Challenges of Providing Access to Cutting-Edge Cancer Medicines in the Countries of Eastern Europe

Frontiers in Public Health

Zdenko Tomić¹ 

关键词: targeted therapy;    monoclonal antibodies;    protein kinase inhibitors;    HTA;    balkans;   

DOI  :  10.3389/fpubh.2018.00193

学科分类：卫生学

来源: Frontiers

【 摘 要 】

The cost of delivering high quality cancer care is outstripping the national budgets of countries of former Yugoslavia. Serbia (SRB), Bosnia and Herzegovina (BiH), FYR Macedonia (MKD) and Croatia (HRV) are classified as upper middle income, while Slovenia (SVN) is the only high income country according to the World Bank data. As witnessed by current estimates given in Table ​Table1,1, health care financing remains under pressure—Serbia and Republic of Srpska (RS) spend the largest share of GDP on healthcare, but actual health expenditure per capita is only around 500 USD. Pharmaceutical expenditure is one of the key components in increased health-care spending, and cancer treatment is important component of pharmaceutical expenditure. Between 10 and 25% of total pharmaceutical expenditure in eastern Europe was related to the procurement of drugs for malignancies. For referencing, Slovakia (SVK), an EU country which shares large number of similarities to the countries of the former Yugoslavia region1, spent almost a quarter of total pharmaceutical expenditure on drugs for malignancies. Aside from the other health costs associated with cancer, pharmacotherapy is an important component of the cancer treatment—recent study conducted in Serbia concluded that pharmacotherapy costs accounted for 42.37% of all cancer related health care expenditure (27). TCTs are the major cancer care cost drivers in Eastern Europe as these drugs are relatively expensive in comparison to the other cancer treatment options. Monoclonal antibodies (Table ​(Table2)2) and protein-kinase inhibitors (Table ​(Table3)3) absolute expenditure is much lower in RS and Serbia compared to Slovakia, Slovenia, and Croatia, but high proportion of pharmaceutical spending stems from TCT procurement. Given the increase in malignancy incidence, aging population, and lack of fully implemented screening programs, the financial pressure novel cancer treatments pose on budgets in countries in transition is expected to increase further in the future. Differences in TCTs spending might be related to differences in level of reimbursement across Eastern Europe, as these large expenses are limiting factor for reimbursement of these medication (26), especially in low resource settings.

【 授权许可】

CC BY