Affordability of aprepitant for cancer patients in routine clinical practice in russia: analysis of government-established database

Introduction: aprepitant-based prophylaxis for chemotherapy-induced nausea and vomiting (CINV) is an established standard of care for cancer patients receiving high-emetogenic chemotherapy (HEC). However, no studies addressed the issues of affordability of aprepitant in Russia and other low-resources countries.

Material and methods: for the purposes of this trial we collected data from government-establish electronic database which use is mandatory for every government-funded healthcare organization. We conducted the analysis of this database for electronic public procurement auctions of aprepitant and fosaprepitant, as well as cisplatin for the period from 01.01.2015 to 01.01.2018. The latter was chosen as a rough estimate of the number of patients receiving highly emetogenic therapy in Russia.

Results: we identified 278 electronic auctions for the purchase of aprepitant/ fosaprepitant. During the study period 77 045 packages of these drugs were purchased. For the same period 32474890 mg of cisplatin was purchased. This amount of cisplatin is equivalent to 240 555 courses of HEC with an average dose of 75 mg/m2 per course and an average body surface area of 1,8 m2. The estimated rate of affordability of aprepitant drugs for cancer was only 32%. Significant interregional variability was revealed.

Conclusions: the vast majority of cancer patients in Russia do not have access to modern antiemetogenic therapy. The development of effective and more affordable methods for the prevention of CINV remains an unmet need.