Aguiar P N, Adashek Jacob J, Roitberg Felipe, Noia Barreto Carmelia Maria, Del Giglio Auro, Lopes Gilberto L
Faculdade de Medicina do ABC, Santo André, Brazil; Américas Centro de Oncologia Integrado, São Paulo, Brazil.
College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, USA.
Value Health Reg Issues. 2019 Dec;20:47-50. doi: 10.1016/j.vhri.2018.12.003. Epub 2019 Mar 9.
Over the past 5 years, 55 new anticancer drugs have been launched worldwide. Considering the increasing costs of innovative treatments, both the number and the relevance of cost-effectiveness analyses have increased, meaningfully supporting decision making by stakeholders and policy makers. Notably, cost-effective treatments remain unavailable to patients because they are still unaffordable for a multitude of payers.
To discuss the differences between cost-effectiveness and affordability.
We reviewed the most relevant data on the divergences between cost-effectiveness and affordability. In addition, we included our recommendations to improve patients' access to innovative cancer therapies.
The increasing costs of recently launched antineoplastic drugs, as high as $150 000 per year, represent a major barrier to patients' access to treatments globally. In Brazil, for example, patients' access to innovative treatments depends greatly on whether the individual has private health insurance. In the public health sector, patients' access to cost-effective innovative treatments varies according to the financial capacity of the facility, leading to inequalities within the same healthcare system.
We conclude that because of the socioeconomic inequality mostly seen in lower and middle-income countries, it is difficult to define a cost-effectiveness threshold by region or a willingness-to-pay threshold affordable to the entire population. We consider that benchmark interventions might help to find an affordable willingness-to-pay threshold, and league table interventions might help policy makers, physicians, and the society to share the decision making.
在过去5年中，全球已有55种新型抗癌药物上市。鉴于创新治疗成本不断增加，成本效益分析的数量及其相关性均有所上升，这为利益相关者和政策制定者的决策提供了有力支持。值得注意的是，具有成本效益的治疗方法患者仍然无法获得，因为众多支付方仍难以承受其费用。
探讨成本效益与可负担性之间的差异。
我们回顾了关于成本效益与可负担性差异的最相关数据。此外，我们还纳入了自己对于改善患者获得创新癌症治疗方法机会的建议。
近期上市的抗肿瘤药物成本不断增加，每年高达15万美元，这是全球患者获得治疗的主要障碍。例如，在巴西，患者能否获得创新治疗很大程度上取决于个人是否拥有私人医疗保险。在公共卫生部门，患者获得具有成本效益的创新治疗的机会因机构的经济能力而异，这导致了同一医疗体系内的不平等现象。
我们得出结论，由于在低收入和中等收入国家普遍存在社会经济不平等现象，因此很难按地区确定成本效益阈值或整个人口都能承受的支付意愿阈值。我们认为，基准干预措施可能有助于找到可承受的支付意愿阈值，而排行榜干预措施可能有助于政策制定者、医生和社会共同做出决策。
