Inequities in cancer drug development in terms of unmet medical need

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Title: Inequities in cancer drug development in terms of unmet medical need
Authors: Barrenho, E
Halmai, R
Miraldo, M
Tzintzun, I
Ali, SR
Toulemon, L
Dupont, J-CK
Rochaix, L
Item Type: Journal Article
Abstract: This study measures inequality and inequity in the distribution of clinical trials on cancer drug development between 1996 and 2016, comparing the number of clinical trials with cancer need, proxied by prevalence, incidence, or survival rates for both rare and non-rare cancers. We leverage a unique global database of clinical trials activity and costs between 1996 and 2016, constructed for 227 different cancer types to measure for rare and non-rare cancers: i) inequalities and inequity of clinical trial activity, considering all trials as well as split by R&D stage; ii) inequalities and inequity in R&D investment proxied by trial enrollment and duration; iii) evolution of inequity over time. Inequalities are measured with concentration curves and indices and inequities measured with the health inequity index. We find four important results. First, we show pro-low need inequity across cancer types for both rare and non-rare cancers, for all need proxies. Second, we show inequity differs across R&D stages and between rare and non-rare cancers. The distribution of clinical trials for non-rare cancers disproportionately favors low-need non-rare cancers from earlier to later stages of R&D, whilst for rare cancers this only occurs in Phase 2 trials. Third, inequity analyses in R&D investment show that only trial enrollment for rare cancers and trial duration for non-rare cancers are disproportionately concentrated among low-need cancers. Finally, while pro-low need inequity has persisted between 1996 and 2016 for non-rare cancers, it has faded for rare cancers post-EU orphan drugs’ legislation.
Issue Date: 1-Jun-2022
Date of Acceptance: 26-Mar-2022
URI: http://hdl.handle.net/10044/1/96729
DOI: 10.1016/j.socscimed.2022.114953
ISSN: 0277-9536
Publisher: Elsevier
Journal / Book Title: Social Science and Medicine
Volume: 302
Copyright Statement: © 2022 Published by Elsevier Ltd. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor/Funder: Commission of the European Communities
Funder's Grant Number: PP-1-2-2018-Rare 2030
Keywords: Clinical trials
Equity
Rare and non-rare cancers
Unmet cancer needs.
Public Health
11 Medical and Health Sciences
14 Economics
16 Studies in Human Society
Publication Status: Published
Embargo Date: 2023-04-13
Article Number: ARTN 114953
Online Publication Date: 2022-04-14
Appears in Collections:Imperial College Business School



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