Cherny N I, Sullivan R, Torode J, Saar M, Eniu A
Cancer Pain and Palliative Medicine Service, Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel.
Institute of Cancer Policy, Kings Health Partners Comprehensive Cancer Centre, King's College London, London, UK.
Ann Oncol. 2017 Nov 1;28(11):2633-2647. doi: 10.1093/annonc/mdx521.
The availability and affordability of safe, effective, high-quality, affordable anticancer therapies are a core requirement for effective national cancer control plans.
Online survey based on a previously validated approach. The aims of the study were to evaluate (i) the availability on national formulary of licensed antineoplastic medicines across the globe, (ii) patient out-of-pocket costs for the medications, (iii) the actual availability of the medication for a patient with a valid prescription, (iv) information relating to possible factors adversely impacting the availability of antineoplastic agents and (v) the impact of the country's level of economic development on these parameters. A total of 304 field reporters from 97 countries were invited to participate. The preliminary set of data was posted on the ESMO website for open peer review and amendments have been incorporated into the final report.
Surveys were submitted by 135 reporters from 63 countries and additional peer-review data were submitted by 54 reporters from 19 countries. There are substantial differences in the formulary availability, out-of-pocket costs and actual availability for many anticancer medicines. The most substantial issues are in lower-middle- and low-income countries. Even among medications on the WHO Model List of Essential Medicines (EML) the discrepancies are profound and these relate to high out-of-pocket costs (in low-middle-income countries 32.0% of EML medicines are available only at full cost and 5.2% are not available at all, and for low-income countries, the corresponding figures are even worse at 57.7% and 8.3%, respectively).
There is wide global variation in formulary availability, out-of-pocket expenditures and actual availability for most licensed anticancer medicines. Low- and low-middle-income countries have significant lack of availability and high out-of-pocket expenditures for cancer medicines on the WHO EML, with much less availability of new, more expensive targeted agents compared with high-income countries.
安全、有效、高质量且价格可承受的抗癌疗法的可及性与可支付性是有效的国家癌症控制计划的核心要求。
基于先前经验证的方法进行在线调查。该研究的目的是评估：（i）全球范围内已获许可的抗肿瘤药物在国家药品目录中的可及性；（ii）患者自付的药物费用；（iii）持有有效处方的患者实际获得药物的情况；（iv）与可能对抗肿瘤药物可及性产生不利影响的因素相关的信息；（v）国家经济发展水平对这些参数的影响。邀请了来自97个国家的304名实地记者参与。初步数据集发布在ESMO网站上以供公开同行评审，并已将修改内容纳入最终报告。
来自63个国家的135名记者提交了调查问卷，来自19个国家的54名记者提交了额外的同行评审数据。许多抗癌药物在药品目录可及性、自付费用和实际可及性方面存在很大差异。最突出的问题存在于中低收入和低收入国家。即使在世卫组织基本药物清单（EML）中的药物之间，差异也很显著，这些差异与高昂的自付费用有关（在中低收入国家，32.0%的EML药物仅需全额付费才能获得，5.2%根本无法获得；对于低收入国家，相应数字更糟，分别为57.7%和8.3%）。
大多数已获许可的抗癌药物在全球范围内，在药品目录可及性、自付费用和实际可及性方面存在广泛差异。低收入和中低收入国家在世卫组织EML中的癌症药物可及性严重不足且自付费用高昂，与高收入国家相比，新的、更昂贵的靶向药物可及性要低得多。
