Faculty of Health Sciences, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa.
Eur J Cancer. 2011 Jun;47(9):1299-304. doi: 10.1016/j.ejca.2011.03.015. Epub 2011 Apr 13.
Worldwide, prices for cancer drugs have been under downward pressure where several governments have mandated price cuts of branded products. A better alternative to government mandated price cuts would be to estimate a final price based on drug performance, cost effectiveness and a country's ability to pay. We developed a global pricing index for new cancer drugs in patients with metastatic colorectal cancer (mCRC) that encompasses all of these attributes.
A pharmacoeconomic model was developed to simulate mCRC patients receiving chemotherapy plus a 'new drug' that improves survival by 1.4, 3 and 6months, respectively. Cost and utility data were obtained from cancer centres and oncology nurses (n=112) in Canada, Spain, India, South Africa and Malaysia. Multivariable analysis was then used to develop the pricing index, which considers survival benefit, per capita GDP and income dispersion (as measured by the Gini coefficient) as predictor variables.
Higher survival benefits were associated with elevated drug prices, especially in higher income countries such as Canada. For Argentina with a per capita GDP of $15,000 and a Gini coefficient of 51, the index estimated that for a drug which provides a 4month survival benefit in mCRC, the value based price would be $US 630 per dose. In contrast, the same drug in a wealthier country like Norway (per capita GDP=$50,000) could command a price of $US 2,775 per dose.
The application of this index to estimate a price based on cost effectiveness and the wealth of a nation would be important for opening dialogue between the key stakeholders and a better alternative to government mandated price cuts.
在全球范围内，癌症药物的价格一直面临下行压力，一些国家的政府已强制要求降低品牌药物的价格。政府强制降价的更好替代方案是根据药物疗效、成本效益和国家的支付能力来估算最终价格。我们开发了一种新的转移性结直肠癌（mCRC）患者用癌症药物的全球定价指数，该指数涵盖了所有这些属性。
我们开发了一种药物经济学模型，用于模拟接受化疗加“新药”治疗的 mCRC 患者，分别将生存时间提高 1.4、3 和 6 个月。成本和效用数据来自加拿大、西班牙、印度、南非和马来西亚的癌症中心和肿瘤护士（n=112）。然后使用多变量分析来开发定价指数，该指数考虑了生存获益、人均 GDP 和收入分配（以基尼系数衡量）作为预测变量。
较高的生存获益与较高的药物价格相关，特别是在加拿大等高收入国家。对于人均 GDP 为 15,000 美元且基尼系数为 51 的阿根廷，指数估计对于在 mCRC 中提供 4 个月生存获益的药物，基于价值的价格将为每剂 630 美元。相比之下，在挪威等更富裕的国家（人均 GDP 为 50,000 美元），相同的药物价格可能高达每剂 2775 美元。
将该指数应用于根据成本效益和国家财富估算价格对于在主要利益相关者之间开展对话以及作为政府强制降价的更好替代方案非常重要。
