Access to essential and innovative anti-cancer medicines: a longitudinal study in Nanjing, China.

PURPOSE: To evaluate the availability, cost, affordability of anti-cancer medicines in Nanjing, Jiangsu. METHODS: A longitudinal tracking investigation study was performed to collect information about 24 essential anti-cancer medicines (EAMs) and 17 innovative anti-cancer medicines (IAMs) in 26 healthcare institutions in Nanjing from 2016 to 2020. The availability, cost, drug utilization and affordability of EAMs and IAMs were investigated. RESULTS: The availability of EAMs showed no significant changes in Nanjing, but the availability of IAMs showed a significant increase in 2018 and 2019 and tended to stabilize in 2020. For EAMs, the DDDc(Defined Daily Dose cost) of LPGs (Lowest-Priced Generics) showed no significant changes, and the DDDc of OBs (Originator Brands) and IAMs significantly decreased. The DDDs(Defined Daily Doses) of EAMs (LPGs) showed a decreasing trend since 2016 and rose again in 2019. Overall, the DDDs of EAMs (LPGs) decreased by 25.18% between 2016 and 2020, but the proportion selected for clinical treatment remained at 67.35% in 2020. The DDDs of EAMs (OBs) and IAMs both showed an increasing trend year by year, with a proportional increase of 207.72% and 652.68%, respectively; but the proportion selected for clinical treatment was only 16.09% and 16.56% respectively in 2020. EAMs (LPGs) had good affordability for urban residents but poor affordability for rural residents; the affordability of EAMs (OBs) and IAMs was poor for both urban and rural residents. CONCLUSIONS: There were no significant changes in the availability and cost of EAMs (LPGs), whose lower prices showed better affordability. Although their relative change in drug utilization showed a decreasing trend, they still dominated clinical treatment. Driven by the national drug price negotiation (NDPN) policy, the availability of IAMs was on the rise. It is necessary to further develop and strengthen policies for essential medicines procurement assessment to improve the accessibility of EAMs.

Coming Up Short: How Cancer Drug Shortages Affect Care.

An oncology fellow shares her experience navigating a cancer drug shortage alongside her patient.

Improving Waiting Time for Chemotherapy with Ahead-of-Time Drug Preparation.

Waiting time for chemotherapy infusion is a fundamental factor to measure quality of care. It has been shown that a prolonged waiting time is related to a higher incidence of anticipatory nausea and poor patient adherence to scheduled appointments and recommended oncology treatment programs. Some chemotherapy regimens can be prepared hours ahead-of-time, due to long stability. We aimed to study the effect of an informatic-led workflow redesign intervention, facilitating workflow changes in the Oncology Pharmacy, on patient waiting time. This intervention included changes on EHR processes and the chemotherapy CPOE. Their main effect was allowing ahead-of-time preparation of selected chemotherapy regimes. We conducted a cross sectional study, comparing waiting times pre and post intervention periods. A total of 4600 programmed chemotherapy episodes were included. We found a 26.5 % decrease in the mean wait time in the post intervention period (p > 0.02). We were able to show a decrease in waiting time and a measurable impact of the intervention. This evaluation produced valuable and actionable data for Oncology units and adds a valuable, Latin American experience to the literature.

Unification of Efforts to Improve Global Access to Cancer Therapeutics: Report From the 2022/2023 Access to Essential Cancer Medicines Stakeholder Summit.

PURPOSE: There is an urgent need to improve access to cancer therapy globally. Several independent initiatives have been undertaken to improve access to cancer medicines, and additional new initiatives are in development. Improved sharing of experiences and increased collaboration are needed to achieve substantial improvements in global access to essential oncology medicines. METHODS: The inaugural Access to Essential Cancer Medicines Stakeholder Meeting was organized by ASCO and convened at the June 2022 ASCO Annual Meeting in Chicago, IL, with two subsequent meetings, Union for International Cancer Control World Cancer Congress held in Geneva, Switzerland, in October 2022 and at the ASCO Annual Meeting in June of 2023. Invited stakeholders included representatives from cancer institutes, physicians, researchers, professional societies, the pharmaceutical industry, patient advocacy organizations, funders, cancer organizations and foundations, policy makers, and regulatory bodies. The session was moderated by ASCO. Past efforts and current and upcoming initiatives were initially discussed (2022), updates on progress were provided (2023), and broad agreement on resulting action steps was achieved with participants. RESULTS: Summit participants recognized that while much work was ongoing to enhance access to cancer therapeutics globally, communication and synergy across projects and organizations could be enhanced by providing a platform for collaboration and shared expertise. CONCLUSION: The summit resulted in new cross-stakeholder insights and planned collaboration addressing barriers to accessing cancer medications. Specific actions and timelines for implementation and reporting were established.

Access to innovative anticancer medicines in China: a national survey on availability, price and affordability.

OBJECTIVES: This study aimed to investigate the availability, price, and affordability of nationally negotiated innovative anticancer medicines in China. DESIGN: Retrospective observational study based on data from a nationwide medical database. DATA SOURCES/SETTING: Quarterly data about the use of innovative anticancer medicines from 2020 to 2022 were collected from the Chinese Medicine Economic Information Network. This study covered 895 public general hospitals in 30 provincial administrative regions in China. Of the total hospitals, 299 (33.41%) were secondary and 596 (66.59%) were tertiary. MAIN OUTCOME MEASURES: The adjusted WHO and Health Action International methodology was used to calculate the availability and affordability of 33 nationally negotiated innovative anticancer medicines in the investigated hospitals. Price is expressed as the defined daily dose cost. RESULTS: On average, the total availability of 33 innovative anticancer medicines increased annually from 2020 to 2022. The median availability of all investigated medicines in tertiary hospitals from 2020 to 2022 was 24.04%, 33.60% and 37.61%, respectively, while the indicators in secondary hospitals were 4.90%, 12.54% and 16.48%, respectively. The adjusted prices of the medicines newly put in Medicare (in March 2021) decreased noticeably, with the decline rate ranging from 39.98% to 82.45% in 2021 compared with those in 2020. Most generic brands were priced much lower than the originator brands. The affordability of anticancer medicines has improved year by year from 2020 to 2022. In comparison, rural residents had lower affordability than urban residents. CONCLUSIONS: The overall accessibility of 33 nationally negotiated innovative anticancer medicines improved from 2020 to 2022. However, the overall availability of most anticancer medicines in China remained at a low level (less than 50%). Further efforts should be made to sufficiently and equally benefit patients with cancer.

Strengthening access to cancer medicines for children in East Africa: policy options to enhance medicine procurement, forecasting, and regulations.

Gaps in access to quality essential medicines remain a major impediment to the effective care of children with cancer in low-and middle-income countries (LMICs). The World Health Organization reports that less than 30% of LMICs have consistent availability of childhood cancer medicines, compared to over 95% in high-income countries. Information provided within this policy brief is drawn from a review of the literature and a mixed-methods study published in the Lancet Oncology that analyzed determinants of cancer medicine access for children in Kenya, Tanzania, Uganda, and Rwanda. Three key policy options are presented to guide strategic policy direction and critical health system planning for strengthening access to cancer medicines for children: pooled procurement, evidence-based forecasting, and regional harmonization of regulatory processes. Enhancing regional pooled procurement to address fragmented markets and improve medicine supply, investing in health information systems for improved forecasting and planning of childhood cancer medicine needs, and promoting regulatory harmonization to streamline medicine approval and quality assurance across East Africa are recommended. This policy brief is intended for policymakers, clinicians, and health-system planners involved in the procurement, supply chain management, policy and financing of childhood cancer medicines.

Descentralización de la elaboración de los tratamientos antineoplásicos. Optimización de los recursos / Decentralisation of the preparation of antineoplastic treatments. Resources

Objetivos: La metodología “Six Sigma” se basa en el análisis de los flujos de trabajo e identificación de los puntos de mejoras con el fin de lograr una máxima eficiencia en los procesos, tanto industriales como sanitarios. El objetivo de este estudio es comparar la eficiencia entre un sistema “clásico” de elaboración de quimioterapia centralizado en el Servicio de Farmacia frente a un modelo descentralizado. Material y métodos: Estudio observacional en el que se analizó la eficiencia de los modelos de elaboración de preparaciones quimioterápicas: 1.- Modelo clásico (MC), a partir del cual se suministran las preparaciones al Hospital de Día de Hematología: las campanas de elaboración de tratamientos y el farmacéutico están presentes en el Servicio de Farmacia.2.- Modelo descentralizado (MD): el farmacéutico y las campanas de preparación de la medicación se encuentran en Hospital de Día de Oncología. La eficiencia de cada sistema se evaluó mediante el tiempo transcurrido desde la recepción de la orden médica hasta la administración de la quimioterapia (TAQ).Resultados: El TAQ siguiendo el MD fue inferior que para el MC: 13,7 [5-28] minutos versus 71,0 [42-96] minutos (p<0,001) con una diferencia media de 57,3 minutos/preparación. El tiempo potencialmente ahorrado con el modelo descentralizado fue de 40,3 horas/día. Conclusiones: Con el presente trabajo hemos querido cuantificar y comparar la eficiencia de los dos modelos de elaboración de mezclas citostáticas, siendo desfavorable para el sistema clásico de centralización para la preparación de la medicación en los Servicios de Farmacia. (AU)

Aims: The «Six Sigma» methodology is based on the analysis of workflows and the identification of areas for improvement in order to achieve maximum efficiency in industrial and healthcare processes. The aim of this study is to compare the efficiency of a «classic» chemotherapy preparation system centralised in the Pharmacy Service versus a decentralised model.Material and methods: Observational study in which the efficiency of the models for the preparation of chemotherapy treatments was analysed: 1.- Classical model (MC), which has the treatment preparation cabinets and a pharmacist located in the Pharmacy Service, and from which the preparations are supplied to the Haematology Day Hospital. 2.- Decentralised model (MD), where both the pharmacist and the medication preparation cabinets are located in the Oncology Day Hospital .For the evaluation of the efficiency of each system, the time elapsed from the receipt of the medical order to the administration of chemotherapy (TAQ) was compared. Results: The TAQ following MD was less than for MC: 13.7 [5-28] minutes versus 71.0 [42-96] minutes (p<0.001) with a mean difference of 57.3 minutes/prescription. The potential time saved with the decentralised model was 40.3 hours/day. Conclusions: The aim of this study was to quantify and compare the efficiency of the two models for the preparation of cytostatic mixtures, showing that the classical centralised system for the preparation of medication in pharmacy services is unfavourable. (AU)

Demandas judiciais por medicamentos antineoplásicos: a ponta de um iceberg? / The lawsuits to antineoplastic drugs: the tip of an iceberg?

Resumo Ações judiciais com medicamentos antineoplásicos geram custos elevados aos governos e demandam análises criteriosas para garantir resultados eficientes e adequados em saúde. Este trabalho analisou processos enviados por entes federados a um instituto referência no tratamento de câncer para emissão de parecer técnico. Coletou-se dados das cópias dos processos analisados entre julho e dezembro/2013 e avaliou-se: subgrupos terapêuticos, presença em lista de medicamentos essenciais, registro sanitário, indicação off label, indicações constantes em diretrizes clínicas, incorporação do medicamento no sistema público de saúde e valor estimado das causas. Foram examinados 158 processos, com 164 solicitações de 35 antineoplásicos. A maioria dos medicamentos eram inibidores da tirosinoquinase, dez figuravam em lista de medicamentos essenciais, três não continham registro sanitário, dez tinham indicação de uso off label, 56,7% estavam descritas em diretrizes clínicas, quatro tinham recomendação para incorporação e o valor estimado das causas foi de R$ 18.110.504,89. Identificou-se que os instrumentos técnico-sanitários disponíveis para subsidiar as decisões parecem ser insuficientes e que há a necessidade de se estabelecer estratégias para minimizar o comprometimento da integralidade do cuidado.

Abstract The lawsuits with antineoplastic drugs generate high costs for governments and require careful analysis to ensure efficient and adequate health results. This study analyzed cases conducted by federal entities to a reference institute for the treatment of cancer for technical opinion. Data were collected from copies of the cases examined from July 1 to December 31, 2013. It was analyzed: therapeutic subgroups, presence in essential drug list, drug registry, off-label use, indications of clinical practice guidelines, drug incorporation in Brazilian Health System and estimated value of court cases. 158 cases were examined, with a total of 164 requests of 35 antineoplastic drugs. Most of the medications were protein kinase inhibitors (31.4%), ten (28.6%) were included in the essential drugs list, three did not contain sanitary registration, ten had indication of off-label use, 56.7% were described in clinical practice guidelines and four drugs were recommended for incorporation. The total estimated amount of the court cases was R$ 18,110,504.89. It was identified that the technical and sanitary instruments currently available to support the decisions seem to be insufficient and that there is need to establish strategies to minimize inconsistencies that compromise the comprehensiveness of care.

Estratégias de instituições da sociedade civil no acesso a medicamentos para câncer de mama no SUS / Strategies by civil society organizations for access to breast cancer drugs in the Brazilian Unified National Health System / Estrategias de las instituciones de la sociedad civil sobre el acceso a medicamentos para el cáncer de mama en el Sistema Único de Salud brasileño

Esta pesquisa objetiva identificar e analisar as estratégias de instituições da sociedade civil dedicadas ao câncer de mama (ISC-CM) no acesso a medicamentos no SUS e seus principais atores sociais. Utilizou-se a abordagem qualitativa, empregando-se os métodos de análise de redes sociais e bola-de-neve e as técnicas de observação participante e entrevistas semiestruturadas. A análise temática baseou-se nas categorias: acesso a medicamentos para tratamento de câncer de mama; relacionamento das ISC-CM com o Estado; relacionamento das ISC-CM com a indústria farmacêutica; e outras estratégias utilizadas por ISC-CM no acesso a medicamentos. Os resultados mostraram que as ISC-CM têm influenciado o acesso a medicamentos para câncer de mama no SUS e sua principal estratégia é a pressão sobre o Estado. A indústria farmacêutica patrocina algumas dessas instituições para fortalecê-las com o intuito de ampliar seu mercado. As principais dificuldades no acesso a medicamentos se referem à deficiência de serviços, à iniquidade dos tratamentos oferecidos, e à inclusão de tecnologias no SUS.

This study aims to identify and analyze strategies by civil society organizations working with breast cancer (CSOs) on access to drugs in Brazilian Unified National Health System (SUS) and the main social actors. A qualitative approach used the snowball technique, semi-structured interviews, and participant observation. Thematic analysis was based on the following categories: access to drugs for breast cancer treatment, relationship between CSOs and government, relationship between CSOs and the pharmaceutical industry, and other strategies used by CSOs. The results showed that civil society organizations have influenced access to drugs for breast cancer in the SUS and that their main strategies have focused on pressuring government at all levels. Meanwhile, the pharmaceutical industry sponsors some CSOs in order to strengthen them and expand its own market. The main difficulties in access to such drugs involve insufficient services, unequal treatment, and inclusion of technology in the SUS.

Esta investigación tiene como objetivo identificar y analizar las estrategias de las instituciones de la sociedad civil, dedicadas al cáncer de mama (ISC-CM), sobre el acceso a los medicamentos en el Sistema Único de Salud (SUS) y sus actores sociales. Se utilizó un enfoque cualitativo, mediante entrevistas semi-estructuradas, de bola de nieve, y observación participante. El análisis temático se basó en las categorías: acceso a los medicamentos para el tratamiento del cáncer de mama; relación de ISC-CM con el Estado; relación de ISC-CM con la industria farmacéutica; y otras estrategias usadas por el ISC-CM. Los resultados mostraron que el ISC-CM ha influido en el acceso a los medicamentos para el cáncer de mama en el SUS y sus principales estrategias se han centrado en la presión sobre el Estado. Por otro lado, la industria farmacéutica patrocina algunos ISC-CM para fortalecerlos a fin de ampliar su mercado. Las principales dificultades en el acceso a los medicamentos se refieren a los servicios de discapacidad, la falta de equidad de los tratamientos que se ofrecen y la inclusión de la tecnología en el SUS.

A judicialização no Sistema Único de Saúde e o caso da fosfoetanolamina sintética / Health litigation in the Unified Health System and the case of the synthetic phosphoethanolamine

A judicialização do direito à saúde, que de acordo com a Carta Magna de 1988 também constitui dever do Estado ­ evoca uma discussão sobre o impacto na equidade e integralidade no Sistema Único de Saúde (SUS), que constitui um bem comum e cujo compartilhamento é coletivo. A judicialização se torna complexa no contexto da Oncologia, em virtude da carga da doença, estrutura do segmento de mercado para Oncologia e da intensa relação do câncer com a inovação. O Caso da Fosfofetanolamina Sintética (FOS-S) compreendeu o litígio por acesso a substância, atingindo um volume de cerca de 15 mil ações em dois anos, acompanhado de intensa discussão social, a partir da suspensão do fornecimento da FOS-S pelo Instituto de Química de São Carlos da Universidade de São Paulo (IQSC/USP), onde foi pesquisada, desenvolvida e distribuída desde 1990 ainda sem comprovação de indicação como medicamento e sem registro sanitário no Brasil., para o tratamento de neoplasias malignas, A Defensoria Pública da União (DPU) por meio de Ação Civil Pública motivou o Poder Executivo a instaurar providências para atendimento da demanda social. A Lei N° 1.3269 de abril /2016 liberou a distribuição da substância. Esta Lei teve sua eficácia suspensa em maio /2016. Este estudo teve como objetivo principal analisar o processo de judicialização na assistência oncológica no SUS considerando o contexto do Caso FOS-S. Como objetivos específicos foram considerados a reconstrução da trajetória do processo de judicialização para o acesso a FOS-S para o tratamento de neoplasias malignas no SUS; a contextualização do processo regulatório para concessão de registro sanitário de insumos farmacêuticos ativos, medicamentos e a incorporação de tecnologias em saúde no SUS; a análise da judicialização na assistência oncológica no SUS no contexto do Caso FOS-S. A estrutura metodológica compreendeu um estudo de caso único tendo como unidade de análise o caso da FOS-S, utilizando análise documental complementada por revisão da literatura nas principais bases de dados eletrônicas sobre o tema. O horizonte temporal compreendeu o período entre 2014 e 2016. O estudo confirmou como primeiro tensor da judicialização em Oncologia distorções gerenciais, envolvendo descompassos entre políticas públicas e o processo de Pesquisa e Desenvolvimento (P&D) de novas moléculas para Oncologia no SUS, e ainda ausência de integração no fluxo de incorporação tecnológica e as listas de medicamentos. O segundo tensor reflete distorções na participação da sociedade na arena política, favorecendo a ausência de formação de grupos de pressão pelo SUS, e ainda na falta de solidariedade no SUS. O estudo concluiu que o fortalecimento das redes de pesquisa em Oncologia pode favorecer a implementação de políticas públicas e de P&D nacional. A revisão do tratamento dados aos antineoplásicos nas listas de medicamentos e na política de reembolso do SUS seria uma prioridade para amenizar a judicialização. A necessidade de discussão social sobre a tomada de decisões sob escassez e ainda sobre a solidariedade no compartilhamento considerando o SUS como bem comum e atuação de grupos de interesse pelo SUS poderiam reduzir o litígio e fortalecer o SUS

Health litigation of the right to health, which according to the Constitution of 1988 is also a duty of the State ­ introduces a discussion on the impact on equity and integrality on the Unified Health System (SUS), which is a common good shared by all citizens in Brazil. Health litigation becomes complex in the context of Oncology due to the burden of disease, the structure of the market segment for Oncology and the intense relationship between cancer and innovation. The Case of Synthetic Phosphoethanolamine (FOS-S) comprised the litigation for access to the substance, reaching a volume of about 15 thousand lawsuits in two years, accompanied by intense social discussion, from the suspension of supply of FOS-S by São Carlos Chemistry Institute of São Paulo State University (IQSC / USP), where it was researched, developed and distributed as a antineoplastic drug since 1990, although still not indicated as medicine and without sanitary registration in Brazil. The Public Defender's Office of the Government (DPU) through a Public Civil Action motivated the Executive Branch to establish measures to meet social demand. Law No. 1.3269 of April / 2016 released the distribution of the substance. This Law was effectively suspended in May / 2016. This study had as main objective to analyze the process of health litigation in Oncology in the SUS considering the context of the FOS-S Case. As specific objectives were considered the reconstruction of the trajectory of the process of health litigation for access to FOS-S for the treatment of malignant neoplasms in the SUS; the contextualization of the regulatory process for granting sanitary registration of active pharmaceutical ingredient and medicines and the incorporation of health technologies in SUS; the analysis of the health litigation in Oncology in the SUS in the context of the FOS-S Case. The methodological structure comprised a single-case study having the FOS-S case as the unit of analysis, using documentary analysis complemented by literature review in the main electronic databases on the subject. The time horizon comprised the period between 2014 and 2016. The study confirmed as the first tensor of the judicialization in Oncology managerial distortions, involving mismatches between public policies and the process of Research and Development (R & D) of new molecules for Oncology in SUS, and still absence of integration in the technological incorporation flow and the lists of medicines. The second tensor reflects distortions in the participation of society in the political arena, favoring the absence of formation of pressure groups by the SUS, also in the lack of solidarity in the SUS. The study concluded that the strengthening of research networks in Oncology can favor the implementation of public policies and national R & D. Reviewing the treatment given to antineoplastics in the lists of medicines and the SUS reimbursement policy would be a priority to ease the judicialization. The need for social discussion about decision making under scarcity and about sharing solidarity considering the SUS as a common good and political lobbism for the SUS could reduce litigation and strengthen the health system

Uso racional de medicamentos antineoplásicos e ações judiciais no Estado de São Paulo / Uso racional de medicamentos antineoplásicos y acciones judiciales en el estado de Sao Paulo, Sureste de Brasil / Rational use of anticancer drugs and patient lawsuits in the state of São Paulo, southeastern Brazil

OBJETIVO: Avaliar a racionalidade das ações judiciais e pedidos administrativos recebidos pela Secretaria de Estado da Saúde de São Paulo segundo evidências científicas de eficácia e segurança. MÉTODOS: Estudo descritivo, transversal, baseado em informações da Secretaria de Saúde sobre os medicamentos antineoplásicos solicitados por via judicial, com maior impacto financeiro para o Sistema Único de Saúde em 2006 e 2007. Os fármacos foram avaliados quanto às evidências clínicas de eficácia e segurança, com base na classificação do Micromedex®, em metanálises e revisões sistemáticas. As indicações foram confrontadas com aquelas aprovadas em agências reguladoras. RESULTADOS: Os medicamentos bevacizumabe, capecitabina, cetuximabe, erlotinibe, rituximabe, imatinibe e temozolomida geraram gastos superiores a R$ 40 milhões para atender 1.220 solicitações, com custo médio de R$ 33,5 mil por paciente. Os estudos selecionados não recomendam parte das indicações dos medicamentos prescritos. Cerca de 17 por cento dos pedidos não tinham evidência para a indicação mencionada no pleito, o que equivale a um gasto inadequado de, no mínimo, R$ 6,8 milhões...

OBJECTIVE: To assess the rationality of legal suits and administrative requests requiring anticancer drugs filed against and submitted to the São Paulo State Department of Health, in view of scientific evidence on efficacy and safety. METHODS: A descriptive cross-sectional study was carried out based on information on lawsuits filed by cancer patients requiring anticancer drugs were furnished by the Department of Health. These drugs are among those having the greatest financial impact on the Brazilian Health System in 2006 and 2007. The drugs were assessed according to clinical evidence on efficacy and safety, based on Micromedex® categorization, on systematic reviews and meta-analyses. Indications present in the legal documentation were compared to the indications approved by regulatory agencies. RESULTS: Bevacizumab, capecitabine, cetuximab, erlotinib, rituximab, imatinib, and temozolomide accounted for expenses over R$ 40 million to meet 1220 requests and lawsuits, at an average cost of R$ 33,500 per patient. Selected studies do not recommend all the indications for the prescribed drugs. Approximately 17 percent of requests and lawsuits did not provide evidence for the required indication, and these amounted to inappropriate expenses of, at least, R$ 6.8 million...

OBJETIVO: Evaluar la racionalidad de las acciones judiciales y pedidos administrativos recibidos por la Secretaria Estatal de Salud de Sao Paulo según evidencias científicas de eficacia y seguridad. MÉTODOS: Estudio descriptivo, transversal basado en informaciones de la Secretaria sobre los medicamentos antineoplásicos solicitados por vía judicial, con mayor impacto financiero para el Sistema Único de Salud en 2006 y 2007. Los fármacos fueron evaluados considerando las evidencias clínicas de eficacia y seguridad, con base en la clasificación de Micromedx®, metanálisis y revisiones sistemáticas. Las indicaciones fueron confrontadas con las aprobadas en agencias reguladoras. RESULTADOS: Los medicamentos bevacizumabe, capecitabina, cetuximabe, erlotinibe, rituximabe, imatinibe y temozolomida generaron gastos superiores a R$ 40 millones para atender 1.220 solicitudes, con costo promedio de R$ 33,5 mil por paciente. Los estudios seleccionados no recomiendan parte de las indicaciones de los medicamentos prescritos. Cerca de 17 por ciento de los pedidos no tenían evidencia para la indicación mencionada en el pleito, lo que equivale a un gasto inadecuado de, mínimo, R$ 6,8 millones...

COVID-19 rapid guideline: delivery of systemic anticancer treatments

The purpose of this guideline is to maximise the safety of patients with cancer and make the best use of NHS resources, while protecting staff from infection. It will also enable services to match the capacity for cancer treatment to patient needs if services become limited because of the COVID-19 pandemic.

Calidad del registro de quimioterapia en los servicios de farmacia hospitalaria de Andalucía / Chemotherapy registry quality in Andalusian hospital pharmacy departments

Objetivo: Analizar la calidad de los registros de las unidadescentralizadas de citostáticos de los hospitales de Andalucía y la disponibilidadde datos para analizar la utilización de estos fármacos.Método: Se elaboró un cuestionario ad hoc, usando variablesrelativas a la cobertura de información sobre pacientes y tratamientos,grado de informatización y organización. Los cuestionarios secumplimentaron en septiembre de 2005 mediante encuesta al responsablede los tratamientos quimioterápicos de los 19 servicios defarmacia de los hospitales que tratan pacientes oncológicos enAndalucía.Resultados: La tasa de respuesta fue del 100%, aunque un serviciono contaba con unidad centralizada de citostáticos. La coberturade preparación centralizada fue del 89% para hospital de día, el84% para pacientes ingresados, el 79% para pacientes hematológicosy el 69% para pacientes pediátricos. El registro está informatizadosólo en 13 hospitales (68%), con una gran variabilidad en losprogramas usados. La dispensación de temozolamida y de capecitabinacuenta con registro propio en el 68 y 42% de los casos. El nombredel paciente y el nombre y la dosis del citostático son los únicosdatos que se registran en todos, mientras que el nombre del protocolosólo se registra en el 47%, el diagnóstico, estadiaje y clasificaciónTNM en el 58, 31 y 16% respectivamente.Conclusiones: Existe una gran variabilidad en los sistemas deinformación para la gestión de uso de citostáticos, y carenciasimportantes en la disponibilidad de datos del paciente para realizarestudios de utilización y adecuación de la prescripción

Objective: To analyze registry quality in centralized cytostatictherapy units in Andalusian hospitals, and the availability of datato analyze the use of these drugs.Method: An ad hoc questionnaire was designed using variablesrelated to information coverage on patients and their treatments,data processing extent, and organization. Questionnaireswere completed in September 2005 by surveying people responsiblefor chemotherapy in all 19 pharmacy departments inAndalusian hospitals that treat oncologic patients.Results: Response rate was 100%, but one department hadno centralized cytostatic therapy unit. Centralized preparationcoverage was 89% for the day hospital, 84% for inpatients, 79%for hematologic patients, and 69% for pediatric patients. Registriesare computerized in only 13 hospitals (68%) with a varietyof software programs. Temozolamide and capecitabine dispensationhas a separate registry in 68% and 42% of cases, respectively.Patient name, and cytostatic name and dosage are the onlydata recorded in all instances, while protocol name is only recordedin 47%, and diagnosis, staging, and TNM categorization in58%, 31%, and 16% of cases, respectively.Conclusions: There is great variability regarding informationsystems for cytostatic use management, and a relevant shortage ofpatient data available for prescription use and adaptation studies

Los medicamentos antineoplásicos y sus perspectivas en los países del tercer mundo / The antineoplastic drugs and their perspectives in the Third World countries

El cáncer es la segunda causa de muerte de la población en la mayoría de los países del mundo, incluyendo en éstos a algunos países subdesarrollados. Sin embargo, los países desarrollados tienen acceso a la mayoría de los medicamentos antineoplásicos en comparación con el que tienen los países del Tercer Mundo; donde existe una gran diferencia en el nivel de consumo por enfermo. Para que se tenga una magnitud de esta problemática, se realiza una evaluación económica estimada de los casos de cáncer en el Tercer Mundo y los costos promedio de los tratamientos quimioterapéuticos; también se realizan una comparación entre los niveles estimados del consumo actual y el consumo necesario para satisfacer las necesidades prioritarias de los países pobres en materia de medicamentos antineoplásicos. Sobre la base de este panorama, los países subdesarrollados sólo tienen una alternativa que es el autoabastecimiento de sus necesidades a partir de la producción nacional de fármacos para el cáncer. Esto no es más, que la adquisición de una planta productora de formas terminadas de medicamentos a partir de la materia prima importada(AU)

Los medicamentos antineoplásicos y sus perspectivas en los países del tercer mundo / The antineoplastic drugs and their perspectives in the Third World countries

El cáncer es la segunda causa de muerte de la población en la mayoría de los países del mundo, incluyendo en éstos a algunos países subdesarrollados. Sin embargo, los países desarrollados tienen acceso a la mayoría de los medicamentos antineoplásicos en comparación con el que tienen los países del Tercer Mundo; donde existe una gran diferencia en el nivel de consumo por enfermo. Para que se tenga una magnitud de esta problemática, se realiza una evaluación económica estimada de los casos de cáncer en el Tercer Mundo y los costos promedio de los tratamientos quimioterapéuticos; también se realizan una comparación entre los niveles estimados del consumo actual y el consumo necesario para satisfacer las necesidades prioritarias de los países pobres en materia de medicamentos antineoplásicos. Sobre la base de este panorama, los países subdesarrollados sólo tienen una alternativa que es el autoabastecimiento de sus necesidades a partir de la producción nacional de fármacos para el cáncer. Esto no es más, que la adquisición de una planta productora de formas terminadas de medicamentos a partir de la materia prima importada