TY - JOUR
T1 - Sharp rise in the expenditures of targeted drugs in Ecuador
T2 - five-year (2010–2014) consumption of oncologic drugs in public and private hospitals
AU - Durán, Carlos E.
AU - Elseviers, Monique
AU - Vander Stichele, Robert
AU - Rottey, Sylvie
AU - Christiaens, Thierry
N1 - Funding Information:
This research received no specific grant from any funding agency. The first author holds a doctorate grant (N°858-2012) from the Ecuadorian Institution of Higher Education, Science, Technology and Innovation – SENESCYT. We wish to thank Paulina Toazo (IESS), Dayra Calderón and Glenda Ramos (SOLCA Guayaquil), Santiago Gonzalez, Carlos Torres and José Yepez (SOLCA Quito), Hernán Valdiviezo (SOLCA Cuenca), who facilitated the administrative and technical process to access the required data from the study locations. We would also like to acknowledge Karina Castro (Ministry of Health) and Yajaira Vásquez, who guided us on the conditions to use the data and in an early stage of the data management respectively. Finally, we acknowledge Joan Rovira (University of Barcelona) and Andrea Vivar, for their advice regarding the economic aspects of the study.
Funding Information:
This research received no specific grant from any funding agency. The first author holds a doctorate grant (N°858-2012) from the Ecuadorian Institution of Higher Education, Science, Technology and Innovation – SENESCYT.
Publisher Copyright:
© 2018 Royal Pharmaceutical Society
PY - 2018/9
Y1 - 2018/9
N2 - Objective: In Ecuador, a new constitutional mandate (2008) allowed the government to implement free universal access to health care, including oncologic drugs. As most Latin American countries, Ecuadorian healthcare system is fragmented between public and private providers, posing a special challenge to collect valid drug utilization data. Data from the public and the private healthcare sectors were collected to examine the utilization of oncologic drugs in Ecuador over a 5-year period (2010–2014). Methods: Oncologic drugs were extracted from individual dispensing data collected in the six largest Ecuadorian cancer hospitals. Drug utilization indicators include the yearly proportion of patients using selected therapeutic groups (targeted drugs, chemotherapy and hormonal drugs), and the mean and total expenditures, by healthcare sector. Key findings: Total number of patients ranged from 12 060 in 2010 to 12 769 in 2014. Median age was 56 years; 60.3% were women. Twenty-three drugs were classified as targeted (monoclonal antibodies, protein kinase inhibitor, vismodegib, vorinostat and abiraterone), 43 as chemotherapy and 11 as hormonal. Patients using chemotherapy decreased from 56% to 52%. Proportion of patients using chemotherapy drugs was 30% lower in the public than in the private sector. Total expenditures on cancer drugs showed a constant increase from USD 17 912 865 in 2010 to USD 40 514 947 in 2014. Patients using targeted drugs doubled from 8% to 14% in 5 years. Targeted drugs accounted for 76% of total expenditures in 2014. Conclusion: Although only a small, but increasing proportion of patients used targeted drugs, it leads to a sharp rise in expenditures. In 2014, it represented three-quarters of the total oncologic drugs expenditures. Differences in chemotherapy consumption between public and private sectors could reflect difficulties in public procurement, shortages and a faster, poorly controlled adoption of new drugs. If unmanaged, this is a possible threat to the health budget in the coming years.
AB - Objective: In Ecuador, a new constitutional mandate (2008) allowed the government to implement free universal access to health care, including oncologic drugs. As most Latin American countries, Ecuadorian healthcare system is fragmented between public and private providers, posing a special challenge to collect valid drug utilization data. Data from the public and the private healthcare sectors were collected to examine the utilization of oncologic drugs in Ecuador over a 5-year period (2010–2014). Methods: Oncologic drugs were extracted from individual dispensing data collected in the six largest Ecuadorian cancer hospitals. Drug utilization indicators include the yearly proportion of patients using selected therapeutic groups (targeted drugs, chemotherapy and hormonal drugs), and the mean and total expenditures, by healthcare sector. Key findings: Total number of patients ranged from 12 060 in 2010 to 12 769 in 2014. Median age was 56 years; 60.3% were women. Twenty-three drugs were classified as targeted (monoclonal antibodies, protein kinase inhibitor, vismodegib, vorinostat and abiraterone), 43 as chemotherapy and 11 as hormonal. Patients using chemotherapy decreased from 56% to 52%. Proportion of patients using chemotherapy drugs was 30% lower in the public than in the private sector. Total expenditures on cancer drugs showed a constant increase from USD 17 912 865 in 2010 to USD 40 514 947 in 2014. Patients using targeted drugs doubled from 8% to 14% in 5 years. Targeted drugs accounted for 76% of total expenditures in 2014. Conclusion: Although only a small, but increasing proportion of patients used targeted drugs, it leads to a sharp rise in expenditures. In 2014, it represented three-quarters of the total oncologic drugs expenditures. Differences in chemotherapy consumption between public and private sectors could reflect difficulties in public procurement, shortages and a faster, poorly controlled adoption of new drugs. If unmanaged, this is a possible threat to the health budget in the coming years.
KW - cancer
KW - drug utilization
KW - Ecuador
KW - health expenditures
KW - Latin America
KW - molecular targeted therapy
KW - oncologic drugs
UR - https://www.scopus.com/pages/publications/85044336706
U2 - 10.1111/jphs.12221
DO - 10.1111/jphs.12221
M3 - Article
AN - SCOPUS:85044336706
SN - 1759-8885
VL - 9
SP - 175
EP - 182
JO - Journal of Pharmaceutical Health Services Research
JF - Journal of Pharmaceutical Health Services Research
IS - 3
ER -