Shortages and price variability of essential cytotoxic medicines for treating children with cancers.
Shortages and price variability of essential cytotoxic medicines for treating children with cancers.
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DOI：
10.1136/bmjgh-2020-003282
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发表时间：
2020-11
影响因子：
8.1
通讯作者：
Robertson J
中科院分区：
文献类型：
--
作者：
Martei YM;Iwamoto K;Barr RD;Wiernkowski JT;Robertson J
低收入和中等收入国家（LMIC）面临儿童癌症死亡率最高的负担，获得治愈性治疗的机会有限。几乎没有对所有收入群体和世界各区域进行比较分析，审查治疗儿童癌症的基本药物的供应情况和采购成本。一项横断面调查涉及五个收入组的国家-低收入、中低收入、中上收入和两个高收入国家组（1991年、1992年）。医生和药剂师报告了34种基本药物的机构使用、供应、缺货和价格（品牌和非专利产品）。价格比较使用美元，并采用外汇汇率和购买力平价调整。计算了治疗急性淋巴细胞白血病（ALL）、伯基特淋巴瘤（BL）和肾母细胞瘤（WT）的药物费用（儿童29 kg，体表面积1 m2）。使用非参数Kruskal-Wallis检验进行比较。58个答复者（50个国家）提供了关于药品使用、供应和缺货的信息，以及来自42个设施（37个国家）的可用价格数据。国际儿科肿瘤学会核心药物和辅助药物的使用程度在不同收入组之间存在差异（分别为p<0.0001和p=0.0002）。LMC和LIC机构使用的药物少于UMC和HIC机构。UMC和LMC设施更有可能报告药物不可用或缺货。药品价格在收入阶层内和收入阶层之间差别很大;非专利产品并不总是比品牌产品便宜。购买力平价调整显示，UMC和LMC设施中某些药品的价格相对较高。药物费用在ALL（p=0.0075 XR; PPP调整分析p=0.0178）和WT（p =<0.0001 XR; PPP调整p=0.0007）的HIC中最高。BL的药物费用没有显著差异。基本药物的供应、可靠的供应链、保密的药品价格和治疗费用的巨大差异等问题，导致在照顾患有可治疗癌症的儿童方面，特别是在中低收入国家，面临持续的挑战。
Low-income and middle-income countries (LMICs) face the largest burden of mortality from childhood cancers with limited access to curative therapies. Few comparative analyses across all income groups and world regions have examined the availability and acquisition costs of essential medicines for treating cancers in children. A cross-sectional survey involved countries in five income groups—low-income (LIC), lower-middle-income (LMC), upper-middle-income (UMC), two high-income country groups (HIC1, HIC2). Physicians and pharmacists reported institutional use, availability, stock outs and prices (brand and generic products) of 34 essential medicines. Price comparisons used US$, applying foreign exchange rates (XR) and purchasing power parity (PPP) adjustments. Medicine costs for treating acute lymphoblastic leukaemia (ALL), Burkitt lymphoma (BL) and Wilms tumour (WT) were calculated (child 29 kg, body surface area 1 m2). Comparisons were conducted using non-parametric Kruskal-Wallis tests. Fifty-eight respondents (50 countries) provided information on medicine use, availability and stock outs, with usable price data from 42 facilities (37 countries). The extent of use of International Society of Paediatric Oncology core and ancillary medicines varied across income groups (p<0.0001 and p=0.0002 respectively). LMC and LIC facilities used fewer medicines than UMC and HIC facilities. UMC and LMC facilities were more likely to report medicines not available or stockouts. Medicine prices varied widely within and between income bands; generic products were not always cheaper than brand equivalents. PPP adjustment showed relatively higher prices in UMC and LMC facilities for some medicines. Medicine costs were highest in HICs for ALL (p=0.0075 XR; p=0.0178 PPP-adjusted analyses) and WT (p =<0.0001 XR; p=0.0007 PPP-adjusted). Medicine costs for BL were not significantly different. Problems with the availability of essential medicines, dependable supply chains, confidential medicine prices and wide variability in treatment costs contribute to persistent challenges in the care of children with treatable cancers, especially in LMICs.
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影响因子：
8.1
作者：
Faruqui, Neha;Martiniuk, Alexandra;Joshi, Rohina
通讯作者：
Joshi, Rohina
DOI：
10.2471/blt.11.087700
发表时间：
2011-12-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Cernuschi, Tania;Furrer, Eliane;McAdams, Susan
通讯作者：
McAdams, Susan
影响因子：
254.7
作者：
Cortes, Javier;Perez-Garcia, Jose Manuel;Arribas, Joaquin
通讯作者：
Arribas, Joaquin
影响因子：
3.7
作者：
Bogaert P;Bochenek T;Prokop A;Pilc A
通讯作者：
Pilc A
DOI：
10.1093/annonc/mdx521
发表时间：
2017-11-01
期刊：
Annals of oncology : official journal of the European Society for Medical Oncology
影响因子：
--
作者：
Cherny NI;Sullivan R;Torode J;Saar M;Eniu A
通讯作者：
Eniu A