Efficacy, Safety and Affordability Disparities of Gastrointestinal Cancer Changing Plans of Treatment of Cancer Patients

Abstract

Purpose: With daily increase of GIT cancer incidence, there is more discovery of new regimens, raising the question: how much can cancer patient afford effective safe treatment? Methods: Safety and efficacy grades version 2021 NCCN evidence-based blocks are used in this research, Egyptian population divided according to income in to 5 categories: Poorest (4860), poor (8460), middle (22800), rich (41100), richest (66583). We considered a medicine as affordable if 20% or less of monthly income is needed to cover monthly need of medicine. Affordability divided to 5 grades according to percentage of income needed to cover treatment: very inexpensive: ≤20%, inexpensive: 20-40%, moderately expensive 40-60%, expensive 60-80%, awfully expensive ≥ 80%. Binary logistic regression model was performed to assess affordability of cancer treatments in different cancer types using efficacy of regimen, safety of regimen, line of therapy, site of treatment and income class as predictors. Results: Most GIT regimens are moderately effective 223 (51.6), while most regimens 277 (64.1) are mildly toxic. Minimally effective regimens increase the chance of being affordable by 15 times if compared to highly effective P<0.0001, moderately effective increase the chance of affordability by 3 times if compared to highly effective P<0.0001. Mildly toxic regimen increases the chance of affordability by 3 times if compared to occasionally toxic treatment. P=0.002. Adjuvant regimens have increased chance of affordability by 17 times if compared to second line. Conclusion : GIT cancer patients have more treatment affordability for neo-adjuvant/adjuvant than other regimens first-line therapy is more affordable than other regimens for stage IV disease, highly effective regimens have the low affordability while mildly toxic regimens have more chance of affordability than other regimens