Seth Rowley1, Pat Garcia-Gonzalez2, Jerald P Radich3, Ann Kim Novakowski2, Irina Usherenko2, Joseph B Babigumira4,5. 1. Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA. 2. The Max Foundation, Seattle, WA, USA. 3. Fred Hutchinson Cancer Research Center, Seattle, WA, USA. 4. Global Medicines Program, Department of Global Health, School of Public Health, University of Washington, Seattle, USA. jobabigumira@gmail.com. 5. The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, USA. jobabigumira@gmail.com.
Abstract
PURPOSE: To estimate the resource gap in the polymerase chain reaction (PCR) monitoring for patients with chronic myeloid leukemia (CML) in low- and middle-income countries (LMICs). METHODS: We developed a model of demand and supply of PCR monitoring of CML patients in 60 LMICs. PCR testing was assumed to use Cepheid's GeneXpert® IV system. We included costs of GeneXpert® instruments, uninterrupted power supplies, warranties, calibration kits, test cartridges, and shipping. We calculated the country-specific monetary gap in PCR monitoring, stratified by country priority defined as the availability of tyrosine kinase inhibitors (TKIs) through The Max Foundation initiatives. RESULTS: The 5-year gap in PCR monitoring was $29.1 million across all countries, 22% ($6.4 million) in countries with all five TKIs available, 20% ($5.7 million) in countries with four TKIs available, 50% ($14.5 million) in countries with three TKIs available, 8% ($2.2 million) in countries with two TKIs available, and 1% ($0.3 million) in countries with one TKI available. The gap was highest in South Asia (52%; $15.1 million) and lowest in Latin America (6%; $1.9 million). Excluding labor costs, the bulk of the resource needs (86%; $25.2 million) were for procurement of BCR-ABL cartridges. CONCLUSION: Removing the 5-year gap in PCR monitoring capacity for CML in LMICs will require the mobilization of significant resources and will likely lead to better treatment outcomes and reduced treatment costs through optimization of treatment, discontinuation of therapy in appropriate patients, and facilitation of clinical research. Development of streamlined monitoring guidelines for resource-limited countries should be considered.
PURPOSE: To estimate the resource gap in the polymerase chain reaction (PCR) monitoring for patients with chronic myeloid leukemia (CML) in low- and middle-income countries (LMICs). METHODS: We developed a model of demand and supply of PCR monitoring of CMLpatients in 60 LMICs. PCR testing was assumed to use Cepheid's GeneXpert® IV system. We included costs of GeneXpert® instruments, uninterrupted power supplies, warranties, calibration kits, test cartridges, and shipping. We calculated the country-specific monetary gap in PCR monitoring, stratified by country priority defined as the availability of tyrosine kinase inhibitors (TKIs) through The Max Foundation initiatives. RESULTS: The 5-year gap in PCR monitoring was $29.1 million across all countries, 22% ($6.4 million) in countries with all five TKIs available, 20% ($5.7 million) in countries with four TKIs available, 50% ($14.5 million) in countries with three TKIs available, 8% ($2.2 million) in countries with two TKIs available, and 1% ($0.3 million) in countries with one TKI available. The gap was highest in South Asia (52%; $15.1 million) and lowest in Latin America (6%; $1.9 million). Excluding labor costs, the bulk of the resource needs (86%; $25.2 million) were for procurement of BCR-ABL cartridges. CONCLUSION: Removing the 5-year gap in PCR monitoring capacity for CML in LMICs will require the mobilization of significant resources and will likely lead to better treatment outcomes and reduced treatment costs through optimization of treatment, discontinuation of therapy in appropriate patients, and facilitation of clinical research. Development of streamlined monitoring guidelines for resource-limited countries should be considered.
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Authors: Jerald P Radich; Michael Deininger; Camille N Abboud; Jessica K Altman; Ellin Berman; Ravi Bhatia; Bhavana Bhatnagar; Peter Curtin; Daniel J DeAngelo; Jason Gotlib; Gabriela Hobbs; Madan Jagasia; Hagop M Kantarjian; Lori Maness; Leland Metheny; Joseph O Moore; Arnel Pallera; Philip Pancari; Mrinal Patnaik; Enkhtsetseg Purev; Michal G Rose; Neil P Shah; B Douglas Smith; David S Snyder; Kendra L Sweet; Moshe Talpaz; James Thompson; David T Yang; Kristina M Gregory; Hema Sundar Journal: J Natl Compr Canc Netw Date: 2018-09 Impact factor: 11.908