Equity in access to high cost drugs in Uruguay

Abstract

Objective: The aim of this study was to determine the equity in access to high cost oncology medicines reimbursed by the Uruguayan National Health System. Also, were determined the causes of access inequities. Methods: Different levels of access were determined by crossing epidemiological and reimbursement data with geographical distribution and number of Health System users. Possible causes of inequities were determined and weighted by Delphi technique. Results: Access of patients assisted in the public sector to bevacizumab for metastatic colorectal cancer, rituximab for the treatment of non-Hodgkin lymphoma and trastuzumab for advanced HER2+ breast cancer, appears to be lower compared to patients assisted in private sector.Regarding rituximab for the treatment of non-Hodgkin lymphoma and trastuzumab for advanced HER2+ breast cancer, the results seem to show less access for patients residing outside the south region compared to those living in the south region.The main barriers to get reimbursement for patients living outside southern region are the access to pathological anatomy studies, imaging and other clinical analysis. Late diagnosis appears to be the main hurdles in access to these anti-cancer drugs, for patients assisted in the public sector. Conclusions: Equitable access to high cost drugs reimbursed by the National Health System requires policy decisions to address this issue.