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IMPLICATIONS OF GLOBAL PRICING POLICIES ON ACCESS TO INNOVATIVE DRUGS: THE CASE OF TRASTUZUMAB IN SEVEN LATIN AMERICAN COUNTRIES

Published online by Cambridge University Press:  20 May 2015

Andres Pichon-Riviere ,
Osvaldo Ulises Garay ,
Federico Augustovski ,
Carlos Vallejos ,
Leandro Huayanay ,
Maria del Pilar Navia Bueno ,
Alarico Rodriguez ,
Carlos José Coelho de Andrade ,
Jefferson Antonio Buendía  and
Michael Drummond
Andres Pichon-Riviere
Affiliation:
IECS – Institute for Clinical Effectiveness and Health Policy; School of Public Health, University of Buenos Airesapichon@iecs.org.ar
Osvaldo Ulises Garay
Affiliation:
IECS – Institute for Clinical Effectiveness and Health Policy
Federico Augustovski
Affiliation:
IECS – Institute for Clinical Effectiveness and Health Policy; School of Public Health, University of Buenos Aires
Carlos Vallejos
Affiliation:
Universidad de La Frontera
Leandro Huayanay
Affiliation:
Universidad Peruana Cayetano Heredia
Maria del Pilar Navia Bueno
Affiliation:
Universidad de San Andrés
Alarico Rodriguez
Affiliation:
Fondo Nacional de Recursos (FNR)
Carlos José Coelho de Andrade
Affiliation:
Brazilian National Cancer Institute-INCA
Jefferson Antonio Buendía
Affiliation:
Department of Pharmacology, School of Medicine, University of Antioquia
Michael Drummond
Affiliation:
Centre for Health Economics, University of York
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Abstract

Objectives: Differential pricing, based on countries’ purchasing power, is recommended by the World Health Organization to secure affordable medicines. However, in developing countries innovative drugs often have similar or even higher prices than in high-income countries. We evaluated the potential implications of trastuzumab global pricing policies in terms of cost-effectiveness (CE), coverage, and accessibility for patients with breast cancer in Latin America (LA).

Methods: A Markov model was designed to estimate life-years (LYs), quality-adjusted life-years (QALYs), and costs from a healthcare perspective. To better fit local cancer prognosis, a base case scenario using transition probabilities from clinical trials was complemented with two alternative scenarios with transition probabilities adjusted to reflect breast cancer epidemiology in each country.

Results: Incremental discounted benefits ranged from 0.87 to 1.00 LY and 0.51 to 0.60 QALY and incremental CE ratios from USD 42,104 to USD 110,283 per QALY (2012 U.S. dollars), equivalent to 3.6 gross domestic product per capita (GDPPC) per QALY in Uruguay and to 35.5 GDPPC in Bolivia. Probabilistic sensitivity analysis showed 0 percent probability that trastuzumab is CE if the willingness-to-pay threshold is one GDPPC per QALY, and remained so at three GDPPC threshold except for Chile and Uruguay (4.3 percent and 26.6 percent, respectively). Trastuzumab price would need to decrease between 69.6 percent to 94.9 percent to became CE in LA.

Conclusions: Although CE in other settings, trastuzumab was not CE in LA. The use of health technology assessment to prioritize resource allocation and support price negotiations is critical to making innovative drugs available and affordable in developing countries.

Keywords

Cost-effectivenessCost utilitytrastuzumabdrug pricingLatin America
Type
Assessments
Information
International Journal of Technology Assessment in Health Care , Volume 31 , Issue 1-2 , 2015 , pp. 2 - 11
Copyright
Copyright © Cambridge University Press 2015 

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