Sruamsiri Rosarin, Ross-Degnan Dennis, Lu Christine Y, Chaiyakunapruk Nathorn, Wagner Anita K
Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America.
PLoS One. 2015 Mar 23;10(3):e0119945. doi: 10.1371/journal.pone.0119945. eCollection 2015.
Increasing access to clinically beneficial targeted cancer medicines is a challenge in every country due to their high cost. We describe the interplay of innovative policies and programs involving multiple stakeholders to facilitate access to these medicines in Thailand, as well as the utilization of selected targeted therapies over time.
We selected two medicines on the 2013 Thai national list of essential medicines (NLEM) [letrozole and imatinib] and three unlisted medicines for the same indications [trastuzumab, nilotinib and dasatinib]. We created timelines of access policies and programs for these products based on scientific and grey literature. Using IMS Health sales data, we described the trajectories of sales volumes of the study medicines between January 2001 and December 2012. We compared estimated average numbers of patients treated before and after the implementation of policies and programs for each product.
Different stakeholders implemented multiple interventions to increase access to the study medicines for different patient populations. During 2007-2009, the Thai Government created a special NLEM category with different coverage requirements for payers and issued compulsory licenses; payers negotiated prices with manufacturers and engaged in pooled procurement; pharmaceutical companies expanded patient assistance programs and lowered prices in different ways. Compared to before the interventions, estimated numbers of patients treated with each medicine increased significantly afterwards: for letrozole from 645 (95% CI 366-923) to 3683 (95% CI 2,748-4,618); for imatinib from 103 (95% CI 72-174) to 350 (95% CI 307-398); and for trastuzumab from 68 (95% CI 45-118) to 412 (95% CI 344-563).
Government, payers, and manufacturers implemented multi-pronged approaches to facilitate access to targeted cancer therapies for the Thai population, which differed by medicine. Routine monitoring is needed to assess clinical and economic impacts of these strategies in the health system.
由于成本高昂，在每个国家增加获得具有临床益处的靶向抗癌药物的机会都是一项挑战。我们描述了涉及多个利益相关者的创新政策和计划之间的相互作用，以促进泰国获得这些药物，以及随着时间推移对选定靶向治疗药物的使用情况。
我们从2013年泰国国家基本药物清单（NLEM）中选择了两种药物[来曲唑和伊马替尼]，以及三种相同适应症的未列入清单的药物[曲妥珠单抗、尼洛替尼和达沙替尼]。我们根据科学文献和灰色文献为这些产品制定了准入政策和计划的时间表。利用艾美仕市场研究公司（IMS Health）的销售数据，我们描述了2001年1月至2012年12月期间研究药物的销量轨迹。我们比较了每种产品政策和计划实施前后估计的平均治疗患者数量。
不同利益相关者实施了多种干预措施，以增加不同患者群体获得研究药物的机会。在2007 - 2009年期间，泰国政府设立了一个特殊的NLEM类别，对支付方有不同的覆盖要求，并颁发了强制许可；支付方与制造商协商价格并进行集中采购；制药公司扩大了患者援助计划并以不同方式降低了价格。与干预前相比，每种药物治疗的估计患者数量在干预后显著增加：来曲唑从645例（95%置信区间366 - 923）增至3683例（95%置信区间2748 - 4618）；伊马替尼从103例（95%置信区间72 - 174）增至350例（95%置信区间307 - 398）；曲妥珠单抗从68例（95%置信区间45 - 118）增至412例（95%置信区间344 - 563）。
政府、支付方和制造商实施了多管齐下的方法，以促进泰国人群获得靶向癌症治疗药物，不同药物的方法有所不同。需要进行常规监测，以评估这些策略在卫生系统中的临床和经济影响。
