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Price of Drugs and Affordability Don’t Always Jibe

TOP - August 2016, Vol 9, No 3

Chicago, IL—A collaborative international pilot study found large differences in retail prices for 23 cancer drugs, showing highest retail prices in the United States and lowest prices in India and South Africa. Lower prices, however, did not necessarily mean the drugs were more affordable. Daniel Goldstein, MD, of Rabin Medical Center, Petach Tikvah, Israel, presented the results of the study at the American Society of Clinical Oncology 2016 Annual Meeting.

When monthly drug price was ex­pressed as a percentage of gross domestic product per capita based on purchasing power parity, cancer drugs appeared to be less affordable in low-income countries despite the lower retail prices.

The study is informative, even though the researchers could not obtain information about discounted prices from the drug manufacturers to factor into their computations.

“The study provides a glimpse into prices and affordability of cancer drugs around the world and sets the stage for further research. However, the implications of our findings are limited because we were not able to take discounts and rebates into account, which would better predict affordability,” said Dr Goldstein.

“Until now it hasn’t been clear what the magnitude of difference in prices is or how prices in each country relate to affordability. The differences in prices are not proportional to ability to pay,” he noted.

Of the 23 cancer drugs, 15 were generic and 8 were patented. These drugs are used to treat a range of cancer types and stages. The 7 countries in the study were Australia, China, India, Israel, South Africa, the United Kingdom, and the United States.

Drugs of both types were most affordable in Australia. The United States had the highest median monthly prices for drugs—both generic and patented—but ranked 5th in affordability per capita for patented drugs, behind Australia, the United Kingdom, Israel, and South Africa, and tied with the United Kingdom for 4th for generic drugs, behind Australia, Israel, and South Africa. Drugs were least affordable in India and China, with China the highest for patented drugs and India the highest for generic drugs. (TABLE 1)

Figure 1

The study did not take into account the health insurance systems in the different countries. Depending on the insurance system, the patient may or may not bear some or all of the cost of the drugs.

“We need open access to discount prices and transparency—which we did not have. This study raises significant questions and shows us that knowing the price of drugs is not all we need to know to determine value. Some drugs save lives, while others benefit patients for weeks,” Dr Goldstein said.

“This is an interesting international comparative study. The concept of affordability is novel and adds another dimension to the discussion of the price of drugs, the value of drugs, and whether they are affordable,” said Patricia Ganz, MD, Jonsson Comprehensive Cancer Center at the University of California Los Angeles. Dr Ganz was not involved in the study.

“The prices of drugs are putting a significant burden on the healthcare system and on patients. More needs to be done to make treatments more affordable and accessible for all patients,” Dr Ganz said.


Goldstein DA, Clark J, Tu Y, et al. Global differences in cancer drug prices: a comparative analysis. Presented at: 2016 American Society of Clinical Oncology Annual Meeting; June 3-7, 2016; Chicago, IL. Abstract LBA6500.

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