scholarly journals Availability, Affordability, Access, and Pricing of Anti-cancer Medicines in Low- and Middle-Income Countries: A Systematic Review of Literature

2021 ◽  
Vol 9 ◽  
Author(s):  
Phyllis Ocran Mattila ◽  
Rabbiya Ahmad ◽  
Syed Shahzad Hasan ◽  
Zaheer-Ud-Din Babar
Keyword(s):  
Systematic Review ◽  
Low Income ◽  
Original Research ◽  
Multiple Stakeholders ◽  
Middle Income ◽  
Middle Income Countries ◽  
Anti Cancer ◽  
Huge Impact ◽  
Treatment Abandonment ◽  
Low And Middle Income

Background: Cancer is the second leading cause of death globally accounting for more than half of deaths in Low- and Middle-Income Countries (LMICs). Cancer treatment is expensive and the high prices of cancer medicines have a huge impact on access in LMICs. Scarcity of pricing or affordability data is one of the major barriers in the development of effective and transparent pricing policies in LMICs. This study aimed to conduct a systematic review of the literature regarding pricing, availability, affordability, and access to anti-cancer medicines in LMICs.Method: A systematic search was conducted across six electronic databases: PubMed, Medline/CINAHL (EBSCO), Web of Science, Springer Links, Scopus, and Google Scholar. The literature (from 2015 to 2020) was reviewed to identify original research articles published in English.Results: A total of 13 studies were included in the review with some having multiple outcomes: five studies on pricing, four studies addressed affordability, five studies reported on availability, and four studies on access to anti-cancer medicines. The studies showed that in LMICs, there are wide variations in cancer prices and availability amongst the medicine brands and across different countries, with less affordability by patients with low-income levels, sometimes leading to treatment abandonment.Conclusion: Given the importance of medicine availability and prices in patient access and medicine buying capacity of governments, multi-pronged policy and program approaches by multiple stakeholders are needed to ensure access to cancer medicines.

scholarly journals Psychological interventions for bipolar disorder in low- and middle-income countries: systematic review

BJPsych Open ◽  
2018 ◽  
Vol 4 (5) ◽  
pp. 375-384 ◽  
Author(s):  
Mekdes Demissie ◽  
Charlotte Hanlon ◽  
Rahel Birhane ◽  
Lauren Ng ◽  
Girmay Medhin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Bipolar Disorder ◽  
Low Income ◽  
Hospital Admissions ◽  
Psychological Interventions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

BackgroundAdjunctive psychological interventions for bipolar disorder have demonstrated better efficacy in preventing or delaying relapse and improving outcomes compared with pharmacotherapy alone.AimsTo evaluate the efficacy of psychological interventions for bipolar disorder in low- and middle-income countries.MethodA systematic review was conducted using PubMed, PsycINFO, Medline, EMBASE, Cochrane database for systematic review, Cochrane central register of controlled trials, Latin America and Caribbean Center on Health Science Literature and African Journals Online databases with no restriction of language or year of publication. Methodological heterogeneity of studies precluded meta-analysis.ResultsA total of 18 adjunctive studies were identified: psychoeducation (n = 14), family intervention (n = 1), group cognitive–behavioural therapy (CBT) (n = 2) and group mindfulness-based cognitive therapy (MBCT) (n = 1). In total, 16 of the 18 studies were from upper-middle-income countries and none from low-income countries. All used mental health specialists or experienced therapists to deliver the intervention. Most of the studies have moderately high risk of bias. Psychoeducation improved treatment adherence, knowledge of and attitudes towards bipolar disorder and quality of life, and led to decreased relapse rates and hospital admissions. Family psychoeducation prevented relapse, decreased hospital admissions and improved medication adherence. CBT reduced both depressive and manic symptoms. MBCT reduced emotional dysregulation.ConclusionsAdjunctive psychological interventions alongside pharmacotherapy appear to improve the clinical outcome and quality of life of people with bipolar disorder in middle-income countries. Further studies are required to investigate contextual adaptation and the role of non-specialists in the provision of psychological interventions to ensure scalability and the efficacy of these interventions in low-income country settings.Declaration of interestNone.

scholarly journals Assessing cognition in people with severe mental disorders in low- and middle-income countries: a systematic review of assessment measures

2021 ◽  
Author(s):  
Yohannes Gebreegziabhere Haile ◽  
Kassahun Habatmu ◽  
Andualem Derese ◽  
Hetta Gouse ◽  
Stephen M. Lawrie ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mental Disorders ◽  
Psychometric Properties ◽  
Low Income ◽  
Measurement Properties ◽  
Severe Mental Disorders ◽  
Middle Income ◽  
Middle Income Countries ◽  
Brief Assessment ◽  
Low And Middle Income

Abstract Background Cognitive difficulties are common in people with severe mental disorders (SMDs) and various measures of cognition are of proven validity. However, there is a lack of systematic evidence regarding the psychometric properties of these measures in low- and middle-income countries (LMICs). Objective To systematically review the psychometric properties of cognitive measures validated in people with SMDs in LMICs. Methods We conducted a systematic review of the literature by searching from four electronic databases. Two authors independently screened studies for their eligibility. Measurement properties of measures in all included studies were extracted. All eligible measures were assessed against criteria set for clinical and research recommendations. Results are summarized narratively and measures were grouped by measurement type and population. Results We identified 23 unique measures from 28 studies. None of these was from low-income settings. Seventeen of the measures were performance-based. The majority (n = 16/23) of the measures were validated in people with schizophrenia. The most commonly reported measurement properties were: known group, convergent, and divergent validity (n = 25/28). For most psychometric property, studies of methodological qualities were found to be doubtful. Among measures evaluated in people with schizophrenia, Brief Assessment of Cognition in Schizophrenia, Cognitive Assessment Interview, MATRICS Consensus Cognitive Battery, and CogState Schizophrenia Battery were with the highest scores for clinical and research recommendation. Conclusions Studies included in our review provide only limited quality evidence and future studies should consider adapting and validating measures using stronger designs and methods. Nonetheless, validated assessments of cognition could help in the management and allocating therapy in people with SMDs in LMICs.

Accessibility of primary healthcare in low and middle income countries: a systematic review

2021 ◽  
Vol 6 (8) ◽  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Low Income ◽  
Primary Healthcare ◽  
Spatial Accessibility ◽  
Low Income Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
Rural Africa ◽  
Low And Middle Income

Background: Accessibility to healthcare is the capability of a population to obtain a specified set of healthcare services. There is a direct link between the distance patients travel to access health and the reduction of ill health and suffering in a country. This has an important impact on the quality of life of people. Objective: To find the spatial or geographic determinants of accessibility of primary healthcare provision in low and middle income countries during last two decades. Methods: Systematic review was done according to PRISMA guidelines. Data bases used were Google scholar, PubMed and Science direct. We found ten different studies from eight different economic groups of countries. Accessibility of primary healthcare in low and middle Income countries published during the period of last two decades were included using the key words like Spatial Accessibility;Geographical Accessibility; Primary Health Care; Primary Care; Low and middle income countries. The countries included were Afghanistan, Bangladesh, Bhutan, Democratic Republic of Congo, India, Indonesia, Sudan, Mozambique /Rural Africa. Two studies each from India and Mozambique (Rural Africa) were included. The categorization as low and middle income counties was as per World Bank classification. Results: We found that accessibility to primary healthcare was worse in low income countries like Afghanistan, Mozambique and South Sudan where more than two third of the population lived in underserved or difficult to access areas while rest of the countries, which come under category of lower middle income countries, more than half of the population lived in underserved or difficult to access areas.] Conclusion: Health care ease of access is a single most important component for equitable and adequate health system. Guaranteeing a healthcare system which is easily accessible to the people is a basic consideration for public health policy makers, policy implementers and academicians.

scholarly journals Economic evaluation guidelines in low- and middle-income countries: a systematic review

2021 ◽  
Vol 38 (1) ◽  
Author(s):  
Caroline Daccache ◽  
Rana Rizk ◽  
Jalal Dahham ◽  
Silvia M. A. A. Evers ◽  
Mickael Hiligsmann ◽  
...  
Keyword(s):  
Systematic Review ◽  
Economic Evaluation ◽  
Low Income ◽  
Impact Analysis ◽  
Low Income Countries ◽  
Cochrane Library ◽  
Middle Income ◽  
Middle Income Countries ◽  
Similarities And Differences ◽  
Low And Middle Income

Abstract Objectives To systematically identify the latest versions of official economic evaluation guidelines (EEGs) in low- and middle-income countries (LMICs) and explore similarities and differences in their content. Methods We conducted a systematic search in MEDLINE (Ovid), PubMed, EconLit, Embase (Ovid), the Cochrane Library, and the gray literature. Using a predefined checklist, we extracted the key features of economic evaluation and the general characteristics of EEGs. We conducted a comparative analysis, including a summary of similarities and differences across EEGs. Results Thirteen EEGs were identified, three pertaining to lower-middle-income countries (Bhutan, Egypt, and Indonesia), nine to upper-middle-income countries (Brazil, China, Colombia, Cuba, Malaysia, Mexico, Russian Federation, South Africa, and Thailand), in addition to Mercosur, and none to low-income countries. The majority (n = 12) considered cost–utility analysis and health-related quality-of-life outcome. Half of the EEGs recommended the societal perspective, whereas the other half recommended the healthcare perspective. Equity considerations were required in ten EEGs. Most EEGs (n = 11) required the incremental cost-effectiveness ratio and recommended sensitivity analysis, as well as the presentation of a budget impact analysis (n = 10). Seven of the identified EEGs were mandatory for pharmacoeconomics submission. Methodological gaps, contradictions, and heterogeneity in terminologies used were identified within the guidelines. Conclusion As the importance of health technology assessment is increasing in LMICs, this systematic review could help researchers explore key aspects of existing EEGs in LMICs and explore differences among them. It could also support international organizations in guiding LMICs to develop their own EEGs and improve the methodological framework of existing ones.

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