Cancer Medicines: What Is Essential and Affordable in India?
Cancer Medicines: What Is Essential and Affordable in India?
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癌症药物：在印度什么是必需的和负担得起的？
DOI：
10.1200/go.22.00060
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发表时间：
2022-07
影响因子：
4.5
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中科院分区：
文献类型：
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世卫组织基本药物清单（EML）指导国家处方药物的选择。在这里，我们评估哪些药物被认为是印度肿瘤学家的最高优先级和他们在日常实践中可用的程度。这是对世卫组织EML癌症医学工作组开展的一项电子调查的二次分析。该调查在全球范围内使用分层雪球方法分发给开全身抗癌治疗的医生。该调查收集了肿瘤学家认为对人口健康最优先的10种药物及其在日常实践中的可用性。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。与其他低收入和中等收入国家相比，印度队列更有可能是医学肿瘤学家（70% vs 31%, P < 0.001），并且专门在私人卫生系统工作（52% vs 17%, P < 0.001）。14/20最常选择的药物是常规细胞毒药物。少数肿瘤学家报告说这些药物普遍可及；19%-58%的肿瘤学家报告了每种药物的自费风险。58%-67%的肿瘤学家报告了利妥昔单抗和曲妥珠单抗的灾难性支出风险。与公共医疗系统相比，私人医疗系统的财务毒性风险要高得多。印度肿瘤学家确定的大多数高优先级癌症药物都是能够大幅改善生存率的非专利化疗药物，并且已经被列入世卫组织基本药物清单。由于患者承受的巨大经济负担，获得这些治疗的机会仍然有限。这在私营卫生系统中尤为严重。迫切需要制定战略，确保印度所有患者都能负担得起并获得高质量的癌症治疗。
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% v 31%, P < .001) and work exclusively in the private health system (52% v 17%, P < .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.