Imatinib improved the overall survival of chronic myeloid leukemia patients in low- and middle-income countries: A therapeutic goal has been reached

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 five-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 five-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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Treatment of Chronic Myeloid Leukemia in Rural Rwanda: Promising Early Outcomes

Journal of Global Oncology ◽

10.1200/jgo.2015.001727 ◽

2016 ◽

Vol 2 (3) ◽

pp. 129-137 ◽

Cited By ~ 5

Author(s):

Neo Tapela ◽

Ignace Nzayisenga ◽

Roshan Sethi ◽

Jean Bosco Bigirimana ◽

Hamissy Habineza ◽

...

Keyword(s):

Chronic Myeloid Leukemia ◽

Myeloid Leukemia ◽

Rural Setting ◽

Middle Income ◽

Middle Income Countries ◽

Included Patient ◽

District Hospitals ◽

Diagnostic Work ◽

Low And Middle Income

Purpose The burden of cancer is rising in low- and middle-income countries, yet cancer treatment requires resources that are often not available in these settings. Although management of chronic myeloid leukemia (CML) has been described in low- and middle-income countries, few programs involve patients treated in rural settings. We describe characteristics and early outcomes of patients treated for CML at rural district hospitals in Rwanda. Methods We conducted a retrospective review of patients with confirmed BCR-ABL–positive CML who were enrolled between July 1, 2009 and June 30, 2014. Types of data included patient demographics, diagnostic work up, treatment, clinical examination, laboratory testing, and death. Results Forty-three patients were included, with a maximum follow-up of 58 months. Of 31 patients who were imatinib-naïve at enrollment, 54.8% were men and the median age at diagnosis was 36.9 years (interquartile range: 29-42 years). Approximately two-thirds of patients (67.7%) were on the national public insurance scheme. The imatinib dose was reduced for 16 patients and discontinued for five. Thirty-two of the 43 patients continued to have normal blood counts at last follow-up. Four patients have died and four are lost to follow-up. Conclusion Our experience indicates that CML can be effectively managed in a resource-constrained rural setting, despite limited availability of on-site diagnostic resources or specialty oncology personnel. The importance of model public-private partnerships as a strategy to bring high-cost, life-saving treatment to people who do not have the ability to pay is also highlighted.

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Analysis of the gap in PCR monitoring availability for patients with chronic myeloid leukemia in 60 low- and middle-income countries

Cost Effectiveness and Resource Allocation ◽

10.1186/s12962-021-00271-x ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Seth Rowley ◽

Pat Garcia-Gonzalez ◽

Jerald P. Radich ◽

Ann Kim Novakowski ◽

Irina Usherenko ◽

...

Keyword(s):

Chronic Myeloid Leukemia ◽

Myeloid Leukemia ◽

Kinase Inhibitors ◽

Labor Costs ◽

Middle Income ◽

Demand And Supply ◽

Middle Income Countries ◽

Resource Limited ◽

Resource Needs ◽

Low And Middle Income

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.

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Analysis of the Gap in PCR Monitoring Availability for Patients with Chronic Myeloid Leukemia in 60 Low- and Middle-Income Countries

10.21203/rs.3.rs-63583/v3 ◽

2021 ◽

Author(s):

Seth Rowley ◽

Patricia Garcia-Gonzalez ◽

Jerald P Radich ◽

Irina Usherenko ◽

Joseph B Babigumira

Keyword(s):

Chronic Myeloid Leukemia ◽

Myeloid Leukemia ◽

Kinase Inhibitors ◽

Labor Costs ◽

Middle Income ◽

Demand And Supply ◽

Middle Income Countries ◽

Resource Limited ◽

Resource Needs ◽

Low And Middle Income

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 five-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 five-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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Analysis of the Gap in PCR Monitoring Availability for Patients with Chronic Myeloid Leukemia in 60 Low- and Middle-Income Countries

10.21203/rs.3.rs-63583/v2 ◽

2020 ◽

Author(s):

Seth Rowley ◽

Patricia Garcia-Gonzalez ◽

Jerald P Radich ◽

Irina Usherenko ◽

Joseph B Babigumira

Keyword(s):

Chronic Myeloid Leukemia ◽

Myeloid Leukemia ◽

Kinase Inhibitors ◽

Labor Costs ◽

Middle Income ◽

Demand And Supply ◽

Middle Income Countries ◽

Resource Limited ◽

Resource Needs ◽

Low And Middle Income

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 five-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 five-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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SOCIAL AND FINANCIAL BARRIERS TO OPTIMUM TKI TREATMENT IN PATIENTS WITH CHRONIC MYELOID LEUKEMIA- A KNOWLEDGE-ATTITUDES-PRACTICES STUDY FROM INDIA

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2021.004 ◽

2020 ◽

Vol 13 (1) ◽

pp. e2021004

Author(s):

Naveen Gupta ◽

Manoranjan Mahapatra ◽

Tulika Seth ◽

Seema Tyagi ◽

Sudha Sazawal ◽

...

Keyword(s):

Chronic Myeloid Leukemia ◽

Myeloid Leukemia ◽

Chronic Phase ◽

Hospital Visit ◽

Cost Of Treatment ◽

Indian States ◽

Financial Barriers ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

Introduction: Outcomes in chronic myeloid leukemia (CML) have vastly improved after the introduction of tyrosine kinase inhibitors. However, patients in low and middle income countries face many challenges due to social and financial barriers. Objective: This study was conducted with the aim of understanding socio-economic hindrances and knowledge-attitudes-practices of patients of chronic phase CML who are taking imatinib. Materials and Methods: Patients of chronic phase CML, aged 15 and above, taking imatinib for 6 months or more were included in the study. A questionnaire (in Hindi language) was administered, enquiring about perceptions of nature of disease and its treatment, how imatinib was obtained, drug-taking behaviour, economic and social burden of the treatment. Results: Four hundred patients were recruited (median age 37 years, median duration on imatinib 63 months). Patients hailed from 16 different Indian states and 29.75% patients had to travel more than 500 kilometres for their hospital visit. Scheduled visits were missed by 14.75%. One third of the patients were unaware of the lifelong duration of treatment and 41.75% were unaware of the risks of discontinuing treatment. Treatment was financed by three different means- 61.75% received imatinib free of cost via the Glivec International Patient Assistance Program (GIPAP), 14.25% had treatment costs reimbursed by their employer, and 24% bore the cost of treatment themselves. Patients felt financially burdened due to cost of drugs (self-paying patients), cost of investigations, expenditure of the commute and stay for hospital visit, and loss of working days due to hospital visits. Conclusion: Cost of treatment, lack of widespread availability of hematology services and poor patient awareness are significant barriers to optimum treatment of CML in low and middle income countries.

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