Disparity in the Markers of Affordability Across Targeted- and Immune-Therapy Drugs Used in Head and Neck Cancers.

Abstract

The expanding use of systemic therapies for recurrent and metastatic head and neck cancer has raised major concerns regarding affordability and equitable access, particularly across countries with differing income levels and health financing structures. We conducted a comparative affordability and budget-reach analysis of commonly used systemic agents-pembrolizumab, nivolumab, cetuximab, gefitinib, and erlotinib-across seven countries (United States, United Kingdom, Australia, South Africa, India, Pakistan, and Bangladesh) representing high-, upper-middle-, and lower-middle-income settings. Immunotherapy was unaffordable across all settings. Six-month pembrolizumab costs corresponded to 7994% of monthly income in India, 4311% in Pakistan, 3133% in Bangladesh, and remained above catastrophic thresholds in high-income countries (591% in the United States; 903% in the United Kingdom). In contrast, oral tyrosine kinase inhibitors were substantially less costly, with gefitinib requiring 171%-412% of monthly income in South Asia and falling below thresholds in Pakistan and Bangladesh. The cost of treating one patient with pembrolizumab could fund treatment for 18-22 patients with gefitinib in South Asia. Despite modest survival benefits, current immunotherapy pricing severely limits global accessibility. Policy reform and pricing strategies are needed to ensure equitable cancer care.