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Exploring the role of polymeric conjugates toward anti-cancer drug delivery: Current trends and future projections. Int J Pharm 2018; 548:500-514. [DOI: 10.1016/j.ijpharm.2018.06.060] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 12/13/2022]
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Goldsbury DE, Yap S, Weber MF, Veerman L, Rankin N, Banks E, Canfell K, O’Connell DL. Health services costs for cancer care in Australia: Estimates from the 45 and Up Study. PLoS One 2018; 13:e0201552. [PMID: 30059534 PMCID: PMC6066250 DOI: 10.1371/journal.pone.0201552] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/17/2018] [Indexed: 11/26/2022] Open
Abstract
Background Cancer care represents a substantial and rapidly rising healthcare cost in Australia. Our aim was to provide accurate population-based estimates of the health services cost of cancer care using large-scale linked patient-level data. Methods We analysed data for incident cancers diagnosed 2006–2010 and followed to 2014 among 266,793 eligible participants in the 45 and Up Study. Health system costs included Medicare and pharmaceutical claims, inpatient hospital episodes and emergency department presentations. Costs for cancer cases and matched cancer-free controls were compared, to estimate monthly/annual excess costs of cancer care by cancer type, before and after diagnosis and by phase of care (initial, continuing, terminal). Total costs incurred in 2013 were also estimated for all people diagnosed in Australia 2009–2013. Results 7624 participants diagnosed with cancer were matched with up to three controls. The mean excess cost of care per case was AUD$1,622 for the year before diagnosis, $33,944 for the first year post-diagnosis and $8,796 for the second year post-diagnosis, with considerable variation by cancer type. Mean annual cost after the initial treatment phase was $4,474/case and the mean cost for the last year of life was $49,733/case. In 2013 the cost for cancers among people in Australia diagnosed during 2009–2013 was ~$6.3billion (0.4% of Gross Domestic Product; $272 per capita), with the largest costs for colorectal cancer ($1.1billion), breast cancer ($0.8billion), lung cancer ($0.6billion) and prostate cancer ($0.5billion). Conclusions The cost of cancer care is substantial and varies by cancer type and time since diagnosis. These findings emphasise the economic importance of effective primary and secondary cancer prevention strategies.
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Affiliation(s)
- David E. Goldsbury
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
- * E-mail:
| | - Sarsha Yap
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
| | - Marianne F. Weber
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Lennert Veerman
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Nicole Rankin
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
- Sydney Catalyst, NHMRC Clinical Trials Centre, Chris O’Brien Lifehouse Building, Camperdown, New South Wales, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- Prince of Wales Clinical School, UNSW Medicine, Sydney, New South Wales, Australia
| | - Dianne L. O’Connell
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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Pettit SD, Kirch R. Do current approaches to assessing therapy related adverse events align with the needs of long-term cancer patients and survivors? CARDIO-ONCOLOGY (LONDON, ENGLAND) 2018; 4:5. [PMID: 32154005 PMCID: PMC7048033 DOI: 10.1186/s40959-018-0031-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/30/2018] [Indexed: 01/29/2023]
Abstract
The increasing efficacy of cancer therapeutics means that the timespan of cancer therapy administration is undergoing a transition to increasingly long-term settings. Unfortunately, chronic therapy-related adverse health events are an unintended, but not infrequent, outcome of these life-saving therapies. Historically, the cardio-oncology field has evolved as retrospective effort to understand the scope, mechanisms, and impact of treatment-related toxicities that were already impacting patients. This review explores whether current systemic approaches to detecting, reporting, tracking, and communicating AEs are better positioned to provide more proactive or concurrent information to mitigate the impact of AE's on patient health and quality of life. Because the existing tools and frameworks for capturing these effects are not specific to cardiology, this study looks broadly at the landscape of approaches and assumptions. This review finds evidence of increasing focus on the provision of actionable information to support long-term health and quality of life for survivors and those on chronic therapy. However, the current means to assess and support the impact of this burden on patients and the healthcare system are often of limited relevance for an increasingly long-lived survivor and patient population.
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Affiliation(s)
- Syril D. Pettit
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
- Health and Environmental Sciences Institute, Washington DC, USA
| | - Rebecca Kirch
- National Patient Advocate Foundation, Washington DC, USA
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Saqib A, Iftikhar S, Sarwar MR. Availability and affordability of biologic versus non-biologic anticancer medicines: a cross-sectional study in Punjab, Pakistan. BMJ Open 2018; 8:e019015. [PMID: 29903783 PMCID: PMC6009472 DOI: 10.1136/bmjopen-2017-019015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES Prime focus of this study was to evaluate the availability and affordability of originator brands (OBs) and lowest price generics (LPGs) of prescribed biologic and non-biologic anticancer medicines. DESIGN, SETTINGS AND PARTICIPANTS A descriptive, cross-sectional survey was conducted in 22 cancer-care hospitals (18 public hospitals and 4 private hospitals) and 44 private pharmacies in Punjab, Pakistan. Sampling population consisted of 4483 patients with cancer aged ≥18 years. The availability was determined by classifying anticancer medicines in four categories: absent/unavailability (medicines not present in any surveyed facility), low availability (medicines present in <50% of surveyed facilities), fairly high availability (medicines present in 50%-74% of surveyed facilities) and high availability (medicines present in >75% of surveyed facilities). Medicines were affordable if overall cost of all the prescribed anticancer medicines were 20% of the household capacity to pay. Data were analysed by using Statistical Packages for Social Sciences (IBM SPSS Statistics for Windows, V.21.0). RESULTS A total of 5060 patients with cancer were approached out of which 4483 patients were included in the survey. Overall, 10 103 anticancer drugs were prescribed. Among them, 96.3% were non-biologics and 3.7% were biologics. Oncologists were reluctant to prescribe biologics due to high prices. 58.1% of non-biologics were affordable; whereas, the affordability of biologics was 3.3%. A total of 43.9% of both biologic and non-biologic OBs were available; whereas, their affordability was 44.2%. On the other hand, the availability of LPGs was 21.3%, and their affordability was 66.1%. For low-income patients, the affordability of non-biologics was 31.6% and the affordability of biologics was 1.1%. CONCLUSIONS Most of the patients with cancer were prescribed non-biologics due to their low price and better affordability. In contrast to OBs, LPGs of both biologics and non-biologics had less availability but more affordability.
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Affiliation(s)
- Anum Saqib
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan
| | - Sadia Iftikhar
- Department of Pharmacy Practice, Akhtar Saeed College of Pharmaceutical Sciences, Lahore, Pakistan
| | - Muhammad Rehan Sarwar
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan
- Department of Pharmacy Practice, Akhtar Saeed College of Pharmaceutical Sciences, Lahore, Pakistan
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Organization, quality and cost of oncological home-hospitalization: A systematic review. Crit Rev Oncol Hematol 2018; 126:145-153. [DOI: 10.1016/j.critrevonc.2018.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/24/2018] [Accepted: 03/21/2018] [Indexed: 11/23/2022] Open
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Yeung K, Suh K, Basu A, Garrison LP, Bansal A, Carlson JJ. Paying for Cures: How Can We Afford It? Managed Care Pharmacy Stakeholder Perceptions of Policy Options to Address Affordability of Prescription Drugs. J Manag Care Spec Pharm 2018; 23:1084-1090. [PMID: 28944726 PMCID: PMC10397928 DOI: 10.18553/jmcp.2017.23.10.1084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND High-priced medications with curative potential, such as the newer hepatitis C therapies, have contributed to the recent growth in pharmaceutical expenditure. Despite the obvious benefits, health care decision makers are just beginning to grapple with questions of how to value and pay for curative therapies that may feature large upfront cost, followed by health benefits that are reaped over a patient's lifespan. Alternative policy options have been proposed to promote high value and financially sustainable use of these therapies. It is unclear which policy options would be most acceptable to health care payer and biomedical manufacturer stakeholders. OBJECTIVES To (a) briefly review pharmaceutical policy options to address health system affordability and (b) assess the acceptability of alternative policy options to health care payers and biomedical manufacturers before and after an Academy of Managed Care Pharmacy (AMCP) continuing pharmacy education (CPE) session. METHODS We searched MEDLINE and Cochran databases for pharmaceutical policy options addressing affordability. With input from a focus group of managed care professionals, we developed CPE session content and an 8-question survey focusing on the most promising policy options. We fielded the survey before and after the CPE session, which occurred as part of the 2016 AMCP Annual Meeting. We first conducted a chi-squared goodness-of-fit test to assess response distributions. Next, we tested how responses differed before and after by using an ordered logit and a multinomial logit to model Likert scale and unordered responses, respectively. RESULTS Although risk-sharing payments over time remained the most favorable choice before (37%) and after (35%) the CPE session, this choice was closely followed by HealthCoin after the session, which increased in favorability from 4% to 33% of responses (P = 0.001). About half of the respondents (54%) indicated that legislative change is the most significant barrier to the implementation of any policy. CONCLUSIONS As high-cost curative drugs reach the market, managed care stakeholders need information from a balanced education source regarding alternative policies to address affordability. We found that after the AMCP CPE session, risk-sharing payments over time and HealthCoin were the most favorable options. DISCLOSURES No funding was provided for this research. Carlson reports consulting fees from Genentech, Pfizer, and Seattle Genetics. The other authors have nothing to disclose. Study concept and design were contributed by Yeung, Garrison, and Carlson. Yeung collected the data, which were interpreted by Yeung and Basu. The manuscript was written by Yeung, Suh, and Bansal and revised by Yeung. A portion of this research was presented at the Academy of Managed Care & Specialty Pharmacy Annual Meeting as a continuing education session entitled "Paying for Cures: How Can We Afford It?" on April 20, 2016, in San Francisco, California.
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Affiliation(s)
- Kai Yeung
- 1 Kaiser Permanente Washington Health Research Institute, Seattle, and Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle
| | - Kangho Suh
- 2 Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle
| | - Anirban Basu
- 3 Department of Health Services, School of Public Health, and Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle
| | - Louis P Garrison
- 2 Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle
| | - Aasthaa Bansal
- 2 Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle
| | - Josh J Carlson
- 2 Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle
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Kantarjian HM, Prat F, Steensma DP, Kurzrock R, Stewart DJ, Sekeres MA, Leveque J. Cancer research in the United States: A critical review of current status and proposal for alternative models. Cancer 2018; 124:2881-2889. [DOI: 10.1002/cncr.31522] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/27/2018] [Accepted: 03/28/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Hagop M. Kantarjian
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Ferran Prat
- Research Administration and Industry Ventures; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - David P. Steensma
- Department of Medical Oncology; Dana-Farber Cancer Institute, Harvard Medical School; Boston Massachusetts
| | - Razelle Kurzrock
- Division of Hematology/Oncology, Department of Medicine; University of California at San Diego; San Diego California
| | - David J. Stewart
- Department of Medicine; University of Ottawa; Ottawa Ontario Canada
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108
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Sulfated polysaccharides from Padina tetrastromatica induce apoptosis in HeLa cells through ROS triggered mitochondrial pathway. Process Biochem 2018. [DOI: 10.1016/j.procbio.2018.02.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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109
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Public Health Care Financing and the Costs of Cancer Care: A Cross-National Analysis. Cancers (Basel) 2018; 10:cancers10040117. [PMID: 29649115 PMCID: PMC5923372 DOI: 10.3390/cancers10040117] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 03/27/2018] [Accepted: 04/08/2018] [Indexed: 12/28/2022] Open
Abstract
Expenditure and financing aspects in the healthcare system in general, and in cancer care in particular, are subjects of increasing concern to the medical community. Nowadays, it is imperative for the healthcare system to respond to the challenge of universal access to quality healthcare, by measuring the financial resources within the healthcare sector. The purpose of this review is to highlight the major gaps in the healthcare expenditures for all types of care, as well as on cancer and anti-cancer drugs across 28 European Union member states. The indicators taken into account are divided into two major groups: (1) healthcare expenditures for all types of care, and (2) healthcare expenditures on cancer and anti-cancer drugs. The programs used for our analysis are SPSS Statistics V20.0 (IBM Corporation, Armonk, NY, USA) and Stat World Explorer. The overall picture confirms that there are considerable disparities between the 28 countries in relation to their expenditures on health. The trend in public expenditures for all types of care, compared to the share of healthcare expenditures as a percentage of the GDP, shows the increase of health expenses between 2010 and 2014, but a lower rise compared to the total GDP increase. Healthcare expenditure on cancer (%THE) is rather low, despite the high cost associated with anti-cancer drugs. New treatments and drugs development will be increasingly difficult to achieve if the share devoted to cancer does not increase, and the lack of funds may act as a barrier in receiving high-quality care.
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110
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Remon J, Bonastre J, Besse B. The 5000% case: a glimpse into the financial issue of lung cancer treatment. Eur Respir J 2018; 47:1331-3. [PMID: 27132267 DOI: 10.1183/13993003.00548-2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 03/16/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Jordi Remon
- Medical Oncology Dept, Institute Gustave Roussy, Villejuif, France
| | - Julia Bonastre
- Service de biostatistique et d'épidémiologie, Institute Gustave Roussy, Villejuif, France CESP Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
| | - Benjamin Besse
- Medical Oncology Dept, Institute Gustave Roussy, Villejuif, France Université Paris-Sud and Institute Gustave Roussy Cancer Campus, Villejuif, France
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111
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Kim HC, Won YY. Clinical, technological, and economic issues associated with developing new lung surfactant therapeutics. Biotechnol Adv 2018; 36:1185-1193. [PMID: 29597031 DOI: 10.1016/j.biotechadv.2018.03.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/20/2018] [Accepted: 03/23/2018] [Indexed: 01/19/2023]
Abstract
Discovery of lung surfactant deficiency as a main cause of neonatal respiratory distress syndrome (NRDS) has influenced a steep increase in lung surfactant research. Although this has yielded impactful scientific discoveries, much of the basic research on lung surfactants has failed to translate into clinical practices. This is attributed to insufficient information covering the entire lung surfactant ecosystem, from the basic science to economics surrounding the development and clinical practices. In this manuscript, developments related to improving therapeutic lung surfactant as well as the degree of unmet need are analyzed from both technical and economic perspectives. Two potential opportunities are emphasized: (1) aerosolized lung surfactants to treat NRDS infants, and (2) synthetic lung surfactants for acute respiratory distress syndrome (ARDS) patients. Each has a modestly projected US market size of $120 million and $4 billion, well enough to make up for the high development costs associated with investigational drug development. Both opportunities have been pursued in the past, but to date these attempts have met with no success mainly due to technical limitations. With the recent advancements in both fields, technology improvements have created opportunities to solve both decades-old problems.
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Affiliation(s)
- Hyun Chang Kim
- School of Chemical Engineering, Purdue University, West Lafayette, IN 47907, United States
| | - You-Yeon Won
- School of Chemical Engineering, Purdue University, West Lafayette, IN 47907, United States.
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112
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Durán CE, Elseviers M, Vander Stichele R, Rottey S, Christiaens T. Sharp rise in the expenditures of targeted drugs in Ecuador: five-year (2010-2014) consumption of oncologic drugs in public and private hospitals. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2018. [DOI: 10.1111/jphs.12221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Carlos E. Durán
- Heymans Institute of Pharmacology; Ghent University; Gent Belgium
| | - Monique Elseviers
- Heymans Institute of Pharmacology; Ghent University; Gent Belgium
- Center for Research and Innovation in Care (CRIC); University of Antwerpen; Gent Belgium
| | | | - Sylvie Rottey
- Heymans Institute of Pharmacology; Ghent University; Gent Belgium
- Drug Research Unit Ghent; Ghent University Hospital; Gent Belgium
- Department of Medical Oncology; Ghent University Hospital; Gent Belgium
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Herbst CL, Miot JK, Moch SL, Ruff P. Access to colorectal cancer (CRC) chemotherapy and the associated costs in a South African public healthcare patient cohort. J Cancer Policy 2018. [DOI: 10.1016/j.jcpo.2017.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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114
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Plants as sources of natural and recombinant anti-cancer agents. Biotechnol Adv 2018; 36:506-520. [DOI: 10.1016/j.biotechadv.2018.02.002] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 01/23/2018] [Accepted: 02/01/2018] [Indexed: 02/07/2023]
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115
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Gilbar PJ, Chambers CR, Vandenbrouche J, Sessink PJM, Tyler TG. How can the use of closed system transfer devices to facilitate sharing of drug vials be optimised to achieve maximum cost savings? J Oncol Pharm Pract 2018; 25:205-209. [DOI: 10.1177/1078155217753890] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Peter J Gilbar
- Cancer and Palliative Care Services, Toowoomba Hospital, Toowoomba, Australia
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Australia
| | - Carole R Chambers
- Department of Cancer Services Pharmacy, Alberta Health Services, Calgary, Canada
| | | | | | - Timothy G Tyler
- Comprehensive Cancer Center, Desert Regional Medical Center, Palm Springs, CA, USA
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New tools for old drugs: Functional genetic screens to optimize current chemotherapy. Drug Resist Updat 2018; 36:30-46. [PMID: 29499836 PMCID: PMC5844649 DOI: 10.1016/j.drup.2018.01.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/29/2017] [Accepted: 01/06/2018] [Indexed: 12/26/2022]
Abstract
Despite substantial advances in the treatment of various cancers, many patients still receive anti-cancer therapies that hardly eradicate tumor cells but inflict considerable side effects. To provide the best treatment regimen for an individual patient, a major goal in molecular oncology is to identify predictive markers for a personalized therapeutic strategy. Regarding novel targeted anti-cancer therapies, there are usually good markers available. Unfortunately, however, targeted therapies alone often result in rather short remissions and little cytotoxic effect on the cancer cells. Therefore, classical chemotherapy with frequent long remissions, cures, and a clear effect on cancer cell eradication remains a corner stone in current anti-cancer therapy. Reliable biomarkers which predict the response of tumors to classical chemotherapy are rare, in contrast to the situation for targeted therapy. For the bulk of cytotoxic therapeutic agents, including DNA-damaging drugs, drugs targeting microtubules or antimetabolites, there are still no reliable biomarkers used in the clinic to predict tumor response. To make progress in this direction, meticulous studies of classical chemotherapeutic drug action and resistance mechanisms are required. For this purpose, novel functional screening technologies have emerged as successful technologies to study chemotherapeutic drug response in a variety of models. They allow a systematic analysis of genetic contributions to a drug-responsive or −sensitive phenotype and facilitate a better understanding of the mode of action of these drugs. These functional genomic approaches are not only useful for the development of novel targeted anti-cancer drugs but may also guide the use of classical chemotherapeutic drugs by deciphering novel mechanisms influencing a tumor’s drug response. Moreover, due to the advances of 3D organoid cultures from patient tumors and in vivo screens in mice, these genetic screens can be applied using conditions that are more representative of the clinical setting. Patient-derived 3D organoid lines furthermore allow the characterization of the “essentialome”, the specific set of genes required for survival of these cells, of an individual tumor, which could be monitored over the course of treatment and help understanding how drug resistance evolves in clinical tumors. Thus, we expect that these functional screens will enable the discovery of novel cancer-specific vulnerabilities, and through clinical validation, move the field of predictive biomarkers forward. This review focuses on novel advanced techniques to decipher the interplay between genetic alterations and drug response.
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The Role of Compounds Derived from Natural Supplement as Anticancer Agents in Renal Cell Carcinoma: A Review. Int J Mol Sci 2017; 19:ijms19010107. [PMID: 29301217 PMCID: PMC5796057 DOI: 10.3390/ijms19010107] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/24/2017] [Accepted: 12/28/2017] [Indexed: 12/24/2022] Open
Abstract
Renal Cell Carcinoma (RCC) is the most prominent kidney cancer derived from renal tubules and accounts for roughly 85% of all malignant kidney cancer. Every year, over 60,000 new cases are registered, and about 14,000 people die from RCC. The incidence of this has been increasing significantly in the U.S. and other countries. An increased understanding of molecular biology and the genomics of RCC has uncovered several signaling pathways involved in the progression of this cancer. Significant advances in the treatment of RCC have been reported from agents approved by the Food and Drug Administration (FDA) that target these pathways. These agents have become drugs of choice because they demonstrate clinical benefit and increased survival in patients with metastatic disease. However, the patients eventually relapse and develop resistance to these drugs. To improve outcomes and seek approaches for producing long-term durable remission, the search for more effective therapies and preventative strategies are warranted. Treatment of RCC using natural products is one of these strategies to reduce the incidence. However, recent studies have focused on these chemoprevention agents as anti-cancer therapies given they can inhibit tumor cell grow and lack the severe side effects common to synthetic compounds. This review elaborates on the current understanding of natural products and their mechanisms of action as anti-cancer agents. The present review will provide information for possible use of these products alone or in combination with chemotherapy for the prevention and treatment of RCC.
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118
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Asami S, Kiga D, Konagaya A. Constraint-based perturbation analysis with cluster Newton method: a case study of personalized parameter estimations with irinotecan whole-body physiologically based pharmacokinetic model. BMC SYSTEMS BIOLOGY 2017; 11:129. [PMID: 29322928 PMCID: PMC5763286 DOI: 10.1186/s12918-017-0513-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Drug development considering individual varieties among patients becomes crucial to improve clinical development success rates and save healthcare costs. As a useful tool to predict individual phenomena and correlations among drug characteristics and individual varieties, recently, whole-body physiologically based pharmacokinetic (WB- PBPK) models are getting more attention. WB-PBPK models generally have a lot of drug-related parameters that need to be estimated, and the estimations are difficult because the observed data are limited. Furthermore, parameter estimation in WB-PBPK models may cause overfitting when applying to individual clinical data such as urine/feces drug excretion for each patient in which Cluster Newton Method (CNM) is applicable for parameter estimation. In order to solve this issue, we came up with the idea of constraint-based perturbation analysis of the CNM. The effectiveness of our approach is demonstrated in the case of irinotecan WB-PBPK model using common organ-specific tissue-plasma partition coefficients (Kp) among the patients as constraints in WB-PBPK parameter estimation. Results We find strong correlations between age, renal clearance and liver functions in irinotecan WB-PBPK model with personalized physiological parameters by observing the distributions of optimized values of strong convergence drug-related parameters using constraint-based perturbation analysis on CNM. The constraint-based perturbation analysis consists of the following three steps: (1) Estimation of all drug-related parameters for each patient; the parameters include organ-specific Kp. (2) Fixing suitable values of Kp for each organ among all patients identically. (3) Re-estimation of all drug-related parameters other than Kp by using the fixed values of Kp as constraints of CNM. Conclusions Constraint-based perturbation analysis could yield new findings when using CNM with appropriate constraints. This method is a new technique to find suitable values and important insights that are masked by CNM without constraints. Electronic supplementary material The online version of this article (10.1186/s12918-017-0513-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shun Asami
- Department of Computational Intelligence and Systems Science, Tokyo Institute of Technology, 4259 Nagatsuda-cho, Midori-ku, Yokohama-shi, Kanagawa, 226-8503, Japan
| | - Daisuke Kiga
- Department of Computational Intelligence and Systems Science, Tokyo Institute of Technology, 4259 Nagatsuda-cho, Midori-ku, Yokohama-shi, Kanagawa, 226-8503, Japan.,Department of Electrical Engineering and Bioscience, Waseda University, 2-2 Wakamatsu-cho, Shinjuku-ku, Tokyo, 162-8480, Japan
| | - Akihiko Konagaya
- Department of Computational Intelligence and Systems Science, Tokyo Institute of Technology, 4259 Nagatsuda-cho, Midori-ku, Yokohama-shi, Kanagawa, 226-8503, Japan. .,School of Computing, Tokyo Institute of Technology, 4259 Nagatsuda-cho, Midori-ku, Yokohama-shi, Kanagawa, 226-8503, Japan. .,National Institute of Informatics, 2-1-2 Hitotsubashi, Chiyoda-ku, Tokyo, 101-8430, Japan.
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Wu AC, Mazor KM, Ceccarelli R, Loomer S, Lu CY. Access to Guideline-Recommended Pharmacogenomic Tests for Cancer Treatments: Experience of Providers and Patients. J Pers Med 2017; 7:jpm7040017. [PMID: 29140263 PMCID: PMC5748629 DOI: 10.3390/jpm7040017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 10/28/2017] [Accepted: 11/08/2017] [Indexed: 01/20/2023] Open
Abstract
Genomic tests are the fastest growing sector in medicine and medical science, yet there remains a dearth of research on access to pharmacogenomic tests and medications. The objective of this study is to explore providers' and patients' experiences and views on test access as well as strategies used for gaining access. We interviewed clinicians who prescribed medications that should be guided by pharmacogenomic testing and patients who received those prescriptions. We organized the themes into the four dimensions suggested by the World Health Organization framework on access to medications and health technologies. Guideline-recommended pharmacogenomic tests for cancer care are generally available, although the timeliness of return of test results is sometimes suboptimal. Accessibility of pharmacogenomic tests is made challenging by the process of ordering pharmacogenomic tests, which is time-consuming. Affordability is a barrier to some patients as expressed by both providers and patients, who noted that the cost of pharmacogenomic tests and medications is high. Acceptability of the tests is high as both providers and patients view the tests positively. Understanding challenges to accessing pharmacogenomic tests will allow policymakers to develop policies that streamline access to genomics-based technologies to improve population health.
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Affiliation(s)
- Ann Chen Wu
- Precision Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, 401 Park Drive, Suite 401, Boston, MA 02215, USA.
| | - Kathleen M Mazor
- Meyers Primary Care Institute, A Joint Endeavor of the University of Massachusetts Medical School, Reliant Medical Group and Fallon Health; 630 Plantation Street, Worcester, MA 02215, USA.
| | - Rachel Ceccarelli
- Precision Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, 401 Park Drive, Suite 401, Boston, MA 02215, USA.
| | - Stephanie Loomer
- Precision Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, 401 Park Drive, Suite 401, Boston, MA 02215, USA.
| | - Christine Y Lu
- Precision Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, 401 Park Drive, Suite 401, Boston, MA 02215, USA.
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De Araújo RF, Pessoa JB, Cruz LJ, Chan AB, De Castro Miguel E, Cavalcante RS, Brito GAC, Silva HFO, Gasparotto LHS, Guedes PMM, Araújo AA. Apoptosis in human liver carcinoma caused by gold nanoparticles in combination with carvedilol is mediated via modulation of MAPK/Akt/mTOR pathway and EGFR/FAAD proteins. Int J Oncol 2017; 52:189-200. [PMID: 29115423 DOI: 10.3892/ijo.2017.4179] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/21/2017] [Indexed: 11/06/2022] Open
Abstract
In cancers, apoptosis signaling pathways and cell survival and growth pathways responsible for resistance to conventional treatments, such as Pi3K/Akt/mTOR and mitogen-activated protein kinase (MAPK) become dysregulated. Recently, alternative treatments to promote tumor cell death have become important. The present study reports on the antitumor and cytoprotective action of gold nanoparticles (GNPs) and carvedilol in combination and in isolated application. Apoptosis was analyzed by FITC/propidium iodide staining flow cytometry; caspase-3, caspase-8, Bcl-2 and MAPK/ERK activity by immunofluorescence microscopy; gene expression of proteins related to cell death as Akt, mTOR, EGFR, MDR1, survivin, FADD and Apaf, by the real-time PCR; and western blot analysis for MAPK/ERK, Akt and mTOR. Oxidative stress evaluation was performed by reduced glutathione (GSH) and malondialdehyde (MDA) levels. Intracellular GNPs targets were identified by transmission electron microscopy. After exposure to a combination of GNPs (6.25 µg/ml) and carvedilol (3 µM), death as promoted by apoptosis was detected using flow cytometry, for expression of pro-apoptotic proteins FADD, caspase-3, caspase-8 and sub-regulation of anti-apoptotic MAPK/ERK, Akt, mTOR, EGFR and MDR1 resistance. Non-tumor cell cytoprotection with GSH elevation and MDA reduction levels was detected. GNPs were identified within the cell near to the nucleus when combined with carvedilol. The combination of GNP and carvedilol promoted downregulation of anti-apoptotic and drug resistance genes, over-regulation of pro-apoptotic proteins in tumor cells, as well as cytoprotection of non-tumor cells with reduction of apoptosis and oxidative stress.
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Affiliation(s)
- Raimundo F De Araújo
- Department of Morphology, Federal University of Rio Grande do Norte, Natal 59072-970, RN, Brazil
| | - Jonas B Pessoa
- Post Graduation Programme in Structural and Functional Biology, Federal University of Rio Grande do Norte, Natal 59072-970, RN, Brazil
| | - Luis J Cruz
- Translational Nanobiomaterials and Imaging, Department of Radiology, Leiden University Medical Center, 2333 CL Leiden, The Netherlands
| | - Alan B Chan
- Percuros B.V., 2333 CL Leiden, The Netherlands
| | | | - Rômulo S Cavalcante
- Post Graduation Programme in Health Science, Federal University of Rio Grande do Norte, Natal 59072-970, RN, Brazil
| | - Gerly Anne C Brito
- Department of Morphology/Postgraduate Program in Morphology/UFC, Fortaleza, CE, Brazil
| | - Heloiza Fernada O Silva
- Group of Biological Chemistry and Chemometrics, Institute of Chemistry, Federal University of Rio Grande do Norte, Natal 59072-970, RN, Brazil
| | - Luiz H S Gasparotto
- Group of Biological Chemistry and Chemometrics, Institute of Chemistry, Federal University of Rio Grande do Norte, Natal 59072-970, RN, Brazil
| | - Paulo M M Guedes
- Department of Parasitology and Microbiology and Post Graduation Program in Parasitary Biology, Federal University of Rio Grande do Norte, Natal 59072-970, RN, Brazil
| | - Aurigena A Araújo
- Department of Biophysics and Pharmacology, Post Graduation Programme in Public Health, Post Graduation Programme in Pharmaceutical Science, Federal University of Rio Grande do Norte, Natal 59072-970, RN, Brazil
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121
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Campbell TC. Cancer Prevention and Treatment by Wholistic Nutrition. JOURNAL OF NATURE AND SCIENCE 2017; 3:e448. [PMID: 29057328 PMCID: PMC5646698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Cancer is traditionally considered a genetic disease. It starts with a gene mutation, often caused by environmental carcinogens that are enzymatically activated to metabolites that covalently bind to DNA. If these now-damaged carcinogen-DNA adducts are not repaired before the cell replicates, they result in a mutation, which is inherited by daughter cells and their subsequent progeny. Still more mutations are added that are thought to advance cellular independence, metastasis, and drug resistance, among other characteristics typically observed for advanced cancer. The stages of initiation, promotion and progression of cancer by mutations infer irreversibility because back mutations are exceedingly rare. Thus, treatment protocols typically are designed to remove or kill cancer cells by surgery, chemotherapy, immunotherapy and/or radiotherapy. However, empirical evidence has existed to show a fundamentally different treatment option. For example, the promotion of cancer growth and development in laboratory animals initiated by a powerful mutagen/carcinogen can be repetitively turned on and off by non-mutagenic mechanisms, even completely, by modifying the consumption of protein at relevant levels of intake. Similar but less substantiated evidence also exists for other nutrients and other cancer types. This suggests that ultimate cancer development is primarily a nutrition-responsive disease rather than a genetic disease, with the understanding that nutrition is a comprehensive, wholistic biological effect that reflects the natural contents of nutrients and related substances in whole, intact food. This perspective sharply contrasts with the contemporary inference that nutrition is the summation of individual nutrients acting independently. The spelling of 'holism' with the 'w' is meant to emphasize the empirical basis for this function. The proposition that wholistic nutrition controls and even reverses disease development suggests that cancer may be treated by nutritional intervention.
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Affiliation(s)
- T Colin Campbell
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14850, USA
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122
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Tsubamoto H, Ueda T, Inoue K, Sakata K, Shibahara H, Sonoda T. Repurposing itraconazole as an anticancer agent. Oncol Lett 2017; 14:1240-1246. [PMID: 28789339 PMCID: PMC5529765 DOI: 10.3892/ol.2017.6325] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 04/07/2017] [Indexed: 12/21/2022] Open
Abstract
Itraconazole, a common anti-fungal agent, has demonstrated potential anticancer activity, including reversing chemoresistance mediated by P-glycoprotein, modulating the signal transduction pathways of Hedgehog, mechanistic target of rapamycin and Wnt/β-catenin in cancer cells, inhibiting angiogenesis and lymphangiogenesis, and possibly interfering with cancer-stromal cell interactions. Clinical trials have suggested the clinical benefits of itraconazole monotherapy for prostate cancer and basal cell carcinoma, as well as the survival advantage of combination chemotherapy for relapsed non-small cell lung, ovarian, triple negative breast, pancreatic and biliary tract cancer. As drug repurposing is cost-effective and timesaving, a review was conducted of preclinical and clinical data focusing on the anticancer activity of itraconazole, and discusses the future directions for repurposing itraconazole as an anticancer agent.
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Affiliation(s)
- Hiroshi Tsubamoto
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
- Department of Medical Oncology, Meiwa Hospital, Nishinomiya, Hyogo 663-8186, Japan
| | - Tomoko Ueda
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Kayo Inoue
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Kazuko Sakata
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Hiroaki Shibahara
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Takashi Sonoda
- Department of Medical Oncology, Meiwa Hospital, Nishinomiya, Hyogo 663-8186, Japan
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Aggarwal A, Fojo T, Chamberlain C, Davis C, Sullivan R. Do patient access schemes for high-cost cancer drugs deliver value to society?-lessons from the NHS Cancer Drugs Fund. Ann Oncol 2017; 28:1738-1750. [PMID: 28453615 PMCID: PMC5834015 DOI: 10.1093/annonc/mdx110] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The NHS Cancer Drugs Fund (CDF) was established in 2010 to reduce delays and improve access to cancer drugs, including those that had been previously appraised but not approved by NICE (National Institute for Health and Care Excellence). After 1.3 billion GBP expenditure, a UK parliamentary review in 2016 rationalized the CDF back into NICE. METHODS This paper analyses the potential value delivered by the CDF according to six value criteria. This includes validated clinical benefits scales, cost-effectiveness criteria as defined by NICE and an assessment of real-world data. The analysis focuses on 29 cancer drugs approved for 47 indications that could be prescribed through the CDF in January 2015. RESULTS Of the 47 CDF approved indications, only 18 (38%) reported a statistically significant OS benefit, with an overall median survival of 3.1 months (1.4-15.7 months). When assessed according to clinical benefit scales, only 23 (48%) and 9 (18%) of the 47 drug indications met ASCO and ESMO criteria, respectively. NICE had previously rejected 26 (55%) of the CDF approved indications because they did not meet cost-effectiveness thresholds. Four drugs-bevacizumab, cetuximab, everolimus and lapatinib-represented the bulk of CDF applications and were approved for a total of 18 separate indications. Thirteen of these indications were subsequently delisted by the CDF in January 2015 due to insufficient evidence for clinical benefit-data which were unchanged since their initial approval. CONCLUSIONS We conclude the CDF has not delivered meaningful value to patients or society. There is no empirical evidence to support a 'drug only' ring fenced cancer fund relative to concomitant investments in other cancer domains such as surgery and radiotherapy, or other noncancer medicines. Reimbursement decisions for all drugs and interventions within cancer care should be made through appropriate health technology appraisal processes.
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Affiliation(s)
- A. Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London
- Institute of Cancer Policy, King’s College London, London, UK
| | - T. Fojo
- Division of Oncology, Columbia University, New York, USA
| | - C. Chamberlain
- School of Social and Community Medicine, University of Bristol, Bristol
| | - C. Davis
- Department of Global Health and Social Medicine, King’s College London, London, UK
| | - R. Sullivan
- Institute of Cancer Policy, King’s College London, London, UK
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Antoñanzas F, Terkola R, Overton PM, Shalet N, Postma M. Defining and Measuring the Affordability of New Medicines: A Systematic Review. PHARMACOECONOMICS 2017; 35:777-791. [PMID: 28477220 DOI: 10.1007/s40273-017-0514-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND In many healthcare systems, affordability concerns can lead to restrictions on the use of expensive efficacious therapies. However, there does not appear to be any consensus as to the terminology used to describe affordability, or the thresholds used to determine whether new drugs are affordable. OBJECTIVES The aim of this systematic review was to investigate how affordability is defined and measured in healthcare. METHODS MEDLINE, EMBASE and EconLit databases (2005-July 2016) were searched using terms covering affordability and budget impact, combined with definitions, thresholds and restrictions, to identify articles describing a definition of affordability with respect to new medicines. Additional definitions were identified through citation searching, and through manual searches of European health technology assessment body websites. RESULTS In total, 27 definitions were included in the review. Of these, five definitions described affordability in terms of the value of a product; seven considered affordability within the context of healthcare system budgets; and 15 addressed whether products are affordable in a given country based on economic factors. However, there was little in the literature to indicate that the price of medicines is considered alongside both their value to individual patients and their budget impact at a population level. CONCLUSIONS Current methods of assessing affordability in healthcare may be limited by their focus on budget impact. A more effective approach may involve a broader perspective than is currently described in the literature, to consider the long-term benefits of a therapy and cost savings elsewhere in the healthcare system, as well as cooperation between healthcare payers and the pharmaceutical industry to develop financing models that support sustainability as well as innovation.
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Affiliation(s)
- Fernando Antoñanzas
- Department of Economics, University of La Rioja, C/La Ciguena 60, 26004, Logrono, Spain.
| | - Robert Terkola
- College of Pharmacy, University of Florida, Gainesville, FL, USA
- Unit of PharmacoTherapy, Epidemiology and Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | | | | | - Maarten Postma
- Unit of PharmacoTherapy, Epidemiology and Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
- University Medical Center Groningen, Institute of Science in Healthy Aging & healthcaRE (SHARE), University of Groningen, Groningen, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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125
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Affiliation(s)
| | - Morie A Gertz
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
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126
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MacEwan SR, Chilkoti A. From Composition to Cure: A Systems Engineering Approach to Anticancer Drug Carriers. Angew Chem Int Ed Engl 2017; 56:6712-6733. [PMID: 28028871 PMCID: PMC6372097 DOI: 10.1002/anie.201610819] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Indexed: 12/21/2022]
Abstract
The molecular complexity and heterogeneity of cancer has led to a persistent, and as yet unsolved, challenge to develop cures for this disease. The pharmaceutical industry focuses the bulk of its efforts on the development of new drugs, but an alternative approach is to improve the delivery of existing drugs with drug carriers that can manipulate when, where, and how a drug exerts its therapeutic effect. For the treatment of solid tumors, systemically delivered drug carriers face significant challenges that are imposed by the pathophysiological barriers that lie between their site of administration and their site of therapeutic action in the tumor. Furthermore, drug carriers face additional challenges in their translation from preclinical validation to clinical approval and adoption. Addressing this diverse network of challenges requires a systems engineering approach for the rational design of optimized carriers that have a realistic prospect for translation from the laboratory to the patient.
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Affiliation(s)
- Sarah R MacEwan
- Department of Biomedical Engineering, Duke University, P.O. Box 90281, Durham, NC, 27708, USA
- Research Triangle MRSEC, Durham, NC, 27708, USA
- Present address: Institute for Molecular Engineering, University of Chicago, Chicago, IL, 60637, USA
| | - Ashutosh Chilkoti
- Department of Biomedical Engineering, Duke University, P.O. Box 90281, Durham, NC, 27708, USA
- Research Triangle MRSEC, Durham, NC, 27708, USA
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127
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Gilbar PJ, Chambers CR, Gilbar EC. Opportunities to significantly reduce expenditure associated with cancer drugs. Future Oncol 2017; 13:1311-1322. [DOI: 10.2217/fon-2017-0033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Aim: To identify cancer drugs amenable to strategies for reducing expenditure and avoiding drug wastage. Methods: Information was sourced from product information in 20 countries on parenteral cytotoxic agents, and cancer and noncancer monoclonal antibodies. Data were collected on vial sizes, overage, stability and presentation forms. Results: Vial size availability varied significantly between countries, with often only single vial sizes for numerous medications. Overage was poorly reported. Stability data were inconsistent and variable between countries, with most drugs only having a 24 h expiry. Three cancer-indicated monoclonal antibodies, thought suitable for prefilled syringe administration, were only available as vials. Conclusion: Many expensive cancer drugs are suitable for global cost-reduction strategies. Collaboration is vital to affecting change and reducing expenditure.
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Affiliation(s)
- Peter J Gilbar
- Cancer & Palliative Care Services, Toowoomba Hospital, Toowoomba, Australia
- School of Medicine, University of Queensland, Toowoomba Hospital, Toowoomba, Australia
| | - Carole R Chambers
- Department of Cancer Services Pharmacy, Alberta Health Services, Calgary, Canada
| | - Erin C Gilbar
- School of Medicine, University of Queensland, Toowoomba Hospital, Toowoomba, Australia
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128
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MacEwan SR, Chilkoti A. Von der Zusammensetzung zur Heilung: ein systemtechnischer Ansatz zur Entwicklung von Trägern für Tumortherapeutika. Angew Chem Int Ed Engl 2017. [DOI: 10.1002/ange.201610819] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Sarah R. MacEwan
- Department of Biomedical Engineering; Duke University; P.O. Box 90281 Durham NC 27708 USA
- Research Triangle MRSEC; Durham NC 27708 USA
- Institute for Molecular Engineering; University of Chicago; Chicago IL 60637 USA
| | - Ashutosh Chilkoti
- Department of Biomedical Engineering; Duke University; P.O. Box 90281 Durham NC 27708 USA
- Research Triangle MRSEC; Durham NC 27708 USA
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129
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Gilbar PJ, Chambers CR. How can we ensure value for money from expenditure on injectable cancer drugs? J Oncol Pharm Pract 2017; 24:473-476. [DOI: 10.1177/1078155217706195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter J Gilbar
- Cancer and Palliative Care Services, Toowoomba Hospital, Toowoomba, Australia
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Australia
| | - Carole R Chambers
- Department of Cancer Services Pharmacy, Alberta Health Services, Alberta, Canada
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Abstract
With more than 1.6 million new cases of cancer occurring each year, anticancer medications are in high demand. Escalating prescription drug prices have become a significant concern. Anticancer medications are among the most expensive prescription medications, many of them exceeding $100 000 a year. The survival benefits of certain newer anticancer medications may be a few months more than that from the existing treatment but at a much higher price tag. Drug cost may play a substantial role in making treatment choices. Multiple factors leading to high prices and some potential solutions to lower them have been highlighted.
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131
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Ruiz R, Strasser-Weippl K, Touya D, Herrero Vincent C, Hernandez-Blanquisett A, St. Louis J, Bukowski A, Goss PE. Improving access to high-cost cancer drugs in Latin America: Much to be done. Cancer 2017; 123:1313-1323. [DOI: 10.1002/cncr.30549] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/15/2016] [Accepted: 09/22/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Rossana Ruiz
- Instituto Nacional de Enfermedades Neoplásicas; Lima Peru
- Global Cancer Institute; Boston Massachusetts
- Massachusetts General Hospital; Boston Massachusetts
| | | | - Diego Touya
- “Dr. Manuel Quintela” Hospital Clinics; Montevideo Uruguay
| | | | | | - Jessica St. Louis
- Global Cancer Institute; Boston Massachusetts
- Massachusetts General Hospital; Boston Massachusetts
| | - Alexandra Bukowski
- Global Cancer Institute; Boston Massachusetts
- Massachusetts General Hospital; Boston Massachusetts
| | - Paul E. Goss
- Global Cancer Institute; Boston Massachusetts
- Massachusetts General Hospital; Boston Massachusetts
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132
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Kantarjian H, Patel Y. High cancer drug prices 4 years later-Progress and prospects. Cancer 2017; 123:1292-1297. [DOI: 10.1002/cncr.30545] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Hagop Kantarjian
- Department of Leukemia; University of Texas MD Anderson Cancer Center; Houston Texas
| | - Yogin Patel
- Pharmacy Clinical Programs; University of Texas MD Anderson Cancer Center; Houston Texas
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133
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Grössmann N, Wild C. Between January 2009 and April 2016, 134 novel anticancer therapies were approved: what is the level of knowledge concerning the clinical benefit at the time of approval? ESMO Open 2017; 1:e000125. [PMID: 28848662 PMCID: PMC5548976 DOI: 10.1136/esmoopen-2016-000125] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 11/21/2016] [Accepted: 11/23/2016] [Indexed: 01/15/2023] Open
Abstract
Objective In the last decade an increasing number of high-priced, new cancer treatments received marketing authorisation in Europe. What is actually known about the clinical benefit of those therapies at the time of approval needs to be elucidated in order to inform decisions about the use and reimbursement of these novel treatment options. Thus, the aim of the current analysis was to systematically investigate oncological therapies approved between January 2009 and April 2016 and extract as well as quantify the level of knowledge of the clinical benefit at the time of marketing authorisation. Methods To assess the benefit of new interventions as well as expanded indications, we extracted the median gain of the two study end points: progression-free survival (PFS) and overall survival (OS). Information is based on approval documents provided by the European Medicines Agency and assessments from the Austrian Horizon Scanning programme. We included all cancer therapies approved in Europe between 2009 (January 1) and 2016 (April 15). Results Cancer drugs for 134 new indications approved since 2009 were identified. In the case of 37 indications (27%), no data were available for PFS or for OS. A positive difference in median OS was reached by 76 licensed indications (55.5%); 22 (16%) of them showed a difference of more than 3 months. Regarding the study end point PFS, an improvement was shown in 90 indications (65.2%). Conclusion Scarce knowledge regarding the clinical benefit of anticancer therapies is available at the time of approval. In addition, the survival benefit of the approved indications is less than 3 months in the majority of approved therapies.
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Affiliation(s)
- Nicole Grössmann
- Ludwig Boltzmann Institute for Health Technology Assessment, Vienna, Austria
| | - Claudia Wild
- Ludwig Boltzmann Institute for Health Technology Assessment, Vienna, Austria
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134
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Al-Badriyeh D, Alameri M, Al-Okka R. Cost-effectiveness research in cancer therapy: a systematic review of literature trends, methods and the influence of funding. BMJ Open 2017; 7:e012648. [PMID: 28131999 PMCID: PMC5278265 DOI: 10.1136/bmjopen-2016-012648] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 11/13/2016] [Accepted: 12/14/2016] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To perform a first-time analysis of the cost-effectiveness (CE) literature on chemotherapies, of all types, in cancer, in terms of trends and change over time, including the influence of industry funding. DESIGN Systematic review. SETTING A wide range of cancer-related research settings within healthcare, including health systems, hospitals and medical centres. PARTICIPANTS All literature comparative CE research of drug-based cancer therapies in the period 1986 to 2015. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes are the literature trends in relation to journal subject category, authorship, research design, data sources, funds and consultation involvement. An additional outcome measure is the association between industry funding and study outcomes. ANALYSIS Descriptive statistics and the χ2, Fisher exact or Somer's D tests were used to perform non-parametric statistics, with a p value of <0.05 as the statistical significance measure. RESULTS Total 574 publications were analysed. The drug-related CE literature expands over time, with increased publishing in the healthcare sciences and services journal subject category (p<0.001). The retrospective data collection in studies increased over time (p<0.001). The usage of prospective data, however, has been decreasing (p<0.001) in relation to randomised clinical trials (RCTs), but is unchanging for non-RCT studies. The industry-sponsored CE studies have especially been increasing (p<0.001), in contrast to those sponsored by other sources. While paid consultation involvement grew throughout the years, the declaration of funding for this is relatively limited. Importantly, there is evidence that industry funding is associated with favourable result to the sponsor (p<0.001). CONCLUSIONS This analysis demonstrates clear trends in how the CE cancer research is presented to the practicing community, including in relation to journals, study designs, authorship and consultation, together with increased financial sponsorship by pharmaceutical industries, which may be more influencing study outcomes than other funding sources.
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Affiliation(s)
| | - Marwah Alameri
- School of Pharmacy, University College London, London, UK
| | - Randa Al-Okka
- National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
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135
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Ersek JL, Nadler E, Freeman-Daily J, Mazharuddin S, Kim ES. Clinical Pathways and the Patient Perspective in the Pursuit of Value-Based Oncology Care. Am Soc Clin Oncol Educ Book 2017; 37:597-606. [PMID: 28561657 DOI: 10.1200/edbk_174794] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The art of practicing oncology has evolved substantially in the past 5 years. As more and more diagnostic tests, biomarker-directed therapies, and immunotherapies make their way to the oncology marketplace, oncologists will find it increasingly difficult to keep up with the many therapeutic options. Additionally, the cost of cancer care seems to be increasing. Clinical pathways are a systematic way to organize and display detailed, evidence-based treatment options and assist the practitioner with best practice. When selecting which treatment regimens to include on a clinical pathway, considerations must include the efficacy and safety, as well as costs, of the therapy. Pathway treatment regimens must be continually assessed and modified to ensure that the most up-to-date, high-quality options are incorporated. Value-based models, such as the ASCO Value Framework, can assist providers in presenting economic evaluations of clinical pathway treatment options to patients, thus allowing the patient to decide the overall value of each treatment regimen. Although oncologists and pathway developers can decide which treatment regimens to include on a clinical pathway based on the efficacy of the treatment, assessment of the value of that treatment regimen ultimately lies with the patient. Patient definitions of value will be an important component to enhancing current value-based oncology care models and incorporating new, high-quality, value-based therapeutics into oncology clinical pathways.
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Affiliation(s)
- Jennifer L Ersek
- From the Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Baylor University Medical Center, Dallas, TX
| | - Eric Nadler
- From the Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Baylor University Medical Center, Dallas, TX
| | - Janet Freeman-Daily
- From the Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Baylor University Medical Center, Dallas, TX
| | - Samir Mazharuddin
- From the Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Baylor University Medical Center, Dallas, TX
| | - Edward S Kim
- From the Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Baylor University Medical Center, Dallas, TX
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136
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Quinteros DA, Bermúdez JM, Ravetti S, Cid A, Allemandi DA, Palma SD. Therapeutic use of monoclonal antibodies: general aspects and challenges for drug delivery. NANOSTRUCTURES FOR DRUG DELIVERY 2017. [PMCID: PMC7151974 DOI: 10.1016/b978-0-323-46143-6.00025-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Monoclonal antibodies are routinely used in several fields but the great challenge has been their use as therapeutic agents for the treatment of diseases, such as breast cancer, leukemia, asthma, macular degeneration, arthritis, Crohn’s disease, and transplants, among others. Monoclonal antibodies are protein molecules made in the laboratory from hybridoma cells by recombinant DNA technology. Important advances have been made over the past decade to improve some critical points, such as safety and efficacy of the first generation of therapeutic antibodies. This type of molecules presents a significant challenge from the pharmaceutical point of view due to their characteristics, such as molecular size, stability, and solubility. In this chapter we have attempted to identify the major issues associated with therapeutic approaches, formulating drawbacks and delivering antibody drugs, particularly focused on the challenges and opportunities that these present for the future.
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Affiliation(s)
| | | | | | - Alicia Cid
- National University of Córdoba, Córdoba, Argentina
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137
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Kieber-Emmons T, Makhoul I, Pennisi A, Siegel ER, Emanuel PD, Monzavi-Karbassi B, Steplewski Z, Beck JT, Hutchins LF. Managing Expectations in the Transition to Proof of Concept Studies. Rev Recent Clin Trials 2017; 12:111-123. [PMID: 28325150 PMCID: PMC9252264 DOI: 10.2174/1574887112666170321121250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/17/2017] [Accepted: 03/16/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND As we move away from the traditional chemotherapy era to targeted therapy, the validity of old assessment paradigms associated with therapeutics are being raised in the context of immunotherapy. The old paradigm required elaborating on the toxicity assessment, with no expectation of efficacy in early phase trials. Safety data from Phase 1 and 2 studies with many immunotherapeutics show limited toxicities and draw attention to the need to demonstrate efficacy in the early evaluation of new agents. METHODS Literature searches indicate that molecular oncology mechanistic-based agents are being linked with molecular disease status and clinical benefit. Biomarkers and other endpoints are being employed to accomplish this. Perspectives for a meaningful context of integrating biomarkers and clinical trial design are reviewed. RESULTS The design and conduct of clinical trials have not been fully adjusted to the new era of personalized oncology, and so we are in transition. A part of this transition is the management of expectations and trial designs that need to be considered relative to preclinical experience in the development of therapeutics. For example, pathological complete response is now considered a surrogate marker for favorable prognosis in breast cancer patients who are treated in the neoadjuvant setting. This surrogate marker is tied to novel agents' mechanistic characteristics with no preclinical counterpart. CONCLUSION The old paradigm considers patients equal with similar chances to respond to treatments, but the new paradigm considers patient's heterogeneity, a major fact that informs the design of clinical trials. By linking every treatment to a mechanism of action and to the presence of a specific biomarker, new trials are going to have more subjects who are likely to respond to the treatment.
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Affiliation(s)
- Thomas Kieber-Emmons
- Winthrop P. Rockefeller Cancer Institute of the University of Arkansas for Medical Sciences, Little Rock AR, USA
| | - Issam Makhoul
- Winthrop P. Rockefeller Cancer Institute of the University of Arkansas for Medical Sciences, Little Rock AR, USA
| | - Angela Pennisi
- Winthrop P. Rockefeller Cancer Institute of the University of Arkansas for Medical Sciences, Little Rock AR, USA
| | - Eric R. Siegel
- Winthrop P. Rockefeller Cancer Institute of the University of Arkansas for Medical Sciences, Little Rock AR, USA
| | - Peter D. Emanuel
- Winthrop P. Rockefeller Cancer Institute of the University of Arkansas for Medical Sciences, Little Rock AR, USA
| | - Behjatolah Monzavi-Karbassi
- Winthrop P. Rockefeller Cancer Institute of the University of Arkansas for Medical Sciences, Little Rock AR, USA
| | | | | | - Laura F. Hutchins
- Winthrop P. Rockefeller Cancer Institute of the University of Arkansas for Medical Sciences, Little Rock AR, USA
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138
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Glode AE, May MB. Rising Cost of Cancer Pharmaceuticals: Cost Issues and Interventions to Control Costs. Pharmacotherapy 2016; 37:85-93. [PMID: 27862122 DOI: 10.1002/phar.1867] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The rising cost of pharmaceuticals and, in particular, cancer drugs has made headline news in recent years. Several factors contribute to increasing costs and the burden this places on the health care system and patients. Some of these factors include costly cancer pharmaceutical research and development, longer clinical trials required to achieve drug approval, manufacturing costs for complex compounds, and the economic principles surrounding oncology drug pricing. Strategies to control costs have been proposed, and some have already been implemented to mitigate cancer drug costs such as the use of clinical treatment pathways and tools to facilitate cost discussions with patients. In this article, we briefly review some of the potential factors contributing to increasing cancer pharmaceutical costs and interventions to mitigate costs, and touch on the role of health care providers in addressing this important issue.
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Affiliation(s)
- Ashley E Glode
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado
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139
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El Rassy E, Assi T, Kattan J. Is minimal residual disease a convincing tool to determine the treatment duration of immune checkpoint inhibitors? Future Oncol 2016; 13:381-383. [PMID: 27884060 DOI: 10.2217/fon-2016-0462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Elie El Rassy
- Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Tarek Assi
- Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Joseph Kattan
- Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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140
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Prasad V, Rajkumar SV. Conflict of interest in academic oncology: moving beyond the blame game and forging a path forward. Blood Cancer J 2016; 6:e489. [PMID: 27813537 PMCID: PMC5148049 DOI: 10.1038/bcj.2016.101] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- V Prasad
- Division of Hematology Oncology, Department of Public Health and Preventive Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - S V Rajkumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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141
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Kolasani BP, Malathi DC, Ponnaluri RR. Variation of Cost among Anti-cancer Drugs Available in Indian Market. J Clin Diagn Res 2016; 10:FC17-FC20. [PMID: 28050395 PMCID: PMC5198348 DOI: 10.7860/jcdr/2016/22384.8918] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/29/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Although cancer remains a major health problem all over the world, its treatment is limited by affordability of patients in a developing country like India. Information generated from cost analysis studies will be helpful for both the doctors in choosing the correct medicine for their patients and also for policy makers in successfully utilizing the meager resources that are available. AIM The aim of the present observational study was to analyse the price variations of anti-cancer drugs available in India. MATERIALS AND METHODS The cost of a particular anti-cancer drug being manufactured by different companies, in the same dose and dosage form, was obtained from latest issue of "Current Index of Medical Specialties" (CIMS) January-April, 2016. The difference between the maximum and minimum prices of various brands of the same drug was analysed and percentage variation in the prices was calculated. The results of the study were expressed as absolute numbers and percentages. RESULTS Overall, the price of a total of 23 drugs belonging to 6 different categories available in 52 different formulations were analysed. Among alkylating agents, oxaliplatin (50mg; injection) showed the maximum price variation of 125.02%. In anti-metabolites, methotrexate (2.5mg; tablet) showed the maximum price variation of 75.30%. The maximum price variation among natural products was seen with paclitaxel (260 mg; injection) of 146.98%, among hormonal drugs, was seen with flutamide (250mg; tablet) of 714.24%, among targeted drugs was seen with imatinib mesylate (100mg; film coated tablet) of 5.56% and among supportive drugs, granisetron (1mg; tablet) showed the maximum price variation of 388.68%. CONCLUSION The average percentage variations of different brands of the same anti-cancer drug in same dose and dosage form manufactured in India is very wide. The government and drug manufacturing companies must direct their efforts in reducing the cost of anti-cancer drugs and minimizing the economic burden on the patients.
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Affiliation(s)
- Bhanu Prakash Kolasani
- Associate Professor, Department of Pharmacology, Vinayaka Missions Medical College and Hospital, Karaikal, Puducherry, India
| | | | - Raghunatha Rao Ponnaluri
- Assistant Professor, Department of Pharmacology, Guntur Medical College, Guntur, Andhra Pradesh, India
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142
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Perceptions of Oncologists, Healthcare Policy Makers, Patients and the General Population on the Value of Pharmaceutical Treatments in Oncology. Adv Ther 2016; 33:2059-2068. [PMID: 27718158 PMCID: PMC5083772 DOI: 10.1007/s12325-016-0415-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Indexed: 01/08/2023]
Abstract
Introduction The purpose of this study was to explore the main factors explaining the relative weight of the different attributes that determine the value of oncologic treatments from the different perspectives of healthcare policy makers (HCPM), oncologists, patients and the general population in Spain. Methods Structured interviews were conducted to assess: (1) the importance of the attributes on treatment choice when comparing a new cancer drug with a standard cancer treatment; (2) the importance of survival, quality of life (QoL), costs and innovation in cancer; and (3) the most worrying side effects related to cancer drugs. Results A total of 188 individuals participated in the study. For all participants, when choosing treatments, the best rated characteristics were greater efficacy, greater safety, treatment adaptation to patients’ individual requirements and the rapid reincorporation of patients to their daily activities. There were important differences among participants in their opinion about survival, QoL and cost. In general, oncologists, patients, and the general population gave greater value to gains in QoL than healthcare policy makers. Compared to other participants healthcare policy makers gave greater importance to the economic impact related to oncology treatments. Conclusions Gains in QoL, survival, safety, cost and innovation are perceived differently by different groups of stakeholders. It is recommended to consider the perspective of different stakeholders in the assessment of a new cancer drugs to obtain more informed decisions when deciding on the most appropriate treatment to use. Funding Eli Lilly & Co, Madrid (Spain).
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143
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Next-generation multiple myeloma treatment: a pharmacoeconomic perspective. Blood 2016; 128:2757-2764. [PMID: 27742709 DOI: 10.1182/blood-2016-09-692947] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 10/12/2016] [Indexed: 01/07/2023] Open
Abstract
Advances in the diagnosis and treatment of multiple myeloma have come at a rapid pace, especially with several new drugs entering the market in the last few years. However, access to and affordability of new treatments poses a major challenge, both in the United States and around the world. High costs of life-saving drugs are detrimental to both the personal finances of the individual patient, as well as society which must bear the increasing costs in terms of increased health insurance premiums, taxes, or both. The challenges are not unique to myeloma, but are commonly encountered in several other cancers as well. But to some extent these pharmacoeconomic concerns are amplified in myeloma due to the need for multidrug regimens that combine 2 or more expensive new drugs, continuous therapy, and the prolonged disease course in most patients. We examine current myeloma therapy from a pharmacoeconomic perspective, and discuss the costs involved. We outline the underlying reasons why cancer drugs are so expensive, the measures that are required to lower cost, and propose potential ways in which costs can be reduced while still delivering high-quality care.
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144
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Kesselheim AS, Tan YT, Darrow JJ, Avorn J. Existing FDA pathways have potential to ensure early access to, and appropriate use of, specialty drugs. Health Aff (Millwood) 2016; 33:1770-8. [PMID: 25288421 DOI: 10.1377/hlthaff.2014.0529] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Specialty drugs are notable among prescription drugs in that they offer the possibility of substantial clinical improvement, come with important risks of adverse events and mortality, can be complex to manufacture or administer, and are usually extremely costly. The Food and Drug Administration (FDA) plays a critical role in ensuring that patients who could benefit from specialty drugs have access to them in a timely fashion. In this article we review the different strategies that the FDA can use to approve and influence the post-approval prescribing of specialty drugs. When specialty drugs show promise in early clinical trials, the FDA can expedite the drugs' availability to patients through expanded access programs and expedited approval pathways that speed regulatory authorization. After approval, to ensure that specialty drugs are directed to the patients who are most likely to benefit from them, the FDA can limit the scope of the drugs' indications, encourage the development of companion diagnostic tests to indicate which patients should receive the drugs, or require that manufacturers subject them to Risk Evaluation and Mitigation Strategies to ensure that their use is appropriately limited to a restricted population that is aware of the drugs' risks and benefits. Implementing these existing regulatory approaches can promote timely patient access to specialty drugs while preventing expensive and potentially inappropriate overuse.
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Affiliation(s)
- Aaron S Kesselheim
- Aaron S. Kesselheim is an associate professor of medicine at Harvard Medical School/Brigham and Women's Hospital, in Boston, Massachusetts
| | - Yongtian Tina Tan
- Yongtian Tina Tan is a medical student at Harvard Medical School, in Boston
| | - Jonathan J Darrow
- Jonathan J. Darrow was a postdoctoral research fellow at Brigham and Women's Hospital at the time of this research
| | - Jerry Avorn
- Jerry Avorn is a professor of medicine at Harvard Medical School/Brigham and Women's Hospital
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145
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Polite B, Ward JC, Cox JV, Morton RF, Hennessy J, Page R, Conti RM. A Pathway Through the Bundle Jungle. J Oncol Pract 2016; 12:504-9. [DOI: 10.1200/jop.2015.008789] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Blase Polite
- The University of Chicago, Chicago, IL; Puget Sound Cancer Centers, Edmonds, WA; University of Texas Southwestern Medical Center, Dallas; The Center for Cancer and Blood Disorders, Fort Worth, TX; Medical Oncology and Hematology Associates, Clive, IA; and Sarah Cannon, Nashville, TN
| | - Jeffery C. Ward
- The University of Chicago, Chicago, IL; Puget Sound Cancer Centers, Edmonds, WA; University of Texas Southwestern Medical Center, Dallas; The Center for Cancer and Blood Disorders, Fort Worth, TX; Medical Oncology and Hematology Associates, Clive, IA; and Sarah Cannon, Nashville, TN
| | - John V. Cox
- The University of Chicago, Chicago, IL; Puget Sound Cancer Centers, Edmonds, WA; University of Texas Southwestern Medical Center, Dallas; The Center for Cancer and Blood Disorders, Fort Worth, TX; Medical Oncology and Hematology Associates, Clive, IA; and Sarah Cannon, Nashville, TN
| | - Roscoe F. Morton
- The University of Chicago, Chicago, IL; Puget Sound Cancer Centers, Edmonds, WA; University of Texas Southwestern Medical Center, Dallas; The Center for Cancer and Blood Disorders, Fort Worth, TX; Medical Oncology and Hematology Associates, Clive, IA; and Sarah Cannon, Nashville, TN
| | - John Hennessy
- The University of Chicago, Chicago, IL; Puget Sound Cancer Centers, Edmonds, WA; University of Texas Southwestern Medical Center, Dallas; The Center for Cancer and Blood Disorders, Fort Worth, TX; Medical Oncology and Hematology Associates, Clive, IA; and Sarah Cannon, Nashville, TN
| | - Ray Page
- The University of Chicago, Chicago, IL; Puget Sound Cancer Centers, Edmonds, WA; University of Texas Southwestern Medical Center, Dallas; The Center for Cancer and Blood Disorders, Fort Worth, TX; Medical Oncology and Hematology Associates, Clive, IA; and Sarah Cannon, Nashville, TN
| | - Rena M. Conti
- The University of Chicago, Chicago, IL; Puget Sound Cancer Centers, Edmonds, WA; University of Texas Southwestern Medical Center, Dallas; The Center for Cancer and Blood Disorders, Fort Worth, TX; Medical Oncology and Hematology Associates, Clive, IA; and Sarah Cannon, Nashville, TN
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146
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Affiliation(s)
- Bishal Gyawali
- Department of Hemato-Oncology, Nobel Hospital, Sinamangal, Kathmandu, Nepal
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147
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Granja A, Pinheiro M, Reis S. Epigallocatechin Gallate Nanodelivery Systems for Cancer Therapy. Nutrients 2016; 8:nu8050307. [PMID: 27213442 PMCID: PMC4882719 DOI: 10.3390/nu8050307] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/10/2016] [Accepted: 05/12/2016] [Indexed: 12/31/2022] Open
Abstract
Cancer is one of the leading causes of morbidity and mortality all over the world. Conventional treatments, such as chemotherapy, are generally expensive, highly toxic and lack efficiency. Cancer chemoprevention using phytochemicals is emerging as a promising approach for the treatment of early carcinogenic processes. (−)-Epigallocatechin-3-gallate (EGCG) is the major bioactive constituent in green tea with numerous health benefits including anti-cancer activity, which has been intensively studied. Besides its potential for chemoprevention, EGCG has also been shown to synergize with common anti-cancer agents, which makes it a suitable adjuvant in chemotherapy. However, limitations in terms of stability and bioavailability have hampered its application in clinical settings. Nanotechnology may have an important role in improving the pharmacokinetic and pharmacodynamics of EGCG. Indeed, several studies have already reported the use of nanoparticles as delivery vehicles of EGCG for cancer therapy. The aim of this article is to discuss the EGCG molecule and its associated health benefits, particularly its anti-cancer activity and provide an overview of the studies that have employed nanotechnology strategies to enhance EGCG’s properties and potentiate its anti-tumoral activity.
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Affiliation(s)
- Andreia Granja
- UCIBIO/REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal.
| | - Marina Pinheiro
- UCIBIO/REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal.
| | - Salette Reis
- UCIBIO/REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal.
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148
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Bennette CS, Richards C, Sullivan SD, Ramsey SD. Steady Increase In Prices For Oral Anticancer Drugs After Market Launch Suggests A Lack Of Competitive Pressure. Health Aff (Millwood) 2016; 35:805-12. [DOI: 10.1377/hlthaff.2015.1145] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Caroline S. Bennette
- Caroline S. Bennette ( ) is an acting assistant professor and an AHRQ Patient Centered Outcomes Research K12 Scholar in the Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, in Seattle
| | - Catherine Richards
- Catherine Richards is director of scientific and user engagement at Aetion Inc., in Los Angeles, California
| | - Sean D. Sullivan
- Sean D. Sullivan is a professor in and dean of the School of Pharmacy at the University of Washington
| | - Scott D. Ramsey
- Scott D. Ramsey is the director of the Hutchinson Institute for Cancer Outcomes Research at the Fred Hutchinson Cancer Research Center, in Seattle
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149
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Selaru P, Tang Y, Huang B, Polli A, Wilner KD, Donnelly E, Cohen DP. Sufficiency of Single-Arm Studies to Support Registration of Targeted Agents in Molecularly Selected Patients with Cancer: Lessons from the Clinical Development of Crizotinib. Clin Transl Sci 2016; 9:63-73. [PMID: 26841346 PMCID: PMC5351315 DOI: 10.1111/cts.12388] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 01/13/2016] [Accepted: 01/23/2016] [Indexed: 01/10/2023] Open
Affiliation(s)
- P Selaru
- Pfizer Oncology, La Jolla, California, USA
| | - Y Tang
- Pfizer Oncology, La Jolla, California, USA
| | - B Huang
- Pfizer Oncology, Groton, Connecticut, USA
| | - A Polli
- Pfizer Oncology, Milan, Italy
| | - K D Wilner
- Pfizer Oncology, La Jolla, California, USA
| | - E Donnelly
- Pfizer Oncology, Cambridge, Massachusetts, USA
| | - D P Cohen
- Pfizer Oncology, La Jolla, California, USA
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150
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Dahl BJ. The Cost of Oncology Drugs: A Pharmacy Perspective, Part I. Fed Pract 2016; 33:22S-25S. [PMID: 30766201 PMCID: PMC6375405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Even in the VA, the high cost of oncology medications are forcing health care providers to confront the economic impact of cancer care.
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Affiliation(s)
- Brian J Dahl
- is an oncology clinical pharmacy specialist and director of the Oncology Pharmacy Program at the VA San Diego Healthcare System in California
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