Abstract
ObjectiveTo assess the variation in price among different brands of anticancer medicines available in hospital pharmacies at Nepalese cancer hospitals.MethodsThe price of different brands of the same anticancer medicines available in the hospital pharmacies of two cancer hospitals was assessed. Prices of different dosage forms such as a single tablet, capsule and vial were calculated. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical industries was determined, and the percentage variation in price was calculated. The prices of medicines (brands) were also compared with the price determined by the government where available.ResultsPrice variation was assessed for 31 anticancer medicines belonging to six broad categories. Prices were found to vary maximally among the following medicines, each belonging to separate categories: among alkylating agents, the price of temozolomide 100 mg capsule varied 308%; among antimetabolite agents, the price of pemetrexed 500 mg injection varied 134%; among hormonal drugs, the price of letrozole 2.5 mg tablet varied 200%; among antibody class, the price of trastuzumab 440 mg injection varied 73%; among natural products, the price of irinotecan 100 mg injection varied 590%; and among miscellaneous agents, the price of bortezomib 2 mg injection varied 241%. There was a significant difference in the mean MRP of the alkylating agents with the antimetabolites (p-value 0.006) and the monoclonal antibody (p-value <.001). Antimetabolites, natural products, hormonal therapy all had significant mean differences in their MRPs with the monoclonal antibodies. (p-value <.001) and the monoclonal antibodies had a significant mean difference in the MRP with the miscellaneous agents. (p-value <.001).ConclusionsThere was a considerable variation in the price of different brands of anticancer medicines available in the Nepalese market. The Government of Nepal has regulated the prices of some medicines, including anticancer medicine. However, it is not enough as prices of the majority of anticancer medicines are still not regulated. Therefore, further strategies are needed to address the variation in the prices of anticancer medicines available in the Nepalese market.
Highlights
Cancer is the second leading cause of death and is accountable for a probable 9.6 million deaths in the year 2018 [1]
There was a considerable variation in the price of different brands of anticancer medicines available in the Nepalese market
The Government of Nepal has regulated the prices of some medicines, including anticancer medicine
Summary
Cancer is the second leading cause of death and is accountable for a probable 9.6 million deaths in the year 2018 [1]. In a systematic analysis by the Global Burden of Disease Cancer Collaboration in 2016, there were 17.2 million incident cancer cases, 8.9 million deaths, and 213.2 million Disability-Adjusted Life-Years (DALYs) due to cancer worldwide [2]. It is one of the major non-communicable diseases (NCDs) in Nepal [3]. Cancer is a major social and financial burden to Nepalese society and the healthcare system. Anti-cancer medicines are usually expensive [6] and cause financial distress to the patients, society, and the country. Studies have reported significant variation in the prices of the same anti-cancer medicines across different countries (up to 388% variation) [7, 8] and within a country (up to 714% variation) [9]
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