key: cord-0018141-gv4a9lke
authors: Patel, Amol; Gupta, Vineet Govinda; Biswas, Bivas; Ganguly, Sandip; Das, Chandan K.; Batra, Atul; Bhethanabhotla, Sainath
title: Reply to D. O'Reilly et al
date: 2021-05-06
journal: JCO Glob Oncol
DOI: 10.1200/go.21.00077
sha: 037c80a2d7b023112259b3a69a4a8aede172bbc2
doc_id: 18141
cord_uid: gv4a9lke

nan

First, although fulvestrant is a good comparator, being a drug that is off-patent and commonly used around the world, its absence from the WHO Model List of Essential Medicines 3 may represent a limitation for wider comparison between developing and developed countries. It may help the applicability of the index to use an off-patent drug from the WHO list. Second, we suggest that monthly salary (a subjective measurement that may be unreliable) may be replaced with per capita income or gross domestic product, an objective measurement that is tracked by economic agencies (eg, World Bank). For example, Figure 1 indicates that the monthly salary in Pakistan is $5,000 in US dollars, equal to the United States, which is far from the truth-the per capita gross domestic product of Pakistan is $1,284 in US dollars and that of United States is more than 50 times that of Pakistan.

We agree whole-heartedly that the high cost of cancer treatment is not just a third-world problem. Irrespective of the wealth of a nation, money spent on cancer drugs is money not spent on other health or development needs. In the United Kingdom's National Health Service, the National Institute for Health and Care Excellence evaluates the cost-effectiveness of new drugs. This is one way of checking on high price of cancer drugs in publicly funded health systems. The same may not be applicable in a country like India, where the majority of treatment is offered through out-of-pocket spending. A few recent publications have indicated that even commonly used drugs like trastuzumab and temozolomide are not cost-effective in India at currently used protocols, despite the lower cost. 4, 5 An index like the Fulvestrant-Big Mac may allow a comparison of cost of drugs between various countries and help identify areas for policy intervention.

The Fulvestrant-Big Mac (FBM) Index: Defining inequality in oncology

Big Mac Index

Cost-effectiveness of temozolamide for treatment of glioblastoma multiforme in India

Cost effectiveness of trastuzumab for management of breast cancer in India

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No other potential conflicts of interest were reported.