Global Disparities in the Availability and Reimbursement of Systemic Therapies for Renal Cell Carcinoma: Results of the International ARON-AID Survey.
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Urun Yuksel, Sridharan Kannan, Zgura Anca, Zayed Anas, Laguado Martin Ignacio Zapata, Yetisyigit Tarkan, Yano Akihiro, Wenzel Mike, Vau Nuno, Tural Deniz, Trindade Karine, Tran Ben, Ting Frederic Ivan Leong, Templeton Arnoud J, Takeshita Hideki, Sunela Kaisa, Souza Vinicius Carrera, Sooro Mopa Alina, Soares Andrey, Siva Shankar, Singh Ashish, Silveira Glauco, Shah Shamik, Seront Emmanuel, Schutz Fabio A, de Liz Vassen Schurmann Maitê, Schieber Timothy, Scagliarini Sarah, Sargsyan Amalya, Simonetti Carlos Salinas, Rushanyan Marine, Roviello Giandomenico, Rodriguez-Vida Alejo, Rodriguez Gonzalez Orion Erenhu, Roberts Robin, Van der Veldt Astrid A M, Rizzo Mimma, Rizzo Alessandro, Poprach Alexandr, Pirshtuk Alina, Pinto Alvaro, Pierce Erin, Peñaloza Jose Mauricio, Pedrani Martino, Park Se Hoon, Okunade Ibukun Adewumi, Odounga Karen Flora, Noriega Julio, Noorzai Edriss, Coronel Maria Tereza Nieto, Navratil Jiri, Myint Zin W, Mutavdzic Vladan, Mukuku Olivier, Mugarura Robert, Marques Monteiro Fernando Sabino, Mohamed Abdikarim Hussein, Mmereki Daniel, Messina Carlo, Melichar Bohuslav, Mukaz Mbey Pitchou, Maturana Ernesto, Matthews Diana, Massari Francesco, Martínez Esther, Maitre Priyamvada, Maison Patrick, Ndjembidouma Beaud Conrad Mabika, Lu Kevin, Li Jiakun, Li Haoran, de Moura Leite Luciana, Lalani Aly-Khan A, Küronya Zsófia, Kucharz Jakub, Koumba Arnaud Boris, Kopp Ray Manneh, Kopecky Jindrich, Kihn-Alarcón Alba J, Keskin Özge, Kabdullina Kymbat, Juarez Álvaro, Fita María José Juan, Jardim Denis Leonardo, James Laurianne Grégoria, Grande Enrique, De Liaño Alfonso Gómez, Giannatempo Patrizia, Ghosn Marwan, Gauna Cinthia, Quiroga Maria Natalia Gandur, Fujita Kazutoshi, Pereira Freitas Marcelo Roberto, Fiala Ondřej, Lazzaro Mauricio Fernandez, Pacheco Glenda M Falcon, Esan Theophilus Olaide, Esan Deborah Tolulope, Du Plessis Danelo, Delgado Silvia Neciosup, Crabb Simon J, Cano Rafael Correa, Corrales Luis, Chen Jixiang, Cayol Federico, Silva Clarissa Cavalin, Carneiro André Paternò Castello Dias, Caprinciu Georgiana Anca, Campos Saul, Büttner Thomas, Buti Sebastiano, Bukhari Nedal, Buchler Tomas, Bourlon Maria T, Bolek Hatice, Boegemann Martin, Bilen Mehmet A, Vaca Laura Bernal, Bastos Diogo Assed, Barthelemy Philippe, Bardakhchyan Samvel, Barbu Maria Alexandra, Baranseh Jalal, Bamias Aristotelis, Bakenga Alex, Anguera Georgia, Angel Martin, Silva Carolina Alves Costa, Alonso-Gordoa Teresa, Almugbel Fahad, Almufti Roula, Almeida Thiago Lins, Aliyev Altay, Aliaga Carlos, Aleem Umair, Akkus Erman, Aceituno Luis Garcia, Abidi Syed Hani, Abahssain Halima, Tartari Francesca, Molina-Cerrillo Javier, Santoni Matteo
Аннотация
METHODS: We conducted a cross-sectional, web-based international survey to assess the availability and reimbursement status of 20 innovative systemic therapies for RCC. Responses were collected from 144 clinicians, including medical oncologists, radiation oncologists, urologists, and nuclear medicine specialists, across 58 countries. Analyses examined associations between national income level, gross domestic product (GDP), and treatment availability.
FINDINGS: 36% of the countries analysed had at least 15 of the 20 therapies available. Full reimbursement for at least 15 of the selected innovative therapies was reported in six countries (10%), while 21 countries (36%) fully reimbursed 10-14 therapies and 13 countries (23%) reimbursed 1-9 therapies. In contrast, no full reimbursement for any of the assessed therapies was reported in 18 countries (31%). Higher national income level was significantly associated with greater availability of innovative therapies (Kruskal-Wallis test, p < 0·0001). Armenia (0·709), Greece (0·685), and Israel (0·666) exhibited the highest GDP-adjusted Drug Availability Index (DAI), whereas India (5·195), Nigeria (4·612), and Morocco (3·794) demonstrated the greatest number of available therapies per US$1000 of GDP per capita.
INTERPRETATION: Access to innovative systemic therapies for RCC remains highly unequal at the global level, with reimbursement posing a major barrier even where drugs are available. Internationally coordinated efforts addressing health policy, infrastructure, and equitable pricing are urgently required to ensure that advances in RCC treatment translate into improved outcomes for patients across diverse economic settings.