What are the volume and budget needs to provide chemotherapy to all children with acute lymphoblastic leukaemia in Thailand? Development and application of an estimation tool
Objective Insufficient access to anticancer medicines may contribute to the wide survival differences of children with cancers across the globe. We developed a tool to estimate the volume of medicines and budget requirements to provide chemotherapy to children with acute lymphoblastic leukaemia (ALL...
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BMJ Publishing Group
2020-10-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/10/e041901.full |
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| author | Alessandra Ferrario Sumit Gupta Dennis Ross-Degnan Anita Katharina Wagner Rosarin Sruamsiri Avram E Denburg A Lindsay Frazier Zachary J Ward Jennifer M Yeh |
| author_facet | Alessandra Ferrario Sumit Gupta Dennis Ross-Degnan Anita Katharina Wagner Rosarin Sruamsiri Avram E Denburg A Lindsay Frazier Zachary J Ward Jennifer M Yeh |
| author_sort | Alessandra Ferrario |
| collection | DOAJ |
| description | Objective Insufficient access to anticancer medicines may contribute to the wide survival differences of children with cancers across the globe. We developed a tool to estimate the volume of medicines and budget requirements to provide chemotherapy to children with acute lymphoblastic leukaemia (ALL).Design Development and application of an estimation tool.Setting Paediatric oncology hospital departments in Thailand.Participants 318 children aged 0–14 years diagnosed with ALL and 215 children with undiagnosed ALL.Interventions Estimates of volume and budget requirements for administering a full course of chemotherapy for ALL and a further course for children who relapse, according to National Treatment Guidelines.Primary and secondary outcome measures Primary outcome measures were the volume (mg) and cost (US$) of medicines needed to treat children with ALL. For medicines whose main indication is paediatric ALL (asparaginase and 6-mercaptopurine), we estimated the difference between volume needed and actual sales in 2017 (secondary outcome).Results Ten anticancer medicines and four chemoprotective agents are needed for the treatment of paediatric ALL according to the Thai treatment guidelines. Of these 14 medicines, 13 are included in the WHO essential medicines list for children. All are available as generics. We estimated that essential chemotherapy and chemoprotective agents to treat all children diagnosed with ALL in Thailand in 2017 would cost US$ 814 952 (US$ 1 365 422 for diagnosed and undiagnosed children), which corresponds to 0.005% (0.008%) of the country’s total health expenditure. The volumes of asparaginase and 6-mercaptopurine available on the Thai market in 2017 were more than sufficient (2.3 and 1.5 times the amounts needed, respectively) to treat all children diagnosed with ALL.Conclusions Procuring sufficient quantities of essential medicines to treat children with ALL requires relatively modest resources. Medicine cost should not be a major barrier to ALL treatment in similar settings. |
| format | Article |
| id | doaj-art-e8ea2afff2ca4e969a390a6cbb41ab3f |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-e8ea2afff2ca4e969a390a6cbb41ab3f2024-11-25T03:50:07ZengBMJ Publishing GroupBMJ Open2044-60552020-10-01101010.1136/bmjopen-2020-041901What are the volume and budget needs to provide chemotherapy to all children with acute lymphoblastic leukaemia in Thailand? Development and application of an estimation toolAlessandra Ferrario0Sumit Gupta1Dennis Ross-Degnan2Anita Katharina Wagner3Rosarin Sruamsiri4Avram E Denburg5A Lindsay Frazier6Zachary J Ward7Jennifer M Yeh8Department of Population Medicine, Division of Health Policy and Insurance Research, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USADivision of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, CanadaDivision of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USADepartment of Population Medicine, Division of Health Policy and Insurance Research, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USACenter of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Tha Pho, Phitsanulok, ThailandUnit for Policy and Economic Research in Childhood Cancer, Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, CanadaDana-Farber/Boston Children`s Cancer and Blood Disorders Center, Boston, Massachusetts, USACenter for Health Decision Science, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USADepartment of Pediatrics, Harvard Medical School, Boston, Massachusetts, USAObjective Insufficient access to anticancer medicines may contribute to the wide survival differences of children with cancers across the globe. We developed a tool to estimate the volume of medicines and budget requirements to provide chemotherapy to children with acute lymphoblastic leukaemia (ALL).Design Development and application of an estimation tool.Setting Paediatric oncology hospital departments in Thailand.Participants 318 children aged 0–14 years diagnosed with ALL and 215 children with undiagnosed ALL.Interventions Estimates of volume and budget requirements for administering a full course of chemotherapy for ALL and a further course for children who relapse, according to National Treatment Guidelines.Primary and secondary outcome measures Primary outcome measures were the volume (mg) and cost (US$) of medicines needed to treat children with ALL. For medicines whose main indication is paediatric ALL (asparaginase and 6-mercaptopurine), we estimated the difference between volume needed and actual sales in 2017 (secondary outcome).Results Ten anticancer medicines and four chemoprotective agents are needed for the treatment of paediatric ALL according to the Thai treatment guidelines. Of these 14 medicines, 13 are included in the WHO essential medicines list for children. All are available as generics. We estimated that essential chemotherapy and chemoprotective agents to treat all children diagnosed with ALL in Thailand in 2017 would cost US$ 814 952 (US$ 1 365 422 for diagnosed and undiagnosed children), which corresponds to 0.005% (0.008%) of the country’s total health expenditure. The volumes of asparaginase and 6-mercaptopurine available on the Thai market in 2017 were more than sufficient (2.3 and 1.5 times the amounts needed, respectively) to treat all children diagnosed with ALL.Conclusions Procuring sufficient quantities of essential medicines to treat children with ALL requires relatively modest resources. Medicine cost should not be a major barrier to ALL treatment in similar settings.https://bmjopen.bmj.com/content/10/10/e041901.full |
| spellingShingle | Alessandra Ferrario Sumit Gupta Dennis Ross-Degnan Anita Katharina Wagner Rosarin Sruamsiri Avram E Denburg A Lindsay Frazier Zachary J Ward Jennifer M Yeh What are the volume and budget needs to provide chemotherapy to all children with acute lymphoblastic leukaemia in Thailand? Development and application of an estimation tool BMJ Open |
| title | What are the volume and budget needs to provide chemotherapy to all children with acute lymphoblastic leukaemia in Thailand? Development and application of an estimation tool |
| title_full | What are the volume and budget needs to provide chemotherapy to all children with acute lymphoblastic leukaemia in Thailand? Development and application of an estimation tool |
| title_fullStr | What are the volume and budget needs to provide chemotherapy to all children with acute lymphoblastic leukaemia in Thailand? Development and application of an estimation tool |
| title_full_unstemmed | What are the volume and budget needs to provide chemotherapy to all children with acute lymphoblastic leukaemia in Thailand? Development and application of an estimation tool |
| title_short | What are the volume and budget needs to provide chemotherapy to all children with acute lymphoblastic leukaemia in Thailand? Development and application of an estimation tool |
| title_sort | what are the volume and budget needs to provide chemotherapy to all children with acute lymphoblastic leukaemia in thailand development and application of an estimation tool |
| url | https://bmjopen.bmj.com/content/10/10/e041901.full |
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