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Table of Contents
LETTER TO EDITOR
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 559-560

Value-based pricing for cancer drugs in India


1 Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India

Date of Submission23-Aug-2021
Date of Decision29-Aug-2021
Date of Acceptance30-Aug-2021
Date of Web Publication08-Oct-2021

Correspondence Address:
Shankar Prinja
Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_200_21

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How to cite this article:
Prinja S, Gupta N. Value-based pricing for cancer drugs in India. Cancer Res Stat Treat 2021;4:559-60

How to cite this URL:
Prinja S, Gupta N. Value-based pricing for cancer drugs in India. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Dec 9];4:559-60. Available from: https://www.crstonline.com/text.asp?2021/4/3/559/327787



We read with interest the paper by Radhakrishnan on issues related to drug pricing which was published in this journal.[1] This paper highlights the important aspect of high out-of-pocket expenditures (OOPEs) for health care in India, contribution of medicine prices in the overall OOPE, and the underlying problem of unregulated drug prices. The problem of market-based pricing, which is the methodology of drug price control order to set market prices for essential drugs, along with the incentives of cartelization among the pharmaceutical industry which it creates is also indicated. Finally, the paper rightfully signals the “window of opportunity” which has been created by the Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (AB PM-JAY)–the large tax-funded health insurance scheme, bulk procurement facility created under the National Cancer Grid, as well as the recent Government initiatives to support generic drugs through the Jan Aushadhi Scheme.

We would like to highlight some important issues in this regard. First, despite enumerating the challenges and opportunities, there are three other important fundamental determinants of rising OOPE as a result of medicines in India.[2] These include a lack of adequate social protection through risk pooling mechanisms, unavailability of cancer medicines in public sector facilities, and lack of consideration of evidence on cost-effectiveness while framing standard treatment guidelines. While the AB PM-JAY provides cover for cancer treatment, it aspires to cover only 40% of the population, and its current coverage is even lower. In the absence of such an insurance program, the availability of free cancer treatment through public sector cancer hospitals becomes even more important. Several State Governments have established state-level medical service corporations which are involved in bulk procurement of drugs. These corporations need to be adequately financed so that they can procure the necessary medicines as per requirement. Secondly, a real-time monitoring system should be established to ensure that the supply-chain management is robust, and patients do not have to spend as a result of unavailability of medicines.

The third problem leading to inflation in the cost of cancer treatment is a lack of recognition of the “value” which a new cancer drug offers relative to its price. Almost all standard treatment guidelines consider the evidence on clinical effectiveness to recommend the use of drugs. Similarly, the regulatory agencies also assess safety and clinical effectiveness while granting approvals. Given the fact that most of these treatments come at a very high cost,[3],[4] with relatively meager survival benefits, the recommendation needs a careful reconsideration. This becomes even more imperative in a setting like India, with lean budgets for the health sector.[5] Recent evidence suggests that several of the drugs which are commonly prescribed may not offer a reasonable “value” to be considered cost-effective in the Indian context.[6],[7],[8]

This leads to a way forward for “value-based pricing” for cancer drugs in India. This becomes even more relevant at a time when the AB PM-JAY is expanding its coverage, and the Government of India has created a health technology assessment (HTA) agency (known as HTAIn), which has a mandate to assess newer drugs and treatments on the grounds of cost-effectiveness.[9],[10] For drugs which are not cost-effective at the current prices, such HTA evaluations also provide important evidence on the price at which the use of the given drug becomes cost-effective. For example, a recent evaluation reported that while the 1-year use of trastuzumab was not cost-effective, the shorter duration regimen should be used.[6] Further, price reduction of 15% to 35% could mean that 1-year trastuzumab may also be cost-effective. This becomes important evidence for setting a value-based price.

To conclude, we recommend a strong role for HTA to be considered by policymakers–while determining health benefit packages and their prices, by oncologists–while framing standard treatment guidelines, and by regulatory agencies–while setting prices. Together, these will enhance the value of oncology practice in India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Radhakrishnan V. Drug pricing: A major barrier to access to cancer care in India. Cancer Res Stat Treat 2021;4:195-7.  Back to cited text no. 1
  [Full text]  
2.
Goyanka R. Economic and non-economic burden of cancer: A propensity score matched analysis using household health survey data of India. Cancer Res Stat Treat 2021;4:29-36.  Back to cited text no. 2
  [Full text]  
3.
Kalra D, Menon N, Singh GK, Dale O, Adak S, Das S, et al. Financial toxicities in patients receiving systemic therapy for brain tumors: A cross-sectional study. Cancer Res Stat Treat 2020;3:724-9.  Back to cited text no. 3
  [Full text]  
4.
Jha V, Dinesh TA, Nair P. Cancer – Too costly to cure? Cancer Res Stat Treat 2021;4:173-4.  Back to cited text no. 4
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5.
Philip CC, Mathew A, John MJ. Cancer care: Challenges in the developing world. Cancer Res Stat Treat 2018;1:58-62.  Back to cited text no. 5
  [Full text]  
6.
Gupta N, Verma RK, Gupta S, Prinja S. Cost effectiveness of trastuzumab for management of breast cancer in India. JCO Glob Oncol 2020;6:205-16.  Back to cited text no. 6
    
7.
Gupta N, Prinja S, Patil V, Bahuguna P. Cost-effectiveness of temozolamide for treatment of glioblastoma multiforme in India. JCO Glob Oncol 2021;7:108-17.  Back to cited text no. 7
    
8.
Gupta N, Verma RK, Prinja S, Dhiman RK. Cost-effectiveness of Sorafenib for treatment of advanced hepatocellular carcinoma in India. J Clin Exp Hepatol 2019;9:468-75.  Back to cited text no. 8
    
9.
Prinja S, Rajsekhar K, Gauba VK. Health technology assessment in India: Reflection and future roadmap. Indian J Med Res 2020;152:444-7.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Prinja S, Downey LE, Gauba VK, Swaminathan S. Health technology assessment for policy making in India: Current scenario and way forward. Pharmacoecon Open 2018;2:1-3.  Back to cited text no. 10
    




 

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