Access Influences Standard of Care for Chinese Breast Cancer Patients
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| Dec 19, 2011
Presuming the patients that most physicians treat in Beijing, Shanghai, and Guangzhou are likely to be wealthier than most patients in rural areas, Herceptin might represent a case study for the ceiling for expected penetration into China based on current and near-term future assumptions. To understand why and its implications, read the blog below or click here to view the Kantar Health White Paper on Information and Insight into Breast Cancer Treatment in China.
Cost of cancer care is a common discussion topic these days. Another topic is the economic growth expected in China that many industries including pharmaceutical manufacturers are hoping to experience. Drugs typically dispensed by retail pharmacies in the United States might experience growth, but specialty pharmaceutical products like oncology drugs will not contribute to the growth unless there is a radical change in Chinese policy.
On one hand, its average annual growth has been an astonishing 25.5%, in direct contrast to the slowing growth rates in other matured markets, including the United States, Japan and the five major European countries. On the other hand, China is struggling with serious problems, such as drug prices on par with Western prices despite lower income levels, poor medical insurance coverage (especially in rural Chinese and migrant populations), counterfeit and/or unsafe drugs, and a rather complicated (and constantly improving) regulatory environment.
For oncology manufacturers, the most important issue to understand is that the expanded healthcare coverage will likely not include coverage for most branded oncolytics but will perhaps include coverage for older generic medicines. Currently, drug reimbursement is primarily managed by the National Essential Drug List (NEDL) and the National Reimbursement Drug List (NRDL). Overall, with no oncology drugs on the NEDL, less than 100 oncology drugs are covered on the NRDL and innovative targeted agents are not on the list, making the insurance status irrelevant.
The lack of coverage of innovative oncolytics plays out very obviously in diseases where they are considered standard of care in Western countries. Key examples include Gleevec® (imatinib, Novartis), Rituxan® (rituximab, Roche), and Herceptin® (trastuzumab, Roche). Currently, Herceptin is not on the reimbursable list of the National Basic Insurance Program (Ministry of Labor and Social Security, MoLSS). Also, no patient assistance programs are in place for Herceptin. The cost of one cycle of Herceptin is about $3,500, which is a highly expensive out-of-pocket cost for the majority of patients. Kantar Health’s syndicated physician research in the United States, Western Europe and Japan presented in CancerMPact® Treatment Architecture 2011 suggests approximately 75% of HER2-positive metastatic breast cancer patients receive Herceptin. Comparatively, our syndicated research of physicians in three Tier 1 cities for CancerMPact® Treatment Architecture China, suggests that only one-third of HER2-positive metastatic patients are receiving Herceptin.
Likely due to the high costs, most HER2-positive patients in China will receive chemotherapy only. In the other three regions, the most common reason for a patient to not receive Herceptin is susceptibility to cardiac toxicity associated with age and treatment with the drug. Our data also shows that of the patients who receive Herceptin-based chemotherapy, most will be given a Herceptin-based chemotherapy for a fixed duration of time – typically 6 months. In contrast, their Western counterparts will typically receive Herceptin until progression.
What seems clear is that diagnosing these patients is no longer a problem in China. According to the Chinese Medical Association survey conducted in 2008, only 57% of Chinese breast cancer patients were tested for HER2 status, despite the relatively low cost of conducting the HER2 test, ranging from $12-15. Reasons for the low testing rate included lack of awareness of the test and its value, and low quality of testing (lack of standardized testing techniques). In 2009, the Pathological Society of China (PSC) sponsored a national program, “National HER2 Testing Quality Certification,” with the goal of providing more accuracy and information on HER2 testing in breast cancer. Our 2011 syndicated research for CancerMPact® Treatment Architecture China showed that 86% of patients were tested for HER2 status. Although the testing rate has increased, the reported very low utilization of Herceptin for both the adjuvant and the metastatic settings strongly suggesting cost of care was key.
In some respects, this seems like a great disservice for breast cancer patients in China and possibly reflects the story in other emerging markets: lack of good therapeutic options due to economic constraints. This situation may change after healthcare reform takes effect, but getting Herceptin and other life-saving cancer agents into the hands of physicians, and ultimately patients, will need support far beyond what insurance can cover.