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Improving patient access to cancer drugs in India: Using economic modeling to estimate a more affordable drug cost based on measures of societal value

Published online by Cambridge University Press:  25 January 2011

George Dranitsaris ,
Ilse Truter ,
Martie S. Lubbe ,
Nitin N. Sriramanakoppa ,
Vivian M. Mendonca  and
Sangameshwar B. Mahagaonkar
George Dranitsaris
Affiliation:
Nelson Mandela Metropolitan University
Ilse Truter
Affiliation:
Nelson Mandela Metropolitan University
Martie S. Lubbe
Affiliation:
North-West University
Nitin N. Sriramanakoppa
Affiliation:
PharmARC Analytic Solutions
Vivian M. Mendonca
Affiliation:
PharmARC Analytic Solutions
Sangameshwar B. Mahagaonkar
Affiliation:
PharmARC Analytic Solutions
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Abstract

Background: Using multiples of India's per capita gross domestic product (GDP) as the threshold for economic value as suggested by the World Health Organization (WHO), decision analysis modeling was used to estimate a more affordable monthly cost in India for a hypothetical new cancer drug that provides a 3-month survival benefit to Indian patients with metastatic colorectal cancer (mCRC).

Methods: A decision model was developed to simulate progression-free and overall survival in mCRC patients receiving chemotherapy with and without the new drug. Costs for chemotherapy and side-effects management were obtained from both public and private hospitals in India. Utility estimates measured as quality-adjusted life-years (QALY) were determined by interviewing twenty-four oncology nurses using the Time Trade-Off technique. The monthly cost of the new drug was then estimated using a target threshold of US$9,300 per QALY gained, which is three times the Indian per capita GDP.

Results: The base-case analysis suggested that a price of US$98.00 per dose would be considered cost-effective from the Indian public healthcare perspective. If the drug were able to improve patient quality of life above the standard of care or survival from 3 to 6 months, the price per dose could increase to US$170 and US$253 and offer the same value.

Conclusions: The use of the WHO criteria for estimating the cost of a new drug based on economic value for a developing country like India is feasible and can be used to estimate a more affordable cost based on societal value thresholds.

Keywords

Drug pricingCost analysisChemotherapyValue
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 27 , Issue 1 , January 2011 , pp. 23 - 30
Copyright
Copyright © Cambridge University Press 2011

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References

REFERENCES

1. Canadian Agency for Drugs and Technology in Health. Guidelines for the economic evaluation of health technologies, 3rd ed. Ottawa, Canada, 2006 http://www.cadth.ca/media/pdf/186_EconomicGuidelines_e.pdf (accessed November 18, 2009).Google Scholar
2. Central Intelligence Agency. The world fact book. 2009. https://www.cia.gov/library/publications/the-world-factbook/rankorder/2004rank.html (accessed November 18, 2009).Google Scholar
3. Chase, JL. Clinical use of anti-vascular endothelial growth factor monoclonal antibodies in metastatic colorectal cancer. Pharmacotherapy. 2008;28:23S–30S.CrossRefGoogle ScholarPubMed
4. Church, S. UK's NICE backs Pfizer's Sutent and Celgene's Revlimid. February 04, 2009. http://www.pharmastrategyblog.com/2009/02 (accessed January 18, 2010).Google Scholar
5. Douillard, JY, Cunningham, D, Roth, AD, et al. Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: A multicentre randomized trial. Lancet. 2000;355:1041–1047.CrossRefGoogle Scholar
6. Dranitsaris, G, Cottrell, W, Spirovski, B, Hopkins, S. Economic analysis of albumin-bound paclitaxel for the treatment of metastatic breast cancer. J Oncol Pharm Pract. 2009;15:67–78.CrossRefGoogle ScholarPubMed
7. Dranitsaris, G, Vincent, M, Crowther, M. Dalteparin vs. warfarin for the prevention of recurrent venous thromboembolic events in cancer patients: A pharmacoeconomic analysis. Pharmacoeconomics. 2006;24:593–607.CrossRefGoogle ScholarPubMed
8. Drummond, MF, Mason, AR. European perspective on the cost and cost effectiveness of cancer therapies. J Clin Oncol. 2007;25:191–195.CrossRefGoogle ScholarPubMed
9. Engstrom, PF. National Comprehensive Cancer Network. Systemic therapy for advanced or metastatic colorectal cancer: National Comprehensive Cancer Network guidelines for combining anti-vascular endothelial growth factor and anti-epidermal growth factor receptor monoclonal antibodies with chemotherapy. Pharmacotherapy. 2008;28 (pt 2):18S–22S.CrossRefGoogle ScholarPubMed
10. Escudier, B, Eisen, T, Stadler, WM, et al. Sorafenib in advanced clear cell renal carcinoma. N Engl J Med. 2007;356:125–134.CrossRefGoogle Scholar
11. Fojo, T, Grandy, C. How much is a life worth: Cetuximab, non small cell lung cancer, and the $440 billion question. J Natl Cancer Inst. 2009;1044–1048.CrossRefGoogle Scholar
12. Gafni, A. Alternatives to the QALY measure for economic evaluations. Support Care Cancer. 1997;5:105–111.CrossRefGoogle Scholar
13. Freeze, GM. GM crops around the world: An accurate picture. http://www.gmfreeze.org/uploads/GM_crops_land_area_final.pdf (accessed April 22, 2010).Google Scholar
14. Goldberg, RM, Sargent, DJ, Morton, RF, et al. A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer. J Clin Oncol. 2004;22:23–30.CrossRefGoogle ScholarPubMed
15. Hillner, BE, Smith, TJ. Efficacy does not necessarily translate to cost effectiveness. A case study in the challenges associated with 21st century cancer drug pricing. J Clin Oncol. 2009;27:2111–2113.CrossRefGoogle Scholar
16. Jonker, DJ, O'Callaghan, CJ, Karapetis, CS, et al. Cetuximab for the treatment of colorectal cancer. N Engl J Med. 2007;357:2040–2048.CrossRefGoogle ScholarPubMed
17. Laupacis, A, Feeny, D, Detsky, AS, Tugwell, PX. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. Can Med Assoc J. 1992;146:473–481.Google ScholarPubMed
18. Leung, P, Tanock, IF, Oza, AM, Puodziunas, A, Dranitsaris, G. Cost utility analysis of chemotherapy using paclitaxel, docetaxel or vinorelbine for patients with anthracycline-resistant breast cancer. J Clin Oncol. 1999;17:3082–3090.CrossRefGoogle ScholarPubMed
19. Murray, CJ, Evans, DB, Acharya, A, Baltussen, RM. Development of WHO guidelines in generalized cost effectiveness analysis. Health Econ. 2000;9:235–251.3.0.CO;2-O>CrossRefGoogle ScholarPubMed
20. Office of the Registrar General and Census Commissioner, New Delhi, India. Census of India. Rural-urban distribution. http://www.censusindia.net/ (accessed April 22, 2010).Google Scholar
21. Ortega, A, Dranitsaris, G, Sturgeon, J, Sutherland, H, Oza, A. Cost utility analysis of paclitaxel in combination with cisplatin for patients with advanced ovarian cancer. Gynecol Oncol. 1997;66:454–463.CrossRefGoogle ScholarPubMed
22. Pandeya, R. Outside the sick bay. Business Standard, June 28, 2007. http://www.business-standard.com/india/news/out-sidesick-bay/289269/ (accessed April 20, 2010).Google Scholar
23. PricewaterhouseCoopers. Emerging market report: Health care in India, 2007. http://www.pwc.com/en_GX/gx/healthcare/pdf/emerging-market-report-hc-in-india.pdf (accessed April 20, 2010).Google Scholar
24. Russell, LB, Gold, MR, Siegel, JE, Daniels, N, Weinstein, MC. The role of cost-effectiveness analysis in health and medicine. JAMA. 1996;276:1172–1177.CrossRefGoogle ScholarPubMed
25. Saltz, LB, Clarke, S, Diaz-Rubio, E, et al. Bevacizumab in combination with oxaliplatin-based chemotherapy as first line therapy in metastatic colorectal cancer: A randomized phase III study. J Clin Oncol. 2008;26:2013–2019.CrossRefGoogle ScholarPubMed
26. Sarin, R. Criteria for deciding cost effectiveness for expensive new anticancer agents. J Cancer Ther. 2008;4:1–2.CrossRefGoogle Scholar
27. Shashikant, S. More countries use compulsory license, but new problems emerge. TWN Info Service on Health Issues No. 4. May 19, 2005. http://www.twnside.org.sg/title2/health.info/twninfohealth004.htm (accessed April 27, 2010).Google Scholar
28. Shiroiwa, T, Fukuda, T, Tsutani, K. Cost-effectiveness analysis of bevacizumab combined with chemotherapy for the treatment of metastatic colorectal cancer in Japan. Clin Ther. 2007;29:2256–2267.CrossRefGoogle ScholarPubMed
29. Tappenden, P, Jones, R, Paisley, S, Carroll, C. Systematic review and economic evaluation of bevacizumab and cetuximab for the treatment of metastatic colorectal cancer. Health Technol Assess. 2007;11:1–128, iii-iv.CrossRefGoogle ScholarPubMed
30. Therasse, P, Arbuck, SG, Eisenhauer, EA, et al. New guidelines to evaluate the response to treatment in solid tumours: European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–216.CrossRefGoogle ScholarPubMed
31. Torrance, GW. Utility approach to measuring health-related quality of life. J Chron Dis. 1987;40:593–600.CrossRefGoogle ScholarPubMed
32. Tournigand, C, Andre, T, Achille, E, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: A randomized GERCOR study. J Clin Oncol. 2004;22:229–237.CrossRefGoogle ScholarPubMed
33. Van Cutsem, E, Peeters, M, Siena, S, et al. Open-label phase III trial of panitumumab plus best supportive care compared with best supportive care alone in patients with chemotherapy-refractory metastatic colorectal cancer. J Clin Oncol. 2007;25:1658–1664.CrossRefGoogle ScholarPubMed
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