- Volume 17 Issue 7
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Financial Burden of Cancer Drug Treatment in Lebanon
- Elias, Fadia (Ministry of Public Health) ;
- Khuri, Fadlo R (Emory University School of Medicine) ;
- Adib, Salim M (American University of Beirut, Faculty of Health Sciences) ;
- Karam, Rita (Lebanese University, Faculty of Medical Sciences) ;
- Harb, Hilda (Ministry of Public Health) ;
- Awar, May (American University of Beirut, Office of Grants & Contracts) ;
- Zalloua, Pierre (Lebanese American University, School of Medicine) ;
- Ammar, Walid (Ministry of Public Health)
- Published : 2016.07.01
Background: The Ministry of Public Health (MOPH) in Lebanon provides cancer drugs free of charge for uninsured patients who account for more than half the total case-load. Other categories of cancer care are subsidized under more stringent eligibility criteria. MOPH's large database offers an excellent opportunity to analyze the cost of cancer treatment in Lebanon. Materials and Methods: Using utilization and spending data accumulated at MOPH during 2008-2013, the cost to the public budget of cancer drugs was assessed per case and per drug type. Results: The average annual cost of cancer drugs was 6,475$ per patient. Total cancer drug costs were highest for breast cancer, followed by chronic myeloid leukemia (CML), colorectal cancer, lung cancer, and Non-Hodgkin's lymphoma (NHL), which together represented 74% of total MOPH cancer drug expenditure. The annual average cancer drug cost per case was highest for CML ($31,037), followed by NHL ($11,566). Trastuzumab represented 26% and Imatinib 15% of total MOPH cancer drug expenditure over six years. Conclusions: Sustained increase in cancer drug cost threatens the sustainability of MOPH coverage, so crucial for socially vulnerable citizens. To enhance the bargaining position with pharmaceutical firms for drug cost containment in a small market like Lebanon, drug price comparisons with neighboring countries which have already obtained lower prices may succeed in lowering drug costs.
- International Medical Statistics (IMS) (2014). Available at: www.imshealth.com/en/about-us/news/ims-health-study:-cancerdrug-innovation-surges-as-cost-growth-moderates.
- Kantarjian HM, Fojo T, Mathisen M, Zwelling LA. (2013). Cancer drugs in the United States: Justum Pretium-the just price. J Clin Oncol, 31, 3600-4. https://doi.org/10.1200/JCO.2013.49.1845
- Lee CP, Chertow GM, Zenios SA (2009). An empiric estimate of the value of life: updating the renal dialysis costeffectiveness standard. Value Health, 12, 80-7. https://doi.org/10.1111/j.1524-4733.2008.00401.x
- Luengo-Fernandez R, Leal J, Gray A, Sullivan R (2013). Economic burden of cancer across the European Union: a population-based cost analysis. Lancet Oncol, 14, 1165-74. https://doi.org/10.1016/S1470-2045(13)70442-X
- Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML (2011). Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst, 103, 117-28. https://doi.org/10.1093/jnci/djq495
- Murray CJ, Kreuser J, Whang W (1994). Cost-effectiveness analysis and policy choices: investing in health systems. Bull World Health Organ, 72, 663-74.
- National Cancer Registry (2008). MOPH. Available at: http://www.moph.gov.lb/Prevention/Surveillance/Pages/Cancer.aspx
- National Cancer Treatment Guidelines (2012). MOPH.
- National Health Accounts (2012). MOPH.
- Newcomer LN, Gould B, Page RD, Donelan SA, Perkins M (2014). Changing physician incentives for affordable, quality cancer care: results of an episode payment model. J Oncol Pract, 10, 322-6. https://doi.org/10.1200/JOP.2014.001488
- The Guardian (2012). Healthcare spending around the world, country by country.
- World Bank (WB) (2015). Health expenditure, total (% of GDP) .
- Yabroff KR, Lund J, Kepka D, Mariotto A (2011). Economic burden of cancer in the United States: estimates, projections, and future research. Cancer Epidemiol Biomarkers Prev, 20, 2006-14. https://doi.org/10.1158/1055-9965.EPI-11-0650
- Zullig LL, Peppercorn JM, Schrag D, et al (2013). Financial distress, use of cost-coping strategies, and adherence to prescription medication among patients with cancer. J Oncol Pract, 9, 60-3. https://doi.org/10.1200/JOP.2013.000971
- Ammar W (2003) Health system and reform in Lebanon. Lebanon: Ministry of Public Health.
- Complete the reference of The Guardian to become: "The Guardian (2012). Healthcare spending around the world, country by country. www.theguardian.com/news/datablog/interactive/2012/jun/30/health-spending-map-world"
- Elkin EB, Bach PB (2010). Cancer's next frontier: addressing high and increasing costs. JAMA, 303, 1086-7. https://doi.org/10.1001/jama.2010.283
- American Cancer Society (2010).The global economic cost of cancer: Atlanta, Georgia, USA.
- American Cancer Society (2008). Global cancer facts & figures. Atlanta, GA: USA.
- Experts in Chronic Myeloid Leukemia (ECML) (2013). The price of drugs for chronic myeloid leukemia (CML) is a reflection of the unsustainable prices of cancer drugs: from the perspective of a large group of CML experts. Blood 121, 4439-42. https://doi.org/10.1182/blood-2013-03-490003
- Himmelstein DU, Thorne D, Warren E, Woolhandler S (2009). Medical bankruptcy in the United States, 2007: results of a national study. Am J Med, 122, 741-6. https://doi.org/10.1016/j.amjmed.2009.04.012
- Himmelstein DU, Woolhandler S (2012). Cost control in a parallel universe: medicare spending in the United States and Canada. Arch Intern Med, 172, 1764-6. https://doi.org/10.1001/2013.jamainternmed.272
- World Health Report (2010). World Health Organization, Geneva, Swtizerland.
- Yabroff KR, Lamont EB, Mariotto A, et al. (2008). Cost of care for elderly cancer patients in the United States. J Natl Cancer Inst, 100, 630-41. https://doi.org/10.1093/jnci/djn103