Roxanne Nelson, BSN, RN

June 10, 2016

CHICAGO — Even though prices tend to be lower, both generic and patented drugs appear to be less affordable in lower-income countries, according to research presented here at the American Society of Clinical Oncology 2016 Annual Meeting.

In one of the largest analyses of differences in cancer drug prices around the world, an international team of researchers looked at the median retail prices of 23 cancer drugs in six different countries.

Not surprisingly, the highest retail prices were in the United States and the lowest were in India and South Africa.

In terms of the ability to pay for drugs, cancer drugs appeared to be most affordable in Australia and least affordable in China and India.

"This study provides a glimpse into prices and affordability of cancer drugs around the world and sets the stage for further research," said lead researcher Daniel A. Goldstein, MD, senior physician in medical oncology at the Rabin Medical Center in Petach Tikvah, Israel.

Various previous analyses have shown that the highest retail prices are in the United States, and that there are considerable price differences among other industrialized countries.

Dr Goldstein pointed to a recent study that looked at cancer drug costs in 16 European countries and in Australia and New Zealand (Lancet Oncol. 2016;17:39-47). The differences in price between the highest-priced country and the lowest-priced country ranged from 28% to 388%

That study "focused primarily on industrialized nations," Dr Goldstein noted. "We don't know about the ability to afford these drugs in other countries."

For example, he pointed out that Kenneth Frazier, chair and CEO of Merck, said that for drug prices in India, "we want to give products to Indians at prices they can afford."

"But what does that really mean?" Dr Goldstein asked.

There is growing consensus that drugs should be "value priced." In addition to existing methods of determining cost-effectiveness, he noted, new frameworks have been developed by several professional organizations to assess value.

Value has become the buzzword in cancer care.

"Value has become the buzzword in cancer care," Dr Goldstein said. "Ultimately, value boils down to a simple equation: benefit divided by cost."

Less Affordable in Poorer Countries

In their study, Dr Goldstein and his colleagues looked at differences in global cancer prices and evaluated how differences in drug prices are related to the ability to pay.

The team calculated monthly costs for 15 generic and eight patented cancer drugs used to treat a wide range of cancer types and stages. They used list prices of drugs in Australia, China, India, Israel, South Africa, United Kingdom, and the United States to make comparisons.

To evaluate affordability, they used the gross domestic product per capita at purchasing power parity (GDPcapPPP), a measure of national wealth that takes cost of living into consideration.

Median monthly retail prices ranged from $1515 in India to $8694 in the United States for patented drugs, and ranged from $654 in the United States to $159 in India and $120 in South Africa for generic drugs.

Table. Prices as a Percentage of GDPcapPPP in Select Countries

Country Generic Drugs, % Patented Drugs, %
Australia 3 71
China 48 288
India 33 313
United States 14 192


"The United States has significantly higher prices than other countries," said Dr Goldstein. "But despite having the highest GDP per capita, given the higher drug prices, the drugs appear to be less affordable than in other developed countries."

He added that this method of measuring affordability is not meant to be a precise indicator of the ability to pay. "It is a broad surrogate marker used to identify trends," Dr Goldstein explained. "There are many other factors that would come into play in the real world, such as insurance coverage, discounts, and wealth differences."

There are many issues that this study does not address, he noted, such as whether drugs should be priced the same globally, or whether there is an ethical duty to price drugs relative to an individual's or population's level of wealth.

"We only interrogated price per month, and understanding value is more complex (clinical benefit, duration of therapy)," Dr Goldstein said. "Alternatives and toxicity all factor in, and this study raises significant questions (ethical, economic, political, and regulatory)."

The United States is paying more for patented drugs than other countries, but when that number is adjusted for ability to pay, you find that the United States is no longer leading the pack when it comes to affordability, said Stacie B. Dusetzina, PhD, assistant professor in the division of pharmaceutical outcomes and policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill.

"A provocative question is whether the United States should be paying more for drugs, or whether other wealthy countries should be paying more," she said.

Increasing prices are putting a significant burden on patients, said Patricia Ganz, MD, director of cancer prevention and control research at the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles.

"More needs to be done to make treatments affordable and accessible for all patients," said Dr Ganz, who moderated a press briefing held in advance of the presentation. When we look at affordability, "it adds another dimension."

The study was unfunded. Dr Goldstein and Dr Dusetzina have disclosed no relevant financial relationships. Study coauthor Salomon Stemmer, MD, from the Rabin Medical Center, reports financial relationships with Novartis and Genomic Health.

American Society of Clinical Oncology (ASCO) 2016 Annual Meeting. Abstract LBA6500. Presented June 6, 2016.


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