CHICAGO (FRONTLINE MEDICAL NEWS) – Cancer drugs are most expensive in the United States and least expensive in India and South Africa, but when taking into account a nation’s wealth and cost of living, the treatments are most affordable in Australia, and least affordable in India and China. The United States is somewhat in between, according to an analysis presented at the annual meeting of the American Society of Clinical Oncology.

“Value has become a major buzzword in cancer care. In addition to existing methods of cost effectiveness, new frameworks have been developed by ASCO, [the National Comprehensive Cancer Network], [the European Society for Medical Oncology], and [the American Board of Internal Medicine]. However, ultimately value boils down to a simple equation,” said Dr. Daniel A. Goldstein of Rabin Medical Center, Petah Tikva, Israel.

“Value is benefit divided by cost. In this study, we interrogated the denominator in this equation. Cost. And we did this on a global perspective.”

Dr. Goldstein and his associates collected drug prices of 15 generic and 8 patented drugs and calculated retail prices in seven countries (Australia, India, China, South Africa, Israel, the United Kingdom, and the United States) for 1 month of therapy using a standardized body surface area to determine dosage. The United States had the highest median monthly retail prices at just under $9,000 for patented drugs. China, Israel, the U.K., and Australia had similar median monthly retail prices that were just under $3,000. India and South Africa had the lowest median monthly retail prices for patented drugs.

Median monthly generic retail prices were fairly similar across the seven countries.

“It is currently unclear how the difference in prices relates to ability to pay for payers in different countries,” Dr. Goldstein said. To assess affordability, the investigators calculated the monthly drug price as a percentage of gross domestic product per capita at purchasing power parity (GDPcap), a measurement that takes into account a nation’s wealth and cost of living.

Cancer drugs were the most affordable in Australia. Monthly drug prices were 3% of GDPcap for generics and 71% for patented drugs. In the United States, the cost of generics was 14% of GDPcap while patented drugs were 192% of GDPcap. Cancer drugs were least affordable in India and China. Monthly drug prices were 48% of GDPcap for generic drugs in China, 288% for patented drugs, 33% for generic drugs in India, and 313% for patented drugs.

“Despite lower drug prices in India and China, these drugs appear to be less affordable than in other countries. In the USA despite having the highest GDP per capita, given the higher drug prices, the drugs appear to be less affordable than in other developed countries. And we see a similar pattern for generic drugs but with a lower magnitude. And this is mostly driven by differences in GDP per capita rather than differences in drug prices,” Dr. Rabin said.

“This is a very interesting international comparative study, and I think the concept of affordability is a novel one because we tend to just look at the cost and say it is so much less expensive in other parts of the world but looking at affordability adds another dimension to the many nuanced issues [of cost],” commented moderator Dr. Patricia Ganz of the University of California, Los Angeles.

A major limitation of this study was the inability to implicate the role of health insurance, drug discounts, rebates, and medical assistance programs into affordability. In response to a question from a reporter, Dr. Goldstein said that wealth disparities within countries would also be an important factor to more thoroughly understand the ability of patients to pay for cancer treatments.

Dr. Goldstein added that a better understanding of a drug’s benefit (improvements on life expectancy, toxicity, duration of therapy, and so on) is also important to truly understand the value of drugs on a global level.

“There are several questions this study does not answer,” Dr. Goldstein said. “Should drugs be priced the same globally? Is there an ethical duty to price drugs relative to an individual or population’s level of wealth? And is there a difference between drugs used in curative and metastatic setting[s]? Should governments or insurance companies provide all drugs with proven efficacy?”

This study was unfunded. Dr. Goldstein had no relevant disclosures to report. One coauthor disclosed a consulting or advisory role with Novartis, and travel, accommodations, or expenses from Genomic Health.


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