Improving the Management of High Cost Anticancer Drugs in a Health Care System
Keywords:Drug expenditure, Managed entry agreement, Oncology, Preparation waste, Postmarketing register
AbstractAs a consequence of the rise in cancer prevalence and in the cost of anticancer drugs, global spending for cancer is increasing rapidly. The aim of this work is to identify and assess some effective cost management parameters and possible strategies to contain expenditure. Cost limitation could be achieved by implementing effective prevention measures and other main actions: diffusion of tailored therapies; systematic postmarketing reviews; cost-effectiveness assessment; accurate treatment choices; more transparent and effective managed entry agreement policies; waste management through personalized dose preparation. To better manage high cost anticancer drugs, oncologists and hospital pharmacists should collaborate in choosing the right drug, for the right patient, at the right time. In addition, besides promoting the use of biosimilars and generic drugs, when different products have a similar clinical effectiveness, a cost-minimization analysis should be performed to identify the best clinical approach at the lowest cost. With the same purpose, verifying real life outcomes by managing postmarketing analyses helps to renegotiate price agreements in a value-for-money model; this could be arranged if the regulatory agencies renegotiate the previously established price within a defined time period. Finally, the centralization of high-cost drug preparation and the implementation of a drug-day (vial sharing) will reduce drug waste.
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