The economic pressures for biosimilar drug use in cancer medicine

The main rationale for using biosimilar drugs is for cost saving. The market development for biosimilar drugs will therefore depend on the degree to which cost saving measures are required by nations, medical insurers and individuals and the absolute savings that could be gained by switching from original drugs. This paper is designed to discover the degree to which financial constraints will drive future health spending and to discover if legal or safety issues could impact on any trend. A structured literature search was performed for papers and documents to 27 August 2011. Where multiple sources of data were available on a topic, data from papers and reports by multinational or national bodies were used in preference to data from regions or individual hospitals. Almost all health systems face current significant cost pressures. The twin driver of increasing cancer prevalence as populations age and cancer medicine costs rising faster than inflation places oncology as the most significant single cost problem. For some countries, this is predicted to make medicine unaffordable within a decade. Most developed countries have planned to embrace biosimilar use as a cost-control measure. Biosimilar introduction into the EU has already forced prices down, both the price of biosimilar drugs and competitive price reductions in originator drugs. Compound annual growth rates of use have been predicted at 65.8% per year. Most developed countries have planned to embrace biosimilar use as a major cost-control measure. Only legal blocks and safety concerns are likely to act against this trend. For centralised healthcare systems, and those with a strong tradition of generic medicine use, biosimilar use will clearly rise with predictions of more than 80% of prescriptions of some biologic drugs within 1 year of market entry in the USA. Delaying the implementation of such programmes however risks a real crisis in healthcare delivery for many countries and hospitals that few can now afford

Targeted therapies: Manufacturer sponsorship bias in economic analyses matters.

A qualitative study indicates that there is a positive selection bias towards favourable economic analysis of targeted therapies, when these are funded by the manufacturer. At a time of increasing budgetary constraints and public scrutiny of the relationship between industry and the professions, we need a more mixed economy of funding for this field. © 2012 Macmillan Publishers Limited. All rights reserved

Variation in the availability of cancer drug generics in the United States of America.

While most of the attention and spending in the oncology community in the United States has been focused on the remarkable scientific inventions of the newer targeted drugs, the shortage of the older essential cancer drugs that are off patent, mostly generics and injectables, has a threatening impact on the health of cancer patients, the execution of clinical trials and the identification of newer drugs and thus impacts upon the burden of costs and pressures on the health system in the United States. It is a part of the problem of the scarcity of generics across all medical specialties, but its oncology is particularly vulnerable. The problem in The United States has been increasing since the beginning of the 21st century until the 2011; since then there has been some improvement in 2012 and the first two quarters of 2013. In the second quarter of 2012, there were 211 active shortages, down from 246 reports of active shortages in the same quarter of 2011. The Food and Drug Administration (FDA) officials ascribe the improvement to efforts that the agency made after President Obama issued an executive order in 2012 that impel the FDA to obtain early reports from companies about potential shortages. The drivers of the shortages are multi-factorial. But are largely economic and are due to the lack of incentives to produce generics. There are efforts from the US government, politicians and the medical, pharmacy and oncology communities. However, the problem is still serious. There is a general agreement that efforts so far have not been adequate, and that there is a need for addressing effectively the fundamentals and the underlying causes. There is a lot that could be done in the United States and across the world to improve the accessibility of economically sustainable better value cancer drugs regardless of whether they are brand or generics and aiming at a win-win outcome for all stakeholders

Free and forced Barkhausen noises in magnetic thin film based cross-junctions

Barkhausen noise, driven by thermal fluctuations in stationary magnetic field, and Barkhausen jumps, driven by sweeping magnetic field, are demonstrated to be effects of different orders of magnitude. The critical magnetic field for domain walls depinning, followed by avalanched and irreversible magnetization jumps, is determined. Magnetoresistive response of NiFe/M/NiFe (M = Au, Ta, Ag) trilayers to stationary and sweeping magnetic field is studied by means of anisotropic magnetoresistance (AMR) and planar Hall effect (PHE) measurements. Thermal fluctuations result in local and reversible changes of magnetization of the layers in thin film magnetic junctions, while the sweeping magnetic field results in reversible and irreversible avalanched domain motion, dependently on the ratio between the values of sweeping magnetic field and domain wall depinning field. The correlation between AMR and PHE responses to Barkhausen jumps is studied. The value of this correlation is found to be dependent on the α angle between the directions of magnetic field and current path. © 2018 Elsevier B.V.1

Breast Radiation Therapy Guideline Implementation in Low- and Middle-income Countries

Radiation therapy plays a critical role in the management of breast cancer and often is unavailable to patients in low-and middle-income countries (LMCs). There is a need to provide appropriate equipment and to improve the techniques of administration, quality assurance, and use of resources for radiation therapy in LMCs. Although the linear accelerator is the preferred equipment, telecobalt machines may be considered as an acceptable alternative in LMCs. Applying safe and effective treatment also requires well trained staff, support systems, geographic accessibility, and the initiation and completion of treatment without undue delay. In early-stage breast cancer, standard treatment includes the irradiation of the entire breast with an additional boost to the tumor site and should be delivered after treatment planning with at least 2-dimensional imaging. Although postmastectomy radiation therapy (PMRT) has demonstrated local control and overall survival advantages in all patients with axillary lymph node metastases, preference in limited resource settings could be reserved for patients who have >= 4 positive lymph nodes. The long-term risks of cardiac morbidity and mortality require special attention to the volume of heart and lungs exposed. A]ternative treatment schedules like hypofractionated radiation and partial breast irradiation currently are investigational. Radiation therapy is an integral component for patients with locally advanced breast cancer after initial systemic treatment and surgery. For patients with distant metastases, radiation is an effective tool for palliation, especially for bone, brain, and soft tissue metastases. The implementation of quality-assurance programs applied to equipment, the planning process, and radiation treatment delivery must be instituted in all radiation therapy centers. Cancer 2008;113(8 suppl):2305-14. (C) 2008 American Cancer Societ

Developing cancer control plans in Africa: examples from five countries

Please help populate SUNScholar with the full text of SU research output. Also - should you need this item urgently, please send us the details and we will try to get hold of the full text as quick possible. E-mail to [email protected]. Thank you.Journal Articles (subsidised)Geneeskunde en GesondheidswetenskappePediatrie En Kindergesondhei

The Educational Impact of Web-based Platforms for Therapeutic Radiology in Sub-Saharan Africa

Purpose: This study explores the effectiveness of remote contouring training for therapeutic radiology in three Sub-Saharan African countries (Nigeria, Tanzania, Cameroon) using a web-based platform (ProKnow). Methods and Materials: A 2-hour real-time video didactic lecture and demonstration of the left parotid tumor contouring on axial CT images was delivered using the ProKnow system and a video conferencing software. Participants were granted week-long access to practice contouring of the left parotid volume after the session. Effectiveness of the remote training was evaluated with a self-assessment questionnaire administered before and after the training. Areas of competence assessed included: (i) ability to identify anatomic structure on axial CT; (ii) ability to contour a parotid volume; (iii) ability to delineate tissues; (iv) dose-volume histogram evaluation (DVH); (v) plan evaluation; (vi) port film evaluation; (vii) cone-beam CT evaluation (CBCT). A comparative statistical analysis was undertaken to evaluate for significant changes in the average self-competence score for the various competency areas before and after intervention. The post-class survey also contained questions to determine the acceptability of the ProKnow system for training and image-guided radiotherapy planning among the participants and their access to the necessary internet services. Results: There was statistically significant improvement in all skill parameters needed to contour parotid volumes on axial CT scan. Percent improvement in average self-competency scores ranged from +14.3% for DVH evaluation to +32.8% for treatment plan evaluation. Although in varying degree, 95% of participants indicated the remote training session was relevant to their clinical practice and training. Also, in varying degrees, all indicated that the web-based tool will be helpful to their professional development; that the web-based platform (ProKnow) was easy to navigate and use; and that they would recommend the resource. Most respondents (84%) had access to strong or moderate internet connectivity to integrate the web-based tools into their clinical practice and training. Conclusion: Web-based interactive contouring atlases have utility in global health, as they can serve as self-directed and remote training tools for oncology and radiology staff, which could improve the accuracy of their treatment planning and ultimately impact the quality of therapeutic radiology.</p

Hypofractionated Radiotherapy in African Cancer Centers

In the advent of the coronavirus disease (COVID-19) pandemic, professional societies including the American Society for Radiation Oncology and the National Comprehensive Cancer Network recommended adopting evidence-based hypofractionated radiotherapy (HFRT). HFRT benefits include reduction in the number of clinical visits for each patient, minimizing potential exposure, and reducing stress on the limited workforce, especially in resource-limited settings as in Low-and-Middle-Income Countries (LMICs). Recent studies for LMICs in Africa have also shown that adopting HFRT can lead to significant cost reductions and increased access to radiotherapy. We assessed the readiness of 18 clinics in African LMICs to adopting HFRT. An IRB-approved survey was conducted at 18 RT clinics across 8 African countries. The survey requested information regarding the clinic’s existing equipment and human infrastructure and current practices. Amongst the surveyed clinics, all reported to already practicing HFRT, but only 44% of participating clinics reported adopting HFRT as a common practice. Additionally, most participating clinical staff reported to have received formal training appropriate for their role. However, the survey data on treatment planning and other experience with contouring highlighted need for additional training for radiation oncologists. Although the surveyed clinics in African LMICs are familiar with HFRT, there is need for additional investment in infrastructure and training as well as better education of oncology leaders on the benefits of increased adoption of evidence-based HFRT during and beyond the COVID-19 era