Expanding Coverage of Oncology Drugs in an Aging, Upper-Middle-Income Country: Analyses of Public and Private Expenditures in Chile
PURPOSE: The population of Chile has aged, and in 2017, cancer became the leading cause of death. Since 2005, a national health program has expanded coverage of drugs for 13 types of cancer and related palliative care. We describe the trends in public and private oncology drug expenditures in Chile...
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| Format: | Article |
| Language: | English |
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American Society of Clinical Oncology
2019-12-01
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| Series: | Journal of Global Oncology |
| Online Access: | http://ascopubs.org/doi/10.1200/JGO.19.00223 |
| _version_ | 1818203879883407360 |
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| author | Veronica Vargas Christine Leopold Marianela Castillo-Riquelme Jonathan J. Darrow |
| author_facet | Veronica Vargas Christine Leopold Marianela Castillo-Riquelme Jonathan J. Darrow |
| author_sort | Veronica Vargas |
| collection | DOAJ |
| description | PURPOSE: The population of Chile has aged, and in 2017, cancer became the leading cause of death. Since 2005, a national health program has expanded coverage of drugs for 13 types of cancer and related palliative care. We describe the trends in public and private oncology drug expenditures in Chile and consider how increasing expenditures might be addressed. METHODS: We analyzed total quarterly drug expenditures for 131 oncology drugs from quarter (Q)3 2012 until Q1 2017, including public and private insurance payments and patient out-of-pocket spending. The data were analyzed by drug-mix, sources of funding, growth, and intellectual property status. The Laspeyres Price Index was used to analyze expenditure growth. RESULTS: We found 131 oncology drugs associated with 87,129 observations. Spending on drugs rose 120% from the first period, spanning from the first 3 quarters (Q3, Q4, Q1 2012-2013) to the last period (Q3, Q4, Q1 2016-2017), corresponding to an annualized rate of 19.2% and totaling US$398 million (in 2017 dollars). The public sector accounted for 84.2% of spending, which included 50 drugs in the official treatment protocols, whereas private insurance accounted for 7.3% in on-protocol drugs. The remaining 8.5% was paid out of pocket. In the public sector, more than 90% of growth resulted from increased use. Seven drugs, including 3 with nonexpired patents, accounted for 50% of total expenditures. CONCLUSION: Increased use and access enabled by expanded public expenditures drove most of the growth in oncology drug expenditures. However, the rate of public expenditure growth may be fiscally unsustainable. Policies are urgently needed to promote the use of generic drugs, the appropriate mix of on-protocol versus off-protocol drugs, and the curbing of off-label prescribing. |
| first_indexed | 2024-12-12T03:32:22Z |
| format | Article |
| id | doaj.art-8252bd322bd74a14824fecee8182b544 |
| institution | Directory Open Access Journal |
| issn | 2378-9506 |
| language | English |
| last_indexed | 2024-12-12T03:32:22Z |
| publishDate | 2019-12-01 |
| publisher | American Society of Clinical Oncology |
| record_format | Article |
| series | Journal of Global Oncology |
| spelling | doaj.art-8252bd322bd74a14824fecee8182b5442022-12-22T00:39:53ZengAmerican Society of Clinical OncologyJournal of Global Oncology2378-95062019-12-01511710.1200/JGO.19.002231Expanding Coverage of Oncology Drugs in an Aging, Upper-Middle-Income Country: Analyses of Public and Private Expenditures in ChileVeronica Vargas0Christine Leopold1Marianela Castillo-Riquelme2Jonathan J. Darrow3Department of Economics, Alberto Hurtado University, Santiago, Chile, and David Rockefeller Center for Latin America Studies, Harvard University, Boston, MADepartment of Population Medicine, Division of Health Policy and Insurance Research, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MAEpidemiology Program, Institute of Population Health, School of Public Health, University of Chile, Santiago, ChileProgram on Regulation, Therapeutics, and Law, Brigham and Women’s Hospital and Harvard Medical School, Boston, MAPURPOSE: The population of Chile has aged, and in 2017, cancer became the leading cause of death. Since 2005, a national health program has expanded coverage of drugs for 13 types of cancer and related palliative care. We describe the trends in public and private oncology drug expenditures in Chile and consider how increasing expenditures might be addressed. METHODS: We analyzed total quarterly drug expenditures for 131 oncology drugs from quarter (Q)3 2012 until Q1 2017, including public and private insurance payments and patient out-of-pocket spending. The data were analyzed by drug-mix, sources of funding, growth, and intellectual property status. The Laspeyres Price Index was used to analyze expenditure growth. RESULTS: We found 131 oncology drugs associated with 87,129 observations. Spending on drugs rose 120% from the first period, spanning from the first 3 quarters (Q3, Q4, Q1 2012-2013) to the last period (Q3, Q4, Q1 2016-2017), corresponding to an annualized rate of 19.2% and totaling US$398 million (in 2017 dollars). The public sector accounted for 84.2% of spending, which included 50 drugs in the official treatment protocols, whereas private insurance accounted for 7.3% in on-protocol drugs. The remaining 8.5% was paid out of pocket. In the public sector, more than 90% of growth resulted from increased use. Seven drugs, including 3 with nonexpired patents, accounted for 50% of total expenditures. CONCLUSION: Increased use and access enabled by expanded public expenditures drove most of the growth in oncology drug expenditures. However, the rate of public expenditure growth may be fiscally unsustainable. Policies are urgently needed to promote the use of generic drugs, the appropriate mix of on-protocol versus off-protocol drugs, and the curbing of off-label prescribing.http://ascopubs.org/doi/10.1200/JGO.19.00223 |
| spellingShingle | Veronica Vargas Christine Leopold Marianela Castillo-Riquelme Jonathan J. Darrow Expanding Coverage of Oncology Drugs in an Aging, Upper-Middle-Income Country: Analyses of Public and Private Expenditures in Chile Journal of Global Oncology |
| title | Expanding Coverage of Oncology Drugs in an Aging, Upper-Middle-Income Country: Analyses of Public and Private Expenditures in Chile |
| title_full | Expanding Coverage of Oncology Drugs in an Aging, Upper-Middle-Income Country: Analyses of Public and Private Expenditures in Chile |
| title_fullStr | Expanding Coverage of Oncology Drugs in an Aging, Upper-Middle-Income Country: Analyses of Public and Private Expenditures in Chile |
| title_full_unstemmed | Expanding Coverage of Oncology Drugs in an Aging, Upper-Middle-Income Country: Analyses of Public and Private Expenditures in Chile |
| title_short | Expanding Coverage of Oncology Drugs in an Aging, Upper-Middle-Income Country: Analyses of Public and Private Expenditures in Chile |
| title_sort | expanding coverage of oncology drugs in an aging upper middle income country analyses of public and private expenditures in chile |
| url | http://ascopubs.org/doi/10.1200/JGO.19.00223 |
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