Nilotinib and Imatinib Utilization in Iran over 14 years
Background: Tyrosine Kinase Inhibitors (TKIs) are drugs of choice for Chronic Myeloid Leukemia (CML) treatment. CML healthcare costs greatly exceed of other haematological malignancies treatment mostly due to TKIs. There are several generic and brand preparations of imatinib and nilotinib, the only available TKIs, in Iran with different prices and varied insurance coverage. We have studied TKIs utilization and also investigate the effect of different insurance coverage on TKIs utilization in Iran.
Methods: This was drug utilization study about Imatinib and Nilotinib over 14 years. It was conductedin two phases; data extraction from pharmaceutical wholesale data (2003-2017) for utilization trend assessment and registered data of prescriptions from Sizdah-Aban Pharmacy (2011-2014) for utilization trend and insurance coverage assessment such as; prescriptions frequency, number of TKIs, insurance companies and their cost coverage in each prescription.
Results: Imatinib consumption increased signifcantly from 2003 to 2013. This trend stoppedafterward. Nilotinib consumption had ascending trend. The trend line of years 2014 to 2017was steeper and statistically signifcant (β=0.0014, p-value=0.02). The amount of nilotinib costcoverage by insurance companies increased signifcantly from 2011 to 2014 (p-value=0.04). The coverage of imatinib costs by insurance companies changed slightly during the study period that was not statistically signifcant. Frequency of prescriptions with full cost coverage doubled for nilotinib, while did not change remarkably for imatinib, from 2011 to 2014. Mean (SD) of imatinib and nilotinib counts per prescription was signifcantly higher in prescriptions for which 100% of the cost was covered.
Conclusion: We found increasing trend in nilotinib utilization and observed some effects fromnilotinib cost coverage by insurance on its consumption. This study made a clear picture for policy makers to monitor imatinib and nilotinib use appropriateness and design the proper cost-effective studies to make evidence-based decisions
2. Bower H, Björkholm M, Dickman PW, Höglund M, Lambert PC, Andersson TM-L. Life expectancy of patients with chronic myeloid leukemia approaches the life expectancy of the general population. J Clin Oncol 2016;34(24):2851-7.
3. DeRemer DL, Ustun C, Natarajan K. Nilotinib: a second-generation tyrosine kinase inhibitor for the treatment of chronic myelogenous leukemia. Clin Ther 2008;30(11):1956-75.
4. Weisberg E, Manley P, Mestan J, Cowan-Jacob S, Ray A, Griffin J. AMN107 (nilotinib): a novel and selective inhibitor of BCR-ABL. Br J Cancer 2006;94(12):1765-9.
5. Saglio G, Kim D-W, Issaragrisil S, et al. Nilotinib versus imatinib for newly diagnosed chronic myeloid leukemia. N Engl J Med 2010;362(24):2251-9.
6. Kantarjian H, Giles F, Wunderle L, et al. Nilotinib in imatinib-resistant CML and Philadelphia chromosome–positive ALL. N Engl J Med 2006;354(24):2542-51.
7. Rogers G, Hoyle M, Thompson-Coon J, et al. Dasatinib and nilotinib for imatinib-resistant or-intolerant chronic myeloid leukaemia: a systematic review and economic evaluation. Health Technol Assess 2012;16(22):1-410
8. Thanopoulou E, Judson I. The safety profile of imatinib in CML and GIST: long-term considerations. Arch Toxicol 2012;86(1):1-12.
9. Zhu Y, Qian S-X. Clinical efficacy and safety of imatinib in the management of Ph+ chronic myeloid or acute lymphoblastic leukemia in Chinese patients. Onco Targets Ther 2014;7:395–404.
10. Daroudi R, Mirzania M, Nikravanfard N, Sadighi S, Sedighi Z, Zendehdel K. Estimation of the prevalence and direct medical costs of chronic myeloid leukemia in the IR of Iran in the era of tyrosine kinase inhibitors. Asia Pac J Clin Oncol 2017;13(5):e416-e422.
11. Rouhollahi MR, Mohammad Nejad S, Harirchi I, et al. Management of Herceptin (Trastuzumab) in Patients with Breast Cancer in Iran: Procurement, Allocation, Patient Eligibility Criteria, Prescription and Financial. Hakim Medical Journal 2012;15(4):270-80.
12. Darrudi A, Daroudi R. High Insurance Coverage and Financial Support for Effective Cancer Drugs in IR Iran. Basic & Clinical Cancer Research 2018;10(3):12-21.
13. Daroudi R, Mirzania M, Zendehdel K. Attitude of Iranian medical oncologists toward economic aspects, and policy-making in relation to new cancer drugs. Int J Health Policy Manag 2015;5(2):99-105.
14. Experts in Chronic Myeloid Leukemia. The price of drugs for chronic myeloid leukemia (CML) is a reflection of the unsustainable prices of cancer drugs: from the perspective of a large group of CML experts. Blood 2013;121(22):4439-42.
15. Wilkes J. CML much higher treatment cost than other haematological cancers. Pharmacoeconomics & Outcomes News 2020;861:9-5.
16. Davari M, Haycox A, Walley T. The Iranian health insurance system; past experiences, present challenges and future strategies. Iran J Public Health 2012;41(9):1-9.
17. Stuart B, Briesacher B. Medication decisions—right and wrong. Med Care Res Rev 2002;59(2):123-45.
18. Stuart B, Shea D, Briesacher B. Prescription drug costs for Medicare beneficiaries: coverage and health status matter. Issue Brief (Commonw Fund) 2000;(365):1-9.
19. Flegel K. The adverse effects of brand-name drug prescribing. CMAJ 2012;184(5):616.
20. Bettiol A, Marconi E, Lombardi N, et al. Pattern of use and long-term safety of tyrosine kinase inhibitors: a decade of real-world management of chronic myeloid leukemia. Clin Drug Investig 2018;38(9):837-844.
21. Jame SZB, Sari AA, Majdzadeh R, Rashidian A, Arab M, Rahmani H. The extent of inappropriate use of magnetic resonance imaging in low back pain and its contributory factors. International Journal of Preventive Medicine 2014;5(8):1029-36.
22. Sheng G, Chen S, Dong C, et al. Societal implications of medical insurance coverage for imatinib as first-line treatment of chronic myeloid leukemia in China: a cost-effectiveness analysis. J Med Econ 2017;20(4):371-81.
23. Grant M, Chapman M. The art of prescribing: negotiating the decision of generic or branded medications. Intern Med J 2015;45(7):774-6
24. Harris BL, Stergachis A, Ried LD. The effect of drug co-payments on utilization and cost of pharmaceuticals in a health maintenance organization. Med Care 1990;28(10):907-17.
25. Li N, Zheng B, Cai H-F, et al. Cost effectiveness of imatinib, dasatinib, and nilotinib as first-line treatment for chronic-phase chronic myeloid leukemia in China. Clin Drug Invest 2018;38(1):79-86.
26. Eldessouky R. Cost effectiveness analysis of Nilotinib versus Imatinib in newly diagnosed chronic myeloid leukemia from the health insurance perspective in Egypt. Value in Health 2016;19(7):A735-A736.
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