Government Agency Perspective on Future Access

Transcription

1 Government Agency Perspective on Future Access UICC 4th December 2014 M. Saeed Quraishy Medical Superintendent & Chair Private Public Partnership Civil Hospital Karachi P A K I S T A N

2 Cancer kills more patients yearly than Malaria, AIDS and Tuberculosis combined The Forgotten Disease in the Developing World

3 Overview of cancer Statistics Cancer becoming a major health burden 32.6 million 14.1 million Living with Cancer New Cancer Cases Developed Nations Developing Nations 25% more in Men Incidence GLOBOCAN 2012 (IARC) 8.2 million Deaths

4 Incidence and Mortality from Cancer 4

5 Achieving MDGs in developing nations is still challenging A case of Pakistan Majority of the indicators in MDG 4,5 & 6 are off track Nation is struggling with mortality rate be it infant or maternal Malaria is still a challenge with added Dengue in recent past Though TB incidence is off track but control is on track Similar situation is seen in other developing nations 5

6 Developing nations are striving for basic health access Primary care is still not fully accessible Cancer is considered largely a surgical disease* Radiation facilities are not even available in many countries My home province has only 5 centers catering more than 43 Million people Natural calamities such as floods, famine or droughts eat majority of resources 6

7 Low and Middle Income Countries Spend Less in Cancer Control Per Patient South America US$ % China US$ % India US$ % United Kingdom US$ % Japan US$ % United States US$ % Pakistan US$ % As a percentage of GNI/Capita Lopes et al. Lancet Oncology, 2013

8 Majority of Asian population does not have access to Cancer treatment 60% 50% 40% 30% 20% 10% 0% Singapore Thailand Indonesia Philippines Veitnam Pakistan

9 Treating cancer is an expensive option A case of Pakistan Per Patient Cost of Treatment* 6 Cycles of FAC US$ 800 Single agent Cisplatin US$ 300 CRC, 6 cycles of 5FU + FA US$ 200 Leukemias incl transfusion US$ 20,000 * Across Generation; Cancer Treatment in developing countries; Zeba Aziz, JCO

10 Disenfranchisement Out of pocket expenditure precipitates POVERTY 10

11 Overview of cancer Statistics Developing world needs a wake up call A huge and largely unperceived cost of inaction from cancer is in the developing world An immediate large-scale global response is required to address this challenge Access initiatives in managing cancer at government level will not only save millions of lives but also billions of dollars 1. Global economic cost of cancer report-livestrong and The American Cancer Society. 11

12 The World Cancer Declaration (WCD), A new start for global cancer care A robust approach in achieving 09 targets by 2025 Cancer control with emphasis on awareness Life style modification: A low cost high outcome based initiative Early detection and diagnosis that may improve health outcomes 12

13 WCD 2013 Target 7 Accurate cancer diagnosis Quality multimodal treatment Rehabilitation Supportive and palliative care Up to date technology 13

14 Overview of cancer access & costs (global preferably but local if not) Access A Huge Challenge Availability of trained professionals Early referral Cost of treatment Reimbursement Struggling with access of drugs that are essential for life Insurance system covers essential or minimal treatment cost Impacts compliance 14

15 Policy Options to Increase Access Government Intervention Price Control and Negotiation Social Insurance, Subsidies, Medication Assistance Funds Market Based Alternatives Better Private Insurance Coverage Price discrimination and Market Access Programs Award for Innovation Innovative Financing, Philanthropy Risk Sharing Schemes Industry Intervention Patent withdrawal Compulsory Licensing Quality generics Innovative pricing models

16 Public Private Partnerships Term coined quite recently Last 2 decades Governments especially in developing nations experimented some successful projects Civil Hospital, Karachi has been at the forefront in Pakistan Sectors initially ventured out were burns, infectious diseases, preventive measures and mass awareness Improved outcomes in patient access Engaging public advocacy and education A variety of complex arrangements of various sizes, forms and scope 16

17 Public Private Partnerships Civil Hospital Karachi, Pakistan Dow Alumni Emergency OT OT Complex Medical ICU Lab Gyn/Obs OR Radiology Center PPP in Drug Access Imatinib and nilotinib in CML Thalassemia Management Oral drug for Hepatitis Program Philanthropy Urology Unit (SIUT) Cancer Unit Children Emergency Endoscopic Unit Burns Center Dietary Services 17

18 Pakistan CML Project PPP A case from developing nation More than 1000 patients and the number is increasing Median age of CML is 35 Years 1 Imatinib prolongs survival by 85% over 8 years Both imatinib (Glivec) and nilotinib (Tasigna) are expensive Cost sharing 15% Govt and 85% corporate Replicated in other provinces based on the success 1.Treating CML in the Imatinib Era/Aziz et al., Cancer 2007;109:

19 Helping the Young Generation Leading a Healthy and Productive Life Total no of Patients: Mortality 63 (6%) Lost to follow up 8.1%

20 Universal Access 20

21 Nothing can be achieved alone Providing health care to a large population in low and middle income countries is a challenging task A joint effort is needed to ensure 100% access Multipronged approach is needed Utilizing the available health infrastructure for sustainable partnerships 21

22 Recommendations Public awareness Drugs Price Optimization Microfinancing Schemes Health Insurance Increased Access Through collaboration between social welfare organizations and Pharmaceutical

23 Together, we can wrap up sorrow and sow happiness Thank you CML Patients