive breast cancer: National Surgical Adjuvant Breast and Bowel Project Protocol B-15. J Natl Cancer Inst. 2000; 92(24): 1991-8.
    • 44. Prieto M M, Torres C S. Situación epidemiológica del cáncer de mama en Chile 1994-2003 Epidemiologic situation of breast cancer in Chile 1994-2003. Rev Méd Clín Condes. 2006; 17(4): 142-8.
    • 45. Piñeros M, Sánchez R, Cendales R, Perry F, Ocampo R, García OA. Características sociodemográficas, clínicas y de la atención de mujeres con cáncer de mama en Bogotá Social, Demographic and Clinical Features in Women with Breast Cancer attending Health Services in Bogotá. Rev colomb cancerol. 2008; 12(4): 181-90.
    • 46. Solidoro Andrés. Cáncer en el Perú del 2000: hechos, cifras, realidades DIAGNOSTICO. 2001; Vol. 40 - 306-317: Available at: http://www.fihudiagnostico.org.pe/revista/numeros/2001/novdic01/306-317.html.
    • 47. Juarez AM. Edad y estadio de la mujeres con cancer de mama, hospitales públicos, Córdoba 1998/2003 Age and stage of the with breast cancer. Public hospitals, Cordoba 1998-2003. Rev Esc Salud Pública. 2009; 13(1): 33-42.
    • 48. Vázquez T, Krygier G, Barrios E, Cataldi S, Vázquez A, Alonso R, et al. Análisis de sobrevida de una población con cáncer de mama y su relación con factores pronósticos: estudio de 1.311 pacientes seguidas durante 230 meses: trabajo de equipo multidisciplinario Survival analysis i a population with breast cancer and its pronostic factors: 230 months-follow up in 1.311 women. Rev méd Urug. 2005; 21(2): 107-21.
    • 49. Kurian AW, Thompson RN, Gaw AF, Arai S, Ortiz R, Garber AM. A costeffectiveness analysis of adjuvant trastuzumab regimens in early HER2/neu-positive breast cancer. J Clin Oncol. 2007; 25(6): 634-41.
    • 50. Ministério da Saúde do Brasil. Secretaria de Ciência, Tecnologia e InsumosEstratégicos. Relatório de recomendação da ComissãoNacional de Incorporação de Tecnologias no SUS CONITEC 07: trastuzumabeparatratamento do câncer de mama inicial. . 2012 [cited 2013 March 15]; Available from: http://portal.saude.gov.br/portal/arquivos/pdf/Trastuzumabe_cainicial_final.pdf
    • 51. Danzon PM, Towse A, Mulcahy AW. Setting cost-effectiveness thresholds as a means to achieve appropriate drug prices in rich and poor countries. Health Aff (Millwood). 2011; 30(8): 1529-38.
    • 52. Goss PE, Lee BL, Badovinac-Crnjevic T, Strasser-Weippl K, Chavarri-Guerra Y, St Louis J, et al. Planning cancer control in Latin America and the Caribbean. Lancet Oncol. 2013; 14(5): 391-436.
    • 53. World Health Organization. WHO Guideline on Country Pharmaceutical Pricing Policies. 2013: Geneva. Available at: http://www.who.int/childmedicines/publications/WHO_GPPP.pdf?ua=1 (October 2014).
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