Sharp rise in the expenditures of targeted drugs in Ecuador : five-year (2010-2014) consumption of oncologic drugs in public and private hospitals

Objective: In Ecuador, a new constitutional mandate (2008) allowed the government to implement free universal access to health care, including oncologic drugs. As most Latin American countries, Ecuadorian healthcare system is fragmented between public and private providers, posing a special challenge to collect valid drug utilization data. Data from the public and the private healthcare sectors were collected to examine the utilization of oncologic drugs in Ecuador over a 5-year period (2010-2014). Methods: Oncologic drugs were extracted from individual dispensing data collected in the six largest Ecuadorian cancer hospitals. Drug utilization indicators include the yearly proportion of patients using selected therapeutic groups (targeted drugs, chemotherapy and hormonal drugs), and the mean and total expenditures, by healthcare sector. Key findings: Total number of patients ranged from 12 060 in 2010 to 12 769 in 2014. Median age was 56 years; 60.3% were women. Twenty-three drugs were classified as targeted (monoclonal antibodies, protein kinase inhibitor, vismodegib, vorinostat and abiraterone), 43 as chemotherapy and 11 as hormonal. Patients using chemotherapy decreased from 56% to 52%. Proportion of patients using chemotherapy drugs was 30% lower in the public than in the private sector. Total expenditures on cancer drugs showed a constant increase from USD 17 912 865 in 2010 to USD 40 514 947 in 2014. Patients using targeted drugs doubled from 8% to 14% in 5 years. Targeted drugs accounted for 76% of total expenditures in 2014. Conclusion: Although only a small, but increasing proportion of patients used targeted drugs, it leads to a sharp rise in expenditures. In 2014, it represented three-quarters of the total oncologic drugs expenditures. Differences in chemotherapy consumption between public and private sectors could reflect difficulties in public procurement, shortages and a faster, poorly controlled adoption of new drugs. If unmanaged, this is a possible threat to the health budget in the coming years