Cancer Drugs Less Affordable in Poorer Countries Despite Lower Prices

Daniel Goldstein, MD

Researchers who set out to understand the affordability of cancer drugs across the globe concluded that lower prices in some poorer countries don’t equate to better access, according to a study presented at the 2016 ASCO Annual Meeting.

The study looked at list prices in 7 different countries for 15 generic drugs and 8 patented ones and compared those with gross domestic product (GDP) per capita in each of the countries to arrive at a picture of relative drug affordability. For example, the researchers found that median monthly retail prices were $1515 for patented drugs in India, or 313% of monthly GDP per capita in that country. In South Africa, monthly patented drug prices were $1708, or 157% of the monthly GDP per capita.

“Despite lower prices … these drugs appear to be relatively less affordable than in other countries,” said lead author Daniel Goldstein, MD, of Rabin Medical Center in Israel and Emory University in Atlanta.

The trend was somewhat different in the United States, where the GDP per capita was the highest among the countries included in the study—around $54,000—and patented retail drugs were still relatively expensive: $8694 for a monthly supply, or just under 192% of GDP per capita. The researchers concluded that drugs are less affordable in the United States than in the United Kingdom, Australia, and Israel. Median monthly patented drug costs in the United Kingdom, Australia, and Israel were below 100% of GDP per capita.

In China, monthly costs for patented drugs were $3173, which was 288% of that country’s GDP per capita. This made patented drugs in China the second most costly among the countries included in the study.

The researchers emphasized that drug prices used as the basis for the comparisons were not the true prices charged. They said that in many instances it was impossible to obtain discounted and reduced price information, which forced them to use list prices, a measure they were not satisfied with but which Goldstein said still allowed a degree of understanding about how oncology drug prices and patient access issues intersect in different countries. “Every study that comes out that is not using discounted prices essentially gets torn apart,” he said. “People say it is not reliable information because there aren’t any discounted prices. Ideally, we would use discounted prices; but, if we can’t get access, I’m not going to say, ‘OK, we’re not going to do the work.’” Goldstein said better information is required to fully understand the issue of global cancer drug affordability, and for that to happen, “open access” to discounted drug prices is needed.Another limitation of the study was that it did not examine who in the 6 countries was footing the bill for drugs—whether it was payers, patients, industry, or government. In lieu of conducting an out-of-pocket analysis, the researchers decided GDP per capita was the most viable measure for this type of a comparison. Goldstein acknowledged also that the price information used was only as reliable as the quality of reporting within the individual countries. “There are extensive differences of wealth within countries. Yes, some countries have higher degrees of inequality, and some countries have lower levels of inequality,” he said.

The researchers said that this type of study has not been conducted on such a broad scale before. Goldstein said the subject merits further investigation, particularly from an ethical standpoint of whether drugs are priced too high in certain countries. “It makes us think about the HIV crisis of 15 years ago when there were many effective drugs that were unavailable because they were priced too highly for many countries, and it’s an ethical question of whether or not the industry has some level of responsibility to make drugs affordable—given that they are holding certain very effective drugs and are not making them available.” He said everything from drugs to Coca-Cola to milk is priced differently, and it’s worth considering “whether we can demand a single global price for every drug, or should drugs be cheaper in poor countries and more expensive in wealthy countries?”

Average generic monthly prices for 6 of the countries included in the study were as follows: Australia, $226; China, $532; India, $159; South Africa, $120; United Kingdom, $458; United States, $654. As a percentage of GDP per capita, those costs are as follows: Australia, 3%; China, 48%; India, 33%; South Africa, 11%; United Kingdom, 14%; United States, 14%.

References

Goldstein DA, Clark J, Tu Y, et al. Global differences in cancer drug prices: A comparative analysis. Presented at: ASCO 2016; June 3-7, 2016; Chicago. Abstract LBA 6500.

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