Benefits of global partnerships to facilitate access to medicines in developing countries: a multi-country analysis of patients and patient outcomes in GIPAP.
Benefits of global partnerships to facilitate access to medicines in developing countries: a multi-country analysis of patients and patient outcomes in GIPAP.
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DOI：
10.1186/1744-8603-5-19
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发表时间：
2009-12-31
影响因子：
10.8
通讯作者：
Garcia-Gonzalez P
中科院分区：
文献类型：
--
作者：
Kanavos P;Vandoros S;Garcia-Gonzalez P
由于缺乏保险和负担能力，发展中国家获得药品仍然是一个重大问题。慢性粒细胞白血病（CML）是一种罕见疾病，可以有效治疗，但可用的药物治疗（伊马替尼）价格昂贵，大多数患者无法承受。 GIPAP 是制造商和非政府组织之间设立的一项计划，旨在为全球 80 个国家/地区符合条件的 CML 患者提供免费治疗。讨论参与 GIPAP 的患者的社会经济和人口特征；研究 GIPAP 对符合援助资格的 CML 患者的健康结果（生存）的影响；并讨论这些结果的决定因素，以及根据社会经济、人口或地理标准是否存在任何差异。对 2005 年至 2007 年期间 15 个国家的 13,568 名患者的数据进行了分析，每季度提供一次。有序 Probit 面板数据分析用于分析患者参与项目进展的决定因素。 2005 年每季度进入的四波患者用于评估样本期内患者的生存情况。样本中的所有患者只要每季度向机构报告一次，就有资格接受治疗。 62.3%的患者为男性，37.7%为女性。大多数（84.4%）进入疾病慢性期，平均年龄为38.4岁。在控制了年龄、地点和职业后，分析表明，无论患者在进入该计划时处于何种疾病阶段，接受治疗后，患者的健康状况明显更有可能改善（OR = 30.5，α = 1%）；诊断与批准参与该计划之间的差距越大，由于缺乏治疗，患者病情恶化的可能性就越大（OR = 0.995，α = 1%）。与样本中的其他国家相比，考虑大国（印度、中国、巴基斯坦）影响的回归没有显示出任何重要差异。生存分析显示，到 2007 年底，2005 年加入该计划的所有患者中至少有 66% 仍然活着且活跃。GIPAP 对于患者获得治疗 CML 等危及生命的疾病的重要药物具有显着的积极作用。它影响疾病的进展和阶段，并导致高存活率。总体而言，它为发展中国家获得治疗树立了良好榜样，此类计划可以替代或补充当地为符合条件的患者提供护理的努力。
Access to medicines in developing countries continues to be a significant problem due to lack of insurance and lack of affordability. Chronic Myeloid Leukemia (CML), a rare disease, can be treated effectively, but the pharmaceutical treatment available (imatinib) is costly and unaffordable by most patients. GIPAP, is a programme set up between a manufacturer and an NGO to provide free treatment to eligible CML patients in 80 countries worldwide. To discuss the socio-economic and demographic characteristics of patients participating in GIPAP; to research the impact GIPAP is having on health outcomes (survival) of assistance-eligible CML patients; and to discuss the determinants of such outcomes and whether there are any variations according to socio-economic, demographic, or geographical criteria. Data for 13,568 patients across 15 countries, available quarterly, were analysed over the 2005-2007 period. Ordered Probit panel data analysis was used to analyze the determinants of a patient's progress in terms of participation in the programme. Four waves of patients entering quarterly in 2005 were used to evaluate patient survival over the sample period. All patients in the sample are eligible to receive treatment provided they report to a facility quarterly. 62.3% of patients were male and 37.7% female. The majority (84.4%) entered during the chronic phase of the disease and their average age was 38.4 years. Having controlled for age, location and occupation, the analysis showed that patients were significantly much more likely to move towards a better health state after receiving treatment irrespective of their disease stage at the point of entry to the program (OR = 30.5, α = 1%); and that the larger the gap between diagnosis and approval for participation in the program, the more likely it is that patients' condition deteriorates (OR = 0.995, α = 1%), due to absence of treatment. Regressions to account for the effect of large countries (India, China, Pakistan) did not show any important differences when compared to the remaining countries in the sample. Survival analysis shows that at least 66 percent of all patients that entered the program in 2005 were alive and active by the end of 2007. GIPAP has a significant positive effect on patient access to important medicines for a life threatening condition such as CML. It impacts both the progress and phase of the disease and leads to a high survival rate. Overall, it sets a good example for access to treatment in developing countries, where such programmes can substitute or complement local efforts to provide care to eligible patients.
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