Cancer drugs predictably cost much more in the U.S. than in poor countries and even other wealthy nations, but a study shows they are less affordable in some developing countries despite the lower price.
Relative to their ability to pay, cancer patients in China and India face much higher prices than wealthier U.S. patients, according to the research released Monday. Australia had the most affordable prices, for both cancer medicines under patent and less-expensive generics.
The pilot study examined list prices, also called retail prices, and affordability in Australia, China, India, Israel, the United Kingdom, the United States and South Africa.
But what is actually paid in most countries is usually much lower because of discounts and rebates manufacturers give insurers and health programs. Those net prices are usually kept secret by drugmakers and their customers, so they weren't available to the researchers.
Also, the countries have varying government and private health insurance programs, so how much of the medicines' costs patients actually bear is unknown.
Lead researcher Dr. Daniel A. Goldstein, of Rabin Medical Center in Petah Tikva, Israel, presented the findings Monday at the American Society of Clinical Oncology conference in Chicago.
“The retail prices are lower in places like India than in the U.S. (but) they're still less affordable than in the U.S.,” Goldstein said in an interview.
He and colleagues analyzed eight drugs covered by patent and 15 generic ones for which retail prices were available in all seven countries, according to the standard monthly dose. To compare the patients' ability to afford the drugs, they used a common indicator of national wealth called gross domestic product, adjusted for differences in living standards in each country.
The patented, or brand-name, drugs included Avastin, Herceptin and Rituxan. Patents give a monopoly for a decade or longer.
For the eight patented drugs, the median monthly price - the midpoint, with half of prices higher and half lower - was $8,694 in the U.S. It was $3,173 in China, $2,741 in Australia and less in the other countries including $1,515 in India. For China and India, the median price amounted to about three times the ability to pay.
The median monthly list price for the generics was $532 in China, versus $654 in the U.S. and only $120 in South Africa and $159 in India. Generics were more affordable, amounting to about half of what patients could afford in China, one-third percent in India and considerably less elsewhere.
Drug prices increasingly are a hot issue in the U.S., including in the presidential race, and both doctor groups and drugmakers have been promoting their views on prices and the true value of medicines.
Rena Conti, a University of Chicago assistant professor of health policy and economics who founded the school's Cost of Cancer Care project, said the disparities in prices and affordability the study found stem from the countries' different health systems.
In the U.S., insurance plans cover the bulk of the medicines' cost, and they negotiate drug price discounts. In the U.K., government health programs set price limits and pay most medicine costs but don't cover some extremely expensive cancer drugs. In China and India, Conti noted, most patients pay nearly all medicine costs. Some sell their homes and possessions to buy cancer drugs.
Conti said the study's flaws include not having net prices for the drugs and an “imperfect measure” of affordability.