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

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.

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

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.

scholarly journals Treatment of Chronic Myeloid Leukemia in Rural Rwanda: Promising Early Outcomes

2016 ◽  
Vol 2 (3) ◽  
pp. 129-137 ◽  
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.

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

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.

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

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.

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

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.

Evaluation of the European LeukemiaNet recommendations for predicting outcomes of patients with acute myeloid leukemia treated in low- and middle-income countries (LMIC): A Brazilian experience

2017 ◽  
Vol 60 ◽  
pp. 109-114 ◽  
Author(s):  
Mariana Tereza de Lira Benicio ◽  
Ana Flávia Tibúrcio Ribeiro ◽  
Andre D. Américo ◽  
Felipe M. Furtado ◽  
Ana B. Glória ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Middle Income ◽  
Middle Income Countries ◽  
Acute Myeloid ◽  
Low And Middle Income

Use of artificial intelligence to improve access to initial leukemia diagnosis in low- and middle-income countries.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14117-e14117
Author(s):  
Tania Raquel Cerrato
Keyword(s):  
Artificial Intelligence ◽  
Myeloid Leukemia ◽  
Initial Diagnosis ◽  
Diagnostic Methods ◽  
Medical Attention ◽  
Middle Income ◽  
Preliminary Diagnosis ◽  
Middle Income Countries ◽  
Improve Access ◽  
Low And Middle Income

e14117 Background: Disparities in access to cancer diagnostic methods affect especially low and middle-income countries (LMIC). Honduras, a country with limited resources of laboratory, and trained personnel to diagnose leukemia have an estimated incidence of leukemia of 5.8 per 100,000 person-years and the mortality is 4.8 per 100,000 person-years. This country has a single immunophenotyping center and similar to many other LMICs, the preliminary diagnosis of leukemia is performed by a morphological study of blood. Machine learning (ML) is a form of artificial intelligence (AI) that has the potential to improve medical attention in several medical fields. The purpose of this study is to evaluate the impact of ML use, as a method to reduce the time interval and the access to a diagnosis of leukemia in Honduras, where the current average time to perform an initial diagnosis of leukemia is from 2 weeks to 3 months. Methods: A quantitative correlational study was designed. With the help of local informatic developers, an automated image processing algorithm was designed, which was fed with a total of 1009, digital images of bone marrow aspirates and peripheral blood of patients with proven leukemia through immunophenotyping. The images were captured using a microscope Carl Zeiss lens with a 100x objective, the process included the segmentation of leukemia cells for its analysis. Bivariate outcomes were assessed using the Pearson chi-squared test. Results: From 2016 to 2018, a total of 341 samples of patients with any symptom of leukemia were included. After anonymization of patient identification, the samples were analyzed using our algorithm by comparing the cells with its database. Posteriorly, an expert hematologist performed an analysis of the sample. A total of 20 samples (5.8%), were diagnosed with a preliminary diagnosis of leukemia. Of the 20 samples, a total of 10(50%) were acute myeloid leukemia, 6 samples (30%) lymphoblastic leukemia and the remaining 4 samples (20%) were compatible with chronic myeloid leukemia. The average time to make an initial diagnosis of leukemia was 75% and 24% in 24 and 48 hours respectively. Local hematologists managed to make treatment decisions earlier with benefit to the patients. In 19 of the samples (95%), there was correspondence between the morphology diagnosis obtained by our algorithm and the immunophenotyping diagnosis. Conclusions: This preliminary study demonstrates that the use of artificial intelligence constitutes an important element to improve access and shortening of the time required to obtain a diagnosis of leukemia in LMCIs, and represents a method to reduce disparities in access to diagnosis of hematological cancers.

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