Pharmacoeconomic study of oral anticancer therapy: results of combined ABC/VEN and frequency analysis

Background. Modern oncology is facing a paradoxical situation in which the rapid increase in the cost of anticancer therapy is not always accompanied by a proportional improvement in its effectiveness. This creates serious economic barriers for healthcare systems worldwide. In the context of limited resources, methods for the rational allocation of the pharmaceutical budgets are becoming particularly important. The combined ABC/VEN analysis serves as an effective tool to address this challenge. This approach is especially valuable when analyzing contemporary oral anticancer drugs, which are playing an increasingly significant role in cancer treatment.

Objective: To evaluate the cost structure of oral anticancer therapy using ABC/VEN and frequency analysis methods.

Material and methods. Distribution by ABC categories was conducted according to generally accepted methodology. Group A (the most expensive drugs) included regimens whose total cost accounted for 80% of all expenditures. Group C (the least expensive) comprised regimens with no more than 5% of total costs. The remaining regimens formed Group B (moderately expensive), which consumed 15% of total expenditures. Final expenditures were determined based on the cost of drug therapy per regimen in a day hospital setting and the number of medical interventions provided under each regimen in 2022. The formal methodology of VEN analysis involved categorizing regimens according to the presence of drugs from the World Health Organization Model List of Essential Medicines. Separately, both ABC and VEN analyses were carried out for chemotherapy, hormone therapy, targeted therapy, and combination treatment regimens. Frequency analysis was conducted based on the number of hospitalizations of patients who received particular anticancer regimens according to real-world data from depersonalized hospitalization registry records.

Results. The resource distribution analysis confirmed the Pareto principle, with 80% of financial expenditures attributed to 9.3% (95% CI 6.0–13.7) of therapeutic regimens (23 regimens) constituting the high-cost Group A. Group C (accounting for no more than 5% of expenditures) included 164 regimens (66.7%; 95% CI 60.4–72.5). The remaining drugs fell into Group B (15% of expenditures) – 24 regimens (9.8%; 95% CI 6.4–14.2). Meanwhile, 35 regimens (14.2%; 95% CI 10.1–19.2) were not used in 2022. The distribution of regimens by VEN groups was consistent with recommendations: 149 regimens (60.6%; 95% CI 54.2–66.7) for Group V, 63 regimens (25.6%; 95% CI 20.3–31.5) for Group E, and 34 regimens (13.8%; 95% CI 9.8–18.8) for Group N. The combined ABC/VEN analysis demonstrated that Group A predominantly included drugs from Group V (52.2%). However, it also revealed disproportions: a significant proportion (39.1%) of Group N drugs in Group A requires special attention and indicates the need for mechanisms to regulate the prescription of high-cost drugs.

Conclusion. The findings provide a foundation for developing balanced approaches to pharmaceutical provision in oncology, combining the principles of clinical appropriateness and economic efficiency. The study justifies the need for resource allocation strategies that ensure the priority provision of evidence-based treatment regimens in the context of limited resources.

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