Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada.
JCO Glob Oncol. 2022 Jul;8:e2200060. doi: 10.1200/GO.22.00060.
The WHO essential medicines list (EML) guides selection of drugs for national formularies. Here, we evaluate which medicines are considered highest priority by Indian oncologists and the extent to which they are available in routine practice.
This is a secondary analysis of an electronic survey developed by the WHO EML Cancer Medicine Working Group. The survey was distributed globally using a hierarchical snowball method to physicians who prescribe systemic anticancer therapy. The survey captured the 10 medicines oncologists considered highest priority for population health and their availability in routine practice.
The global study cohort included 948 respondents from 82 countries; 98 were from India and 67 were from other low- and middle-income countries. Compared with other low- and middle-income countries, the Indian cohort was more likely to be medical oncologist (70% 31%, < .001) and work exclusively in the private health system (52% 17%, < .001). 14/20 most commonly selected medicines were conventional cytotoxic drugs. Universal access to these medicines was reported by a minority of oncologists; risks of significant out-of-pocket expenditures for each medicine were reported by 19%-58% of oncologists. Risk of catastrophic expenditure was reported by 58%-67% of oncologists for rituximab and trastuzumab. Risks of financial toxicity were substantially higher within the private health system compared with the public system.
Most high-priority cancer medicines identified by Indian oncologists are generic chemotherapy agents that provide substantial improvements in survival and are already included in WHO EML. Access to these treatments remains limited by major financial burdens experienced by patients. This is particularly acute within the private health system. Strategies are urgently needed to ensure that high-quality cancer care is affordable and accessible to all patients in India.
世界卫生组织基本药物清单（EML）指导国家处方集的药物选择。在这里，我们评估了印度肿瘤学家认为哪些药物是最高优先级的，以及这些药物在常规实践中的可用性。
这是世界卫生组织 EML 癌症药物工作组开发的电子调查的二次分析。该调查通过分层雪球法在开具全身抗癌治疗药物的医生中进行全球分发。该调查捕获了肿瘤学家认为对人群健康最重要的 10 种药物及其在常规实践中的可用性。
全球研究队列包括来自 82 个国家的 948 名受访者；其中 98 人来自印度，67 人来自其他中低收入国家。与其他中低收入国家相比，印度队列更有可能是医学肿瘤学家（70% 31%，<.001），并且专门在私立医疗系统工作（52% 17%，<.001）。在 20 种最常选择的药物中，有 14 种是常规细胞毒性药物。少数肿瘤学家报告称这些药物普遍获得；19%-58%的肿瘤学家报告了每种药物存在重大自付费用的风险。58%-67%的肿瘤学家报告了利妥昔单抗和曲妥珠单抗发生灾难性支出的风险。与公共系统相比，私立医疗系统中财务毒性的风险要高得多。
印度肿瘤学家确定的大多数高优先级癌症药物都是提供生存显著改善的通用化疗药物，并且已经包含在世界卫生组织 EML 中。由于患者面临重大经济负担，这些治疗方法的可及性仍然有限。在私立医疗系统中尤其如此。迫切需要制定策略，确保所有印度患者都能负担得起高质量的癌症护理。
