Trends in Sales Volumes of Cancer Medicines in Six Asian Countries Working Toward Universal Health Coverage

Abstract

Background: In low- and middle-income (LMIC), medicines represent an important proportion of total out-of-pocket expenditures on health care and should therefore be a key target for financial protection through inclusion in benefit packages under universal health coverage (UHC). For antineoplastic medicines, this need will become even more urgent with the increasing incidence of cancers in LMIC and the availability of new, highly priced cancer. Previous studies have shown that countries have listed cancer medicines recommended in the World Health Organization (WHO) essential medicines list (EML) in their national EMLs. However, little is known about use of these medicines at country level and changes in use over time as countries work toward UHC. Aim: To analyze trends in sales volumes of cancer medicines in China, Indonesia, Kazakhstan, Malaysia, the Philippines and Thailand between 2006 and 2017. Methods: Using quarterly data from IQVIA (former IMS and Quintiles) on sales volumes in 6 middle-income Asian countries of cancer medicines (ATC-L01/02) included in the 2017 WHO EML, we estimated annual sales by international nonproprietary name, year and country. Sales volumes were estimated in total milligrams and total defined daily doses (DDD) per new cancer case. The reference DDD were taken from the German Institute of Medical Documentation and Information. We adjusted total mg and DDD by the total number of new cancer cases per country in 2012 ( Globocan 2012 ). Results: The 2017 WHO EML contains 49 medicines in the antineoplastic section; 40 of them were used in 1 or more countries included in the study. Availability of these 40 medicines ranged from 33 in Indonesia to 40 in the Philippines. The median percentage increase in sales volumes between 2006 and 2017 ranged from 42% in Thailand to 94% in Indonesia. Use of new, high-priced medicines such as trastuzumab and rituximab increased more than 90% and 72% in all countries, respectively, during the study period. Limitations: National sales volumes are extrapolated from standardized audits of procurement and sales data in sample facilities and/or distribution data supplied by wholesalers in each country and may underestimate actual sales. Given different indications for which a cancer medicine can be used and highly individualized antineoplastic treatment regimens and dosages, standardized DDD do not represent actual prescribed daily doses. Growth rates will reflect the place of the medicine within the national treatment guidelines and healthcare delivery capacity. Conclusion: This study provides evidence that use of WHO-recommended essential medicines for cancers increased in 6 Asian countries working toward UHC. Many factors are likely to have contributed to this outcome, including improvements in diagnosis and treatments. The next step in this study will be to assess the role of insurance coverage changes as a factor contributing to changes in utilization of cancer medicines.