Original Articles

High Insurance Coverage and Financial Support for Effective Cancer Drugs in I.R. Iran


Background: In recent years, financial coverage and availability of new and expensive cancer drugs have changed into one of the challenges of the health system, especially in low-income and middle-income countries,. We studied the availability ofanticancer drugs, insurance coverage and the financial burden of these drugs in Iran.Methods: In this cross-sectional descriptive study, first, we listed effective cancer drugs according to the World Health Organization’s Model List of Essential Medicinesand previous studies. Then, we evaluated financial burden of these drugs byusing the available data in Iran pharmaceutical Pharmacopoeia, the national pharmaceuticalsales statistics database (pharmaceutical Amarnameh), and inquiry of theinsurance organizations, the availability, insurance coverage in Iran. Excel softwarewas used for data analysis.Results: All of the medicines incorporated into the latest version of the WHO Model List of Essential Medicines were available in Iran, and, except for Bendamustine and Anastrazole all medicines were covered by insurance. In addition, of the 19 drugs,those were not on the WHO Model List of Essential Medicines, there were sevendrugs in Iran, insurance covered that six drugs. The total Dollar sales of the studiedcancer drugs amounted to US$350.85 million in 2015 and US$384.96 million in 2016.Conclusion: It seems that the status of access to effective cancer drugs in Iran is better than many low and middle-income countries. However, since the cost of cancerdrugs is rising, health policy makers inevitably need to prioritize cancer drugs by using the results of health technology assessment methods and provide patients withaccess to drugs that are cost-effective in order to the optimal allocation of limitedresources and provide maximum access to cancer drugs throughout the country.

Meropol NJ, Schulman KA. Perspectives on the cost of cancer care. Journal of Clinical Oncology. 2007;25(2):169-70.

Abboud C, Berman E, Cohen A, Cortes J, DeAngelo D, Deininger M, et al. The price of drugs for chronic myeloid leukemia (CML) is a reflection of the unsustainable prices of cancer drugs: from the perspective of a large group of CML experts. Blood. 2013;121(22):4439-42.

Neumann PJ, Palmer JA, Nadler E, Fang C, Ubel P. Cancer therapy costs influence treatment: a national survey of oncologists. Health Affairs. 2010;29(1):196-202.

Kim P. Cost of cancer care: the patient perspective. Journal of Clinical Oncology. 2007;25(2):228-32.

Shih YCT, Halpern MT. Economic evaluations of medical care interventions for cancer patients: how, why, and what does it mean? CA: a cancer journal for clinicians. 2008;58(4):231-44.

Pfister DG. The just price of cancer drugs and the growing cost of cancer care: Oncologists need to be part of the solution. Journal of Clinical Oncology. 2013;31(28):3487-9.

Irwin B, Kimmick G, Altomare I, Marcom PK, Houck K, Zafar Y, et al. Patient experience and attitudes toward addressing the cost of breast cancer care. The oncologist. 2014:theoncologist. 2014-0117.

Mousavi S. Executive Guideline for Registering and Reporting Cancer Cases. Tehran: Cancer Office and the Research Fellowship of Cancer Research Center of Cancer Institute. 2007:122.

Kanavos P. The rising burden of cancer in the developing world. Annals of oncology. 2006;17(suppl 8):viii15-viii23.

Mohebbi E, Nahvijou A, Hadji M, Rashidian H, Seyyedsalehi MS, Nemati S, et al. Iran Cancer Statistics in 2012 and projection of cancer incidence by 2035. Basic & Clinical Cancer Research. 2018;9(3).

Daroudi R, Sari AA, Nahvijou A, Kalaghchi B, Najafi M, Zendehdel K. The economic burden of breast cancer in Iran. Iranian journal of public health. 2015;44(9):1225.

Vahdatimanesh Z, Zendehdel K, Akbari Sari A, Farhan F, Nahvijou A, Delavari A, et al. Economic burden of colorectal cancer in Iran in 2012. Medical Journal of The Islamic Republic of Iran (MJIRI). 2017;31(1):768-73.

Tekinturhan E, Audureau E, Tavolacci M-P, Garcia-Gonzalez P, Ladner J, Saba J. Improving access to care in low and middle-income countries: institutional factors related to enrollment and patient outcome in a cancer drug access program. BMC health services research. 2013;13(1):1-9.

Daroudi R, Mirzania M, Zendehdel K. Attitude of Iranian medical oncologists toward economic aspects, and policy-making in relation to new cancer drugs. International journal of health policy and management. 2016;5(2):99.

Robertson J, Barr R, Shulman LN, Forte GB, Magrini N. Essential medicines for cancer: WHO recommendations and national priorities. Medicine. 2016;94(10).

Cherny NI, Sullivan R, Dafni U, Kerst JM, Sobrero A, Zielinski C, et al. A standardised, generic, validated approach to stratify the magnitude of clinical benefit that can be anticipated from anti-cancer therapies: the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS). Annals of Oncology. 2015;26(8):1547-73.

Cherny N, Dafni U, Bogaerts J, Latino N, Pentheroudakis G, Douillard J-Y, et al. ESMO-magnitude of clinical benefit Scale version 1.1. Annals of Oncology. 2017;28(10):2340-66.

World Health Organization. "19th WHO Model List of Essential Medicines. 2017." World Health Organization. Online. Accessed(2017).‏.

Cherny NI, Sullivan R, Torode J, Saar M, Eniu A. ESMO International Consortium Study on the availability, out-of-pocket costs and accessibility of antineoplastic medicines in countries outside of Europe. Annals of Oncology. 2017;28(11):2633-47.

Iran Food and Drug Administration. Iranian Drug List. 2017; [cited 2018 January 15]. Available from: http://fda.gov.ir/uploads/f67935ab51e766acef37da816cbcf48b.xls.

Iran Food and Drug Administration. Pharmaceutical Statistics. 2017; [cited 2018 January 15]. Available from: http://www.fda.gov.ir/uploads/3323be2047c0877211170104f3867599.xlsx.

Iran Food and Drug Administration. Pharmaceutical Statistics. 2016; [cited 2018 January 15]. Available from: http://www.fda.gov.ir/uploads/fdfbc2a6d58904aa214d60d1d8c25088.xlsx.

Cherny N, Sullivan R, Torode J, Saar M, Eniu A. ESMO European Consortium Study on the availability, out-of-pocket costs and accessibility of antineoplastic medicines in Europe. Annals of Oncology. 2016;27(8):1423-43.

Evans J, Laking G, Strother M, Wang T, Metcalfe S, Blick G, et al., editors. Mind the gap: An analysis of foregone health gains from unfunded cancer medicines in New Zealand. Seminars in Oncology; 2016: Elsevier.

Vogler S, Vitry A. Cancer drugs in 16 European countries, Australia, and New Zealand: a cross-country price comparison study. The Lancet Oncology. 2016;17(1):39-47.

Bazargani Y, de Boer A, Schellens J, Leufkens H, Mantel-Teeuwisse AK. Essential medicines for breast cancer in low and middle income countries. BMC cancer. 2015;15(1):591.

ARYANKHESAL A, ETEMADI M, MOHSENI M, AZAMI-AGHDASH S, NAKHAEI M. Catastrophic Health Expenditure in Iran: A Review Article. Iranian journal of public health. 2018;47(2):166.

Karikios D, Schofield D, Salkeld G, Mann KP, Trotman J, Stockler MR. Rising cost of anticancer drugs in Australia. Internal medicine journal. 2014;44(5):458-63.

Aggarwal A, Sullivan R. Affordability of cancer care in the United Kingdom–Is it time to introduce user charges? Journal of Cancer Policy. 2014;2(2):31-9.

Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes: Oxford university press; 2015.

Bertram MY, Lauer JA, De Joncheere K, Edejer T, Hutubessy R, Kieny M-P, et al. Cost–effectiveness thresholds: pros and cons. Bulletin of the World Health Organization. 2016;94(12):925.

IssueVol 10 No 3 (2018) QRcode
SectionOriginal Articles
Accessibility insurance coverage financial burden cancer drugs

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How to Cite
Darrudi A, Daroudi R. High Insurance Coverage and Financial Support for Effective Cancer Drugs in I.R. Iran. Basic Clin Cancer Res. 2018;10(3):12-21.