The fight against cancer in Asia06 February 2023
Thomas Hofmarcher :
In Asia, the annual number of new cancer cases increased from 4.9 million in 2002 to 9.5 million in 2020. Until 2040, projections by the International Agency for Research on Cancer estimate 15.1 million new cases per year. The key determinant of this development is population aging, which is taking place at an unprecedented rate across the region, causing a surge in the numbers of elderly people. It is, therefore, no surprise that Japan, the country with the oldest population in the world, has the highest rate of cancer.
High-income countries with higher proportions of older populations, such as Japan or the Republic of Korea, face much higher cancer numbers than middle-income countries with higher proportions of younger populations such as India and Indonesia.
However, this pattern is reversed for the survival of cancer. In the wealthier countries of the Asia and the Pacific region, such as Australia, Japan, and the Republic of Korea, around 56-65 in every 100 new patients survive cancer, whereas in the developing part of the region only around 28-40 in every 100 new patients survive.
Explanations for the poor showing of middle-income countries in Asia can be found in all areas of cancer care. Early detection of cancer cases can greatly improve the chances of a curative outcome. In Asia, early detection is hampered by low awareness of the early signs of cancer among the general population and the absence of or low participation in screening programs, such as for breast cancer.
Universal access to standard cancer therapies and care is another pressing challenge. Several of the most basic cancer medicines listed on the World Health Organization's Model List of Essential Medicines are not listed on national formularies in lower-middle-income countries and low-income countries in Asia.
Therefore, cancer patients in these countries incur full out-of-pocket costs for some generic, inexpensive medicines, while all of these medicines are readily available in high-income and upper-middle-income countries in Asia.
The root cause of these challenges is underfunded health care systems and the absence of universal health coverage. Despite being a centerpiece of the United Nations Sustainable Development Goals 2030, universal health coverage is still to be achieved in many countries in Asia. Apart from access to health care services, what matters is also the quality of the services.
Cancer patients in many countries throughout Asia face a double burden. On the one hand, poor access and quality of care dashes patients' hopes of survival. On the other hand, there is a great financial burden on cancer patients and their families.
Economies also face a heavy impact from not providing adequate cancer care. Premature death, sick leave, and the early retirement of cancer patients, who otherwise would have been working, represent a productivity loss to the economy. Family members who must stay at home and care for the cancer patient instead of pursuing their regular work are another source of loss to the economy.
Cancer medicines can play an important role in meeting the growing demands. The launch of over 100 new cancer medicines over the last decade is a testimony to this. However, not all new medicines are equally effective, calling for the prioritization of truly innovative medicines that bring significant impact to individual patients, their families, and society at large.
The inclusion of new medicines in national formularies should be value-based and evidence-based in order to maximize patient outcomes under limited health resources. Health technology assessment is a tool to support evidence-based reimbursement decision-making for inclusion in national formularies, but its use is still in its infancy in many Asian countries.
Generic brand competition and stricter price control of originator medicines after patent expiry could create considerable budget headroom for governments. A published estimation of a basket of cancer medicines with generic brands points to savings opportunities of around 3 per cent-20 per cent of total cancer medicine expenditure in Asia and the Pacific region.
These savings could be re-channeled to fund and list innovative medicines, offering a more sustainable financing model while improving patient outcomes.
(The writer is a guest lecturer at Lund University in Sweden).