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Anti-Cancer Medicines Availability: Article
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Rhenium–platinum antitumor systems | The Ukrainian Biochemical Journal
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Rhenium–platinum antitumor systems
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At the time of our review, in June , the median year of release of the most recently available national medicines list was range: — Another three countries — Angola, Djibouti and Sierra Leone — were excluded because their national essential medicines lists only covered primary health care or health kits. A median of 3 range: 0—15 of the 16 anti-cancer medicines added to the Model List via the revision was included in the national medicines lists we investigated.
For example, of the 16 anti-cancer medicines added to the Model List via the revision, only a median of 1 range: 0—10 was included in the national lists of the low-income countries we studied whereas the corresponding value for the high-income study countries was 10 range: 2— There also seemed to be considerable variation between WHO regions.
For example, the median number of anti-cancer medicines — on the Model Lists — that appeared on the national medicines lists of the 37 study countries in the African Region was relatively low. The very low median number of medicines listed in the Western Pacific Region is mostly the result of nine small Pacific Island countries that each included just two to five cytotoxic agents — often just methotrexate and tamoxifen — on their national medicines lists.
Similar results were seen for the correlations between numbers of anti-cancer medicines listed and physician density — with corresponding r -values of 0. At the time of our review, many countries had already updated their national lists to include at least some of the 16 anti-cancer medicines that were added to the Model List as a result of the revision.
This confirms that the revision of the WHO list was long overdue after more than 20 years of limited review of anti-cancer medicines for adults and modest changes to the list of medicines for children in None of the six agents identified as priority medicines by a working group but rejected by the expert committee in was widely included in the national lists.
The relevant expert committee did not recommend inclusion of trastuzumab on the Model List for adults but agreed that the clinical data supported inclusion of the medicine, as an essential medicine, in health systems that had the capacity to manage breast cancer adequately — including early diagnosis, histopathology, surgery and radiotherapy. We found higher percentages of countries with medicines listed for breast cancer than previously reported, 13 due, in part, to the between-study differences in selection criteria, the larger numbers of countries included in our study and our use of more recent versions of the national medicines lists for more than 25 countries.
The inclusion of some expensive anti-cancer and other anti-neoplastic medicines on many national medicines lists raises questions about treatment affordability, particularly in resource-constrained environments. The budget impact of providing trastuzumab may make it unaffordable at the country level.
This situation highlights the tensions caused by differences, between high-income and low-income countries, in the affordability of high-cost patented cancer medicines and access to potentially life-saving treatments for women. Standard and alternative treatment regimens for particular cancers were proposed, with the recognition that costs would be prohibitive in some settings. The four medicines in the so-called CHOP regimen used to treat diffuse large B-cell lymphoma are relatively old and off-patent.
Although rituximab is patent-protected and costlier and more difficult to administer than the cyclophosphamide, doxorubicin, prednisone and vincristine used in the standard CHOP regimen, its addition to the regimen increases survival rates.
Essential medicines for cancer: WHO recommendations and national priorities
However, where rituximab is not available, the CHOP regimen should still be used since many patients will benefit from its use. Although relatively expensive, the targeted anti-cancer medicines imatinib, rituximab and trastuzumab have each demonstrated large benefits. Almost half of our study countries had included one or more of the granulocyte colony-stimulating factors in their national medicines lists.
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