Model solutions for ethical allocation during cancer medicine shortages.
Model solutions for ethical allocation during cancer medicine shortages.
复制标题
癌症药物短缺期间道德分配的模型解决方案。
DOI：
10.1016/s2352-3026(21)00055-7
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Abel,GregoryA
中科院分区：
文献类型：
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作者：
Hantel,Andrew;Peppercorn,Jeff;Abel,GregoryA
在过去十年中，多个高收入国家（HIC）发生了挽救生命的癌症药物的间歇性短缺，迫使肿瘤学家定量治疗。1，2最近长春新碱、门冬酰胺酶、奈拉滨和阿扎胞苷短缺对血液系统恶性肿瘤的影响尤为严重。高收入国家的癌症药物短缺源于缺乏生产低利润仿制药或维持高质量供应的激励措施，制药行业内部的整合以及缺乏供应链透明度。3在低收入和中等收入国家，这些问题因针对癌症的资源减少而变得更加复杂，导致一些基本癌症药物间歇性短缺和完全缺乏，在高收入国家和中等收入国家，政策制定、直接供应方案和积极的药房管理正在使癌症药物的获得范围有所扩大。3然而，尽管取得了重大进展，但在可预见的未来，药物短缺将继续影响高收入国家和低收入国家的癌症患者。一些血癌治疗药物，如奈拉滨和天冬酰胺酶的高成本和有限生产，也使血癌患者面临更高的短缺风险。现有的短缺分配指导是基于规范的道德框架，这些框架理由充分，但存在缺陷，支持其使用的数据很少。最近，模拟建模方法取得了进展，为如何处理这些情况提供了新的见解。4–6
Over the past decade, intermittent shortages of life-saving cancer medicines have occurred in multiple high-income countries (HICs), forcing oncologists to ration treatments. 1, 2 Haematological malignancies have been particularly affected by recent shortages of vincristine, asparaginase, nelarabine, and azacitidine. Cancer medicine scarcity in HICs stems from a paucity of incentives to produce low-margin generic medicines or maintain high-quality supply, consolidation within the pharmaceutical industry, and an absence of supply chain transparency. 3 In low-income and middle-income countries (LMICs), these problems are compounded by decreased availability of cancer-directed resources, resulting in both intermittent shortages and the total absence of some essential cancer medicines.In both HICs and LMICs, policy development, direct supply programmes, and proactive pharmacy management are leading to some expansion of access to cancer medicines. 3 However, despite substantial gains, drug scarcity will continue to affect patients with cancer in both HICs and LMICs for the foreseeable future. 3 High costs and limited production of some blood cancer therapeutics, such as nelarabine and asparaginase, also place patients with blood cancers at higher risk of shortages. Existing shortage allocation guidance is based on normative ethical frameworks, which are well reasoned but have drawbacks and few data to support their use. Recently, simulation modelling methods have advanced, providing fresh insight into how to approach these situations. 4–6