Recommendations for Management of the Trastuzumab (Herceptin) among Iranian Breast Cancer Patients, A Policy Brief

Abstract

Background: Allocation of the new (expensive) drugs for difficult refractory diseases and financial protection of the patients is an important challenge in the national health systems worldwide especially in developing countries.  Trastuzumab (Herceptin) as one of the effective but expensive drugs, put major financial burden for the Iranian patients and government. So the Ministry of Health and Medical Education (MOHME), decided to implement a national program for appropriate management of breast cancer and regulation of Trastuzumab in I.R of Iran (NPMBCT). In this policy brief we evaluated this issue and provided necessary recommendations.Method: We designed a conceptual model consisting of the goals, main and supporting processes for management of Trastuzumab in the national program. Five macro-processes selected as the main concerns. Then an expert panel including different scientific disciplines discussed the different aspects of the issue and provided the necessary recommendations. We determined the link between the suggested recommendations and the objectives of the program.Results: Based on the five selected main processes, the experts provided 10 recommendations including: 1) balance in the resource allocation, 2) appropriate modeling for the subsides allocation, 3) avoiding “poor subsidize the rich†phenomenon, 4) development and updating the clinical guidelines, 5) cost-effectiveness analysis on accepted guideline, 6) Quality improvement of diagnostic tests, 7) standardization of the laboratory kits, 8) brand management and lowering the drug cost, 9) improving the patient registry system by ICT infra-structure, 10) development of expert systems to empower the diagnostic laboratories.Conclusion: Given these recommendations, the NPMBCT program will be a successful model for the appropriate management of the expensive drugs and treatment of breast cancer in I.R. of Iran and other developing countries.