Essential medicines for breast cancer in low and middle income countries.
BACKGROUND
Breast cancer is the most common type of cancer among women worldwide. In low and middle-income countries (LMICs), appropriate selection of medicines on national essential medicines lists (NEMLs) is a first step towards adequate access to treatment. We studied selection of systemic treatments for breast cancer on NEMLs and assessed its alignment with treatment guidelines for different types of early and advanced breast cancer. Furthermore, influence of country characteristics on the selection was investigated.


METHODS
NEMLs from 75 LMICs were studied for inclusion of all components of therapy in each stage of breast cancer according to international consensus guidelines. The results were then grouped by income level, WHO region and the NEMLs' release date. Non parametric tests were used for statistical analysis.


RESULTS
Unlike HER2-targeted therapies (<10%), aromatase inhibitors (12%) and taxanes (28%); tamoxifen and first generation chemotherapeutic regimens (e.g., anthracycline-based regimens) were frequently found in the NEMLs (71-78%). Consequently, all components of treatment for "Luminal A" early breast cancer and non HER2 overexpressed advanced breast cancer were found on the NEMLs of over 70% of countries. However, 40% of the low income countries did not have all the components of therapy for any type of early breast cancer in their NEMLs, and adequate treatment of HER2 overexpressed breast cancer was hardly possible with the current selections. Recent NEMLs were more aligned with the guidelines (p < 0.05). Eastern Mediterranean and African regions less frequently incorporated all components of breast cancer treatment in their NEMLs.


CONCLUSIONS
Alignment of selection with guidelines' recommendations was inconsistent for different types of early and advanced breast cancer in NEMLs. Regular updates and more attention to clinical guidelines is therefore recommended.
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, David de Wied building, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands. y.bazargani@uu.nl.
Y T
YT
Bazargani
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, David de Wied building, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands. a.deboer@uu.nl.
A
A
de Boer
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, David de Wied building, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands. J.H.M.Schellens@uu.nl.|Division of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. J.H.M.Schellens@uu.nl.
J H M
JH
Schellens
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, David de Wied building, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands. H.G.M.Leufkens@uu.nl.
H G M
HG
Leufkens
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, David de Wied building, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands. A.K.Mantel@uu.nl.
Aukje K
AK
Mantel-Teeuwisse
D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D003657:Decision Making; D003906:Developing Countries; D018954:Drugs, Essential / Q000191:economics*; D005260:Female; D006801:Humans; D011203:Poverty; D013629:Tamoxifen / Q000191:economics / Q000627:therapeutic use*
D018954:Drugs, Essential; D013629:Tamoxifen