Implications of global pricing policies of pharmaceuticals for access the innovative drugs: the case of trastuzumab in seven Latin American countries

ANDRES PICHON RIVIERE

Seoul

Congreso; HTAi 10th Annual Meeting; Junio de 2013, Seoul, Korea; 2013

HTAi - Healtha Technology Assessment International

Background Differential pricing (DP), on the basis of countries? purchasing power, has been recommended by the WHO to secure more affordably priced medicines. However, in developing countries (DC) innovative drugs have similar or even higher prices than in high-income countries (HIC). We conducted a cost-effectiveness (CE) analysis to estimate the impact of this global pricing policy on trastuzumab in Latin-America (LA). Methods Model structure and a common methodology for identifying resource use and costs were agreed amongst the country research teams. A Markov model was designed to evaluate life years (LYs), quality-adjusted life years (QALYs) and costs from a health care perspective. A systematic search for data on effectiveness, local epidemiology and cost studies was undertaken to populate the model. To better fit local cancer prognosis, a base case scenario using transition probabilities from trastuzumab clinical trials was complemented with two alternative scenarios with transition probabilities adjusted to reflect breast cancer epidemiology in each country. Findings Incremental discounted benefits of the trastuzumab strategy ranged from 0?87 to 1?00 LY and 0?51 to 0?60 QALY. Incremental CE ratios ranged from $42,104 to $110,283 (2012 US dollars) per QALY, equivalent to 3?6 gross domestic product per capita (GDPPC) per QALY in Uruguay to 35.5 in Bolivia. The probabilistic sensitivity analysis showed a 0% probability that trastuzumab is CE if the willingness-to-pay (WTP) threshold is one GDPPC per QALY, and remained 0% at a WTP threshold of three GDPPC except for Chile and Uruguay which showed probabilities of 4?3% and 26?6% respectively. Interpretation Although proven to be CE in other settings, trastuzumab was not CE in LA at its current price. Greater cooperation between the public and private sectors is needed to make innovative drugs available and affordable in DC. Funding Global Health Research Initiative Key words: Cost effectiveness, Cost utility, trastuzumab, drug pricing, Latin America.