Tang Brandon, Bodkyn Curt, Gupta Sumit, Denburg Avram
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
JCO Glob Oncol. 2020 Feb;6:67-79. doi: 10.1200/JGO.19.00300.
Improving access to essential medicines is necessary to reduce global mortality resulting from childhood cancer. However, there is a lack of context-specific data in many low- to middle-income countries on the determinants of access to essential childhood cancer medicines. We conducted a mixed-methods case study of the barriers to and enablers of access to WHO essential medicines for childhood cancer care in Trinidad and Tobago, in response to domestic calls for policy attention and reform.
We interviewed stakeholders (N = 9) across the pharmaceutical supply system using a novel analytic framework and qualitative interview guide. Interviews were recorded, transcribed, and analyzed with constant comparative methods to capture emergent themes. Quantitatively, we examined alignment of the national essential medicines list with the 2017 WHO Essential Medicines List for Children (EMLc). National buyer prices for EMLc cancer medicines were compared with median international prices, with calculation of median price ratios to assess procurement efficiency.
Principal barriers identified included a lack of data-driven procurement, low supplier incentive to engage in tenders, reactive rather than proactive processes in response to stockouts, and siloed information systems. Recurring themes of regionalization, standardization, and proactivity emerged as priorities for policy reform. Quantitative analysis of the national essential medicines list and median price ratios for procured medicines aligned with findings reported qualitatively.
Our study contributes to global efforts to improve childhood cancer care by identifying policy-relevant evidence on access to essential childhood cancer medicines and providing a model for future studies in other jurisdictions.
改善基本药物的可及性对于降低儿童癌症导致的全球死亡率至关重要。然而，许多低收入和中等收入国家缺乏关于儿童基本癌症药物可及性决定因素的具体数据。应国内对政策关注和改革的呼吁，我们对特立尼达和多巴哥儿童癌症治疗中获取世界卫生组织基本药物的障碍和促进因素进行了一项混合方法的案例研究。
我们使用一个新颖的分析框架和定性访谈指南，采访了整个药品供应系统的利益相关者（N = 9）。访谈进行了录音、转录，并采用持续比较法进行分析，以捕捉新出现的主题。在定量方面，我们检查了国家基本药物清单与《2017年世界卫生组织儿童基本药物清单》（EMLc）的一致性。将EMLc癌症药物的国家采购价格与国际中位数价格进行比较，并计算中位数价格比以评估采购效率。
确定的主要障碍包括缺乏数据驱动的采购、供应商参与招标的积极性低、应对缺货的过程是被动而非主动的，以及信息系统孤立。区域化、标准化和主动性等反复出现的主题成为政策改革的优先事项。对国家基本药物清单和采购药品的中位数价格比的定量分析与定性报告的结果一致。
我们的研究通过确定与获取儿童基本癌症药物相关的政策证据，并为其他司法管辖区的未来研究提供一个模型，为改善儿童癌症治疗的全球努力做出了贡献。
