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Access to new cancer drugs limited in Brazil and Mexico

Published on 13/04/12 at 03:15pm

Between one-quarter and one-third of patients in Brazil and Mexico who are eligible for treatment with new cancer drugs do not receive them, usually because of cost factors.

Pharma market analysts Decision Resources interviewed payers from Brazil and Mexico and found access to new anti-angiogenesis drugs was severely restricted in both countries.

The report found that in Brazil, patient performance status is a key determinant in deciding which patients have access to angiogenesis inhibitors, and that there is a “one-out one-in system” in INCA (National Cancer Institute of Brazil) hospitals in which likely candidates must wait for another patient to stop therapy before being considered for treatment with the new drugs. In Mexico, interviewed payers say the acquisition of these expensive drugs through cancer charities is 'sporadic' and is similarly limited to select patients.

Decision Resources’ new Emerging Markets Physician & Payer Forum report entitled Payer and Clinician Perspectives on the Role of Premium-Priced Angiogenesis Inhibitors in Brazil and Mexico also finds that - in line with interviewed payer insights- surveyed prescribers of Roche’s Avastin in Brazil and Mexico identify patients with good performance status as prime candidates for Avastin treatment, along with younger patients and those without co-morbidities. In the absence of biomarkers for response to Avastin, these attributes signify patients who are most likely to benefit from treatment.

“We found that approximately three-quarters of Brazilian and Mexican oncologists point to reimbursement and/or budget-related restrictions as limiting the use of angiogenesis inhibitors,” said Decision Resources Analyst Andreia Ribeiro, Ph.D. “Interviewed payers indicated that access to these agents is extremely limited because of the drugs’ high cost and the restricted availability of funds.”

None of the angiogenesis inhibitors covered in the report are included in the national programmes for free or discounted medicines sponsored by the Brazilian government. However, steady demand for the drugs is ensured by the fact that most public hospitals include angiogenesis inhibitors in their treatment guidelines. Budget restraints mean Brazil’s national healthcare system hospitals typically do not have angiogenesis inhibitors in stock, and instead direct patients to the state Health Secretariat, with a request to release the drug.

“If the patient’s need is great and the drug required is labelled for that indication then, generally, in both Brazil and Mexico, treatment is ultimately accessed as the patient has a legal right to that treatment,” Dr. Ribeiro said. “However, most public sector patients in Brazil must actually instigate legal action before they are granted access to angiogenesis inhibitors.”

In Mexico, Avastin, Pfizer’s Sutent and Bayer/Onyx’s Nexavar are included in the institutional formularies of the Social Security programmes that provide healthcare largely to employed/retired people. Patients have 100% coverage for treatments with these drugs when they are in stock. Interviewed payers reveal that in practice, despite formulary listing, access to angiogenesis inhibitors is limited in Social Security hospitals due to budget restrictions. Conversely, however, in some cases, clinicians are able to prescribe angiogenesis inhibitors for indications that are ‘off label’ in Mexico (such as Avastin for glioblastoma multiform), if the doctor can support the prescription of the drug with documented evidence of likely benefit to the patient.


Andrew McConaghie

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