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Utilization and Expenditure of Anti-Cancer Medicines in Kosovo: Findings and Implications

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Utilization and Expenditure of Anti-Cancer Medicines in Kosovo: Findings and Implications PharmacoEconomics Open (2018) 2:423–432 https://doi.org/10.1007/s41669-017-0066-8 ORIGINAL RESEARCH ARTICLE Utilization and Expenditure of Anti-cancer Medicines in Kosovo: Findings and Implications 1,2 3,4,5 5 5 Arianit Jakupi • Brian Godman • Antony Martin • Alan Haycox • Indrit Baholli6 Published online: 2 February 2018 Ó The Author(s) 2018. This article is an open access publication Abstract Method National drug utilization data is available in Background and Objective The Ministry of Health (MoH) Kosovo. Utilization and expenditure on anti-cancer leads and organizes health policy in Kosovo, which medicines [Anatomical Therapeutic Chemical (ATC) code includes procurement and provision of medicines, includ- L], initially from 2011 to 2013, especially for anti-cancer ing anti-cancer medicines, which compose a special group medicines on the essential medicines list was analysed of medicines. However, there has been limited analysis of from national data. In addition, current systems for the utilization and expenditure on anti-cancer medicines in procuring and managing anti-cancer medicines in Kosovo Kosovo; consequently, the objective of this study is to was documented. undertake research to provide future guidance on the use of Results There was appreciable variability in the utilization anti-cancer medicines. of anti-cancer medicines over the years, with low or limited use of some anti-cancer medicines on the Essential Medi- cine List. This is a concern in view of their essential & Brian Godman medicine status. From 2011 to 2013, €16.49 million was [email protected]; [email protected]; spent on anti-cancer medicines (ATC L). The process of [email protected] selection of new medicines begins with suggestions from Arianit Jakupi doctors at the University Clinical Centre in Kosovo. [email protected]; [email protected]; [email protected] Conclusion The analysis has shown appreciable variation with current utilization patterns for anti-cancer medicines Antony Martin [email protected] in Kosovo. This needs to be addressed as part of improving the drug management process to optimize patient care Alan Haycox [email protected] within available resources. Future years and reforms need to be assessed to improve current utilization and expendi- Indrit Baholli [email protected] ture patterns. 1 Faculty of Pharmacy, UBT Higher Education Institution, Prishtina, Kosovo 2 Pharmaceutical Consulting, Prishtina, Kosovo 3 Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK 4 Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden 5 Health Economics Centre, University of Liverpool Management School, Liverpool, UK 6 European University of Tirana, Tirana, Albania 424 A. Jakupi et al. there is an imperative need to review current utilization and Key points for decision makers expenditure patterns for cancer medicines, as well as the selection process for new anti-cancer medicines, to make There are considerable discrepancies regarding the sure available resources are being optimally used. In recent current utilization patterns of anti-cancer medicines years the prevalence of cancers in Kosovo has been in Kosovo as there was no utilization of some anti- increasing [13]. In 2015, the greatest incidence was for cancer medicines considered vital, essential, or melanomas and other malignant neoplasms of the skin (411 necessary based on the essential medicine list. new cases), breast neoplasms (274 new cases), malignant tumors of the digestive system (262 new cases), and Only a few anti-cancer medicines have very high malignant tumors of the genital organs (257 new cases). expenditure; however, there are variations in their Together, these made up 1204 of the total 1751 new cases use across the years. of cancer in Kosovo 2015 [14]. The MoH should carefully consider introducing In addition, reports following MoH workshops have updated processes for the selection and pricing for suggested that in 2017 there is an increasing trend in the new medicines. total number of cancers in Kosovo, and that some of these cases are due to better diagnostics and awareness cam- paigns leading to more patients being diagnosed earlier (A. Jakupi, unpublished data). The Kosovo University Clinical Center Service 1 Introduction (KUCCS) is a key institution in Kosovo’s health system as all of the hospitals that offer secondary and tertiary-level For many years health authorities across the world have care, such as the University Clinical Centre of Kosovo published annual medicine consumption data, which have (UCCK), function within its framework. The Oncology been widely used among key stakeholder groups. This Institute operates within the UCCK and KUCCS frame- includes monitoring the influence of ongoing reforms and work and, along with other institutes, also deals with the initiatives, and using the outputs to plan future initiatives overall management of cancer patients in Kosovo, includ- and budgets [1–4]. This is particularly the case in a number ing chemotherapy and radiotherapy. The supply of of European countries where health authorities and health medicines in UCCK is undertaken through the central insurance agencies strive towards universal access within pharmacy, which supplies all clinics. finite budgets. However, little is known generally about medicine In Kosovo currently, the Ministry of Health (MoH) leads consumption in Kosovo including anti-cancer medicines, and organizes health policy processes, achieving many of although drug consumption data for 2011–2013 were its objectives through subordinate institutions such as the published by the KMA in 2014. In addition, the procure- Kosovo Medicines Agency (KMA). The KMA is respon- ment process of the MoH is now centralized, as recom- sible for the public health of the population by ensuring mended by the World Health Organization (WHO) and the drug safety, quality, and efficacy, as well as overseeing the World Bank [15]. In contrast, the other processes have importation of medicines into Kosovo and conducting been decentralized since 2015 as every hospital, through its analyses of overall drug consumption. own structures, is now responsible for the planning, New anti-cancer medicines are typically seen as a spe- selection, and ordering of medicines and equipment. cial group of medicines as this is an emotive area, generally The current selection process to update the oncology leading to greater leeway for pricing considerations and medicine list begins with physicians, in this case those in funding than for other medicines, such as those for car- the Institute of Oncology. The list and suggested changes diovascular diseases or mental health [5, 6]. There is are subsequently reviewed by the head of the clinic, the growing concern worldwide regarding these drugs, with central pharmacy director, and the general director of the prices of cancer medicines rising up to tenfold during the hospital. After this process, the suggested updated list is past 10 years in some countries despite often limited health submitted to the professional working group of the MoH gains [7, 8]. This causes particular concern in countries for the final review and approval by the Minister of Health. with fixed budgets, with the resultant opportunity cost Figure 1 illustrates this process. implications for patients with cancer and other diseases Once the list is signed by the Minister, the second part of [9, 10] leading to prescribing restrictions and other mea- the drug management process proceeds, i.e., the procure- sures to limit their use and reduce the prices of new cancer ment of the medicines from the agreed essential medicines medicines [11, 12]. Consequently, in European countries list intended for hospital use. This process is carried out in with appreciable pressure on resources such as Kosovo, a centralized way by the MoH for all hospitals in Kosovo, Anti-cancer medicines in Kosovo 425 Fig. 1 Selection process for updating the Essential Medicines List for new anti- cancer medicines (based on Quick et al. [16]) with the system being transparent to help reduce possible The utilization of anti-cancer drugs in Kosovo is based corruption [17]. After this, the process is continued with on 58 molecules currently available in the Essential Med- the distribution to the central pharmacies (of each hospital), icine List (EML) according to their generic name or from where available medicines are supplied to all of the International Nonproprietary Name (INN) [27] each cal- clinics. This process is carried out under the supervision of endar year. For this initial study, data were collected from the chief pharmacists of the hospitals, ready for clinicians wholesalers for the 2011–2013 period [28], as all of the to use the oncology medicines in their clinics. licensed wholesalers in Kosovo are obliged to make an Consequently, the aim of this paper is to critically application to the KMA for all medicines they import, review the utilization of and expenditure on anti-cancer which includes their INN name, brand (originator) name, medicines in Kosovo, including the selection processes for dosage form, strength, serial number, and quantity. The listing medicines in Kosovo. The findings are then used to reason for the 3-year period was that this was the first suggest future strategies in Kosovo to improve the use of official publication by the KMA on drug
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