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Global Comparator Report on Funding and Access to Oncology Drugs with special reference to South Africa

Global Comparator Report on Funding and Access to Oncology Drugs with special reference to South Africa. Dr Nils Wilking Karolinska Institutet, Stockholm, Sweden October 6, 2007. The 2007 report An up-date and extension of the 2005 European report.

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Global Comparator Report on Funding and Access to Oncology Drugs with special reference to South Africa

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  1. Global Comparator Report onFunding and Access to Oncology Drugswith special reference to South Africa Dr Nils Wilking Karolinska Institutet, Stockholm, Sweden October 6, 2007.

  2. The 2007 report An up-date and extension of the 2005 European report • A global comparison regarding patient access to cancer drugs B. Jönsson1 & N. Wilking2 1Stockholm School of Economics; 2Karolinska Institute, Stockholm, Sweden Annals of Oncology 18 (Supplement 3) 2007 • The report looked at access in 25 countries: • 19 countries in Europe • United States, Canada, Japan, Australia, New Zealand and South Africa • Total population 984 million • The European countries included in the study constitute 76% of the European population (447 million) • Data on South Africa from a sub-report in manuscript.

  3. Key points • Incidence is increasing while mortality is constant or declining • Progress in medical treatments has meant that cancer is becoming a chronic condition, incurable but treatable. However, these benefits are only realised once the drugs get to the patients. • There are great inequities between countries in the uptake and use of these drugs.

  4. Most common Cancers cervical cancer Breast cancer Prostate cancer Lung cancer Oesophageal cancer Kaposis sarcoma Incidence 15-9/100 000 Mortality 8-9/100 000 South Africa. Cancer numbers. 1997-1999

  5. Incidence of cancer in females in selected countries (Canada, Czech Republic, Denmark, Finland, New Zealand, Norway and Sweden) given as age-standardized rate per 100.000 inhabitants.

  6. Incidence of cancer in males in selected countries (Canada, Czech Republic, Denmark, Finland, New Zealand, Norway and Sweden) given as age-standardized rate per 100.000 inhabitants.

  7. Mortality of cancer in females in Norway, Poland, Portugal, Spain, Sweden, Switzerland, United Kingdom and the United States of America given as age-standardized rate.

  8. Mortality of cancer in males in Norway, Poland, Portugal, Spain, Sweden, Switzerland, United Kingdom and the United States of America given as age-standardized rate.

  9. Incidence of breast cancer in Canada, Czech Republic, Denmark, Finland, New Zealand, Norway and Sweden given as age-standardized rate.

  10. Mortality of breast cancer in Norway, Poland, Portugal, Spain, Sweden, Switzerland, United Kingdom and the United States of America given as age-standardized rate.

  11. Causes of Death and Disease Burden

  12. The ten disease groups with largest disease burden in South Africa, with statistics for Czech Republic/Hungary/Poland and the E-13 countries presented for comparison (2002 data)

  13. Cancer in developing countriesThe Size of the Problem The incidence of cancer is lower in countries at a lower level of economic development, but they account for more than half of global cancer and a higher fraction of patients die

  14. Estimates (Africa) Adopted from Dr Ian Magrath Cancer is rapidly increasing, but is neglected, compared to infectious diseases These diseases interact, increasing further the burden of disease

  15. Crude Rates by Regions Adopted from Dr Ian Magrath More affluent regions have higher actual incidence and mortality rates and lower mortality: incidence ratios

  16. ASR (World) by region: Comparison: Effect of Age Adopted from Dr Ian Magrath Adjustment of rates to a world standard population shows that incidence rates would remain lower but mortality rates would increase in low income regions as populations age

  17. The Global Pattern of Cancer; Contrasts Globocan 2002

  18. Less and More Developed Crude Incidence versus Cases Adopted from Dr Ian Magrath Per 100,000 per annum Thousands per annum 2002

  19. A Neglected Health Problem in Low Income Countries Adopted from Dr Ian Magrath • Cancer causes more deaths globally than AIDS, malaria and TB combined • In 2002, >50% of the 11 million estimated patients with cancer and 70% of cancer deaths were in developing countries, which have perhaps 5-10% of global resources • Developing countries will account for an ever increasing fraction of the global cancer burden • The WHA has approved a resolution (May 2005) recommending that countries develop and implement cancer control plans

  20. Cancer Registration; From CI on V Continents I-VIII Adopted from Dr Ian Magrath Fraction of World Population 14%9% 5% 60% 11% 1% Number of registries does not accurately reflect population coverage (e.g., African registries cover approx 7 million of the 888 million people

  21. Conclusions • Cancer services are limited and already overwhelmed in developing countries in spite of relatively low cancer burden • The cancer burden will increase markedly in the next decades (150m 2000-2020) • Building human capital is a priority, but obstacles include pool of teachers, losses of personnel to better circumstances (internal or external) • Material shortages – facilities, equipment, drugs etc. – and poorly structured health services compound the problem • Poverty, illiteracy, stigmata, traditional healers create additional obstacles to care

  22. Direct and indirect cost of cancer • Cancer accounts for about 5% of all health care expenditures in the USA • The share for cancer has been stable over the last 30 years • Cost of hospitalisation is the dominating cost item • Indirect costs in terms of lost production is more than double the direct health care costs

  23. Direct costs for cancer care in selected countries in 2004. Costs are PPP (Purchasing Power Parity) adjusted.Total in million euro, per capita in euro, and share of total health care costs(%) T

  24. Cost of cancer drugs in perspective • 2-2.5 new drugs per year since 1995 • Drug costs increase by 15-20 % per year • 3.5-7 % of total drug expenditure are cancer drugs. • Cancer drugs account for a minor, but growing, part (10-15%) of total cancer care expenditure

  25. Total cancer drug sales Total cancer drug sales (€000s) in all 25 countries. 1995-2005 by year of first world wide launch. Source IMS Health, IMS MIDAS Quantum

  26. Limitations in Resources: Anti-Cancer Drugs

  27. Approval of cancer drugs

  28. Limitations in Resources for RadiotherapyAdopted from Dr Ian Magrath In Dec 2004, there were approximately 2500 radiotherapy centers and 3700 machines for cancer therapy in the developing world (enough for 1.85 million patients per year compared to 3 million who need it. Maldistribution worsens the situation: many countries have one machine for millions of patients (1 per 250,000 in high income countries). Over 20 countries – mostly African - have none (IAEA). Many existing machines are idle for lack of maintenance, expired sources or lack of radiotherapists or physicists Old cobalt sources require longer radiation times

  29. Inequities between countries in the uptake and use of these drugs

  30. PPP-adjusted per capita cancer drug sales (€) in 22 of the study countries in 2005.Distributed on drugs of different “vintage”

  31. PPP-adjusted per capita cancer drug sales (€) in 2005 (For South Africa sales per capita is presented also with two capita rates for the total population as well as for the insured part (18.5%) of the population

  32. Gemcitabine uptake in Czech Republic, E13, Hungary, Poland, South Africa insured pop., South Africa total pop. and the UK

  33. Imatinib uptake in Czech Republic, E13, Hungary, Poland, South Africa insured pop., South Africa total pop. and the UK

  34. Rituximab uptake in Czech Republic, E13, Hungary, Poland, South Africa insured pop., South Africa total pop. and the UK

  35. Trastuzumab uptake in Czech Republic, E13, Hungary, Poland, South Africa insured pop., South Africa total pop. and the UK

  36. In many countries new drugs are not reaching patients quickly enough • Austria, France, Switzerland and the US are the leaders in the use of new cancer drugs, with France replacing Spain among the top four since the 2005 report was published. • Uptake of new cancer drugs is “low and slow” in New Zealand, Poland, Czech Republic, South Africa and the UK.

  37. Questions to be sorted out • Is improved cancer survival related to access to cancer drugs? • or to early detection; change in biology and diagnosis; surgery and radiation therapy? • Does survival improvement in clinical trials translate into survival effects in a population with cancer? • If yes: How do we measure this? • If no: “Then we have a real problem…”

  38. Contribution of the increase in cancer drug vintage to the decline in the age-adjusted cancer mortality rate. Frank Lichtenberg; Columbia University, NY,NY. Increase in drug vintage accounts for 30% of the 1995-2003 decline in the age-adjusted cancer mortality rate.

  39. Actions proposed • Give us better data!! • Move from 10 year old epidemiology data to real time data on ”Impact of Preventive, Diagnostic and Therapeutic Interventions” (iPDTi) • Common medical view on risks and benefits • Post marketing studies • CRT or non-interventional trials • Special budget for innovative treatments • Take a global perspective • Cancer in the developing countries will be a major challenge. • Re-think price and volume

  40. Final comments • Patients should have equal and early access to innovative treatments • Research on access of therapy is an important part of cancer research

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