Assessment of Prescription Patterns and Costs of Oncology Drugs Used in the Paediatric Unit of Queen Elizabeth Central Hospital, Malawi

Abstract

Background Cancer is one of the global leading causes of childhood morbidity and mortality. High childhood cancer mortality rates in developing countries have been linked to chemotherapy prescribing patterns that fails to conform to good standards of treatment which leads to ineffective treatment, occurrence of adverse events, prolonged hospitalization and increased economic burden to patients. Children are more vulnerable to effects of irrational prescribing owing to their underdeveloped pharmacokinetic and pharmacodynamics profiles. Malawi has a paucity of data on prescribing patterns and cost of pediatric anticancer drugs. Objectives The study assessed prescribing patterns and costs of anticancer drugs used in the paediatric cancer unit of Queen Elizabeth Central Hospital in Blantyre, Malawi. Methodology A retrospective cohort study was conducted in the pediatric oncology unit at Queen Elizabeth Central Hospital (QECH). Data was abstracted from 293 files of children aged 0-18 years and diagnosed with cancer between January 2017 and December 2020. Prescribing pattern was assessed by comparing prescription patterns with the established QECH pediatric Oncology guidelines, and the WHO rational prescribing indicators. Dispensed quantity of drugs was used to compute a cost of chemotherapy prescription using current market prices obtained from Central Medical Stores catalogue and private wholesale suppliers. The local currency was converted to US dollar using reserve Bank of Malawi conversion rates to allow comparison. Data analysis was done using Microsoft Excel (2016) and STATA (version 13.1). Continuous variables were summarized as median and interquartile range (IQR) while categorical variables were summarized as frequencies and percentages. Results Majority of the participants were children aged between 0 to 5 years (45.4%). More males (60.4%) were affected by childhood cancer disease than females (39.6%). Over 75% of the participants were from rural areas. About 13% of the children were malnourished. Over half of the children had no comorbidities while 19.7% had malaria and/or HIV/AIDS. Burkitt’s lymphoma (24.9%) was the most prevalent childhood cancer followed by retinoblastoma (18.4%), non-Hodgkin’s lymphoma (10.6%), and Kaposi’s sarcoma (10.6%). Close to 30% of the participants died at the end of the review period. Twenty eight percent of the children recovered while 17.5% were discharged to receive palliative care. Vincristine (25.5%) was the most frequently prescribed anticancer agent while morphine was prescribed for 92.5% of the patients. Rituximab (USD36 442.25) was the most expensive anticancer drug at the oncology unit. Prescribing error of omission of height (47%) was the most prevalent. Majority of prescriptions (48.1%) had three drugs. The mean number of drugs per encounter was 3.5 (n=1028). The proportion of drugs prescribed from formulary, and by generic name was 100% and 99.2% respectively. Low grade glioma and Burkitt’s lymphoma were the costliest anticancer prescriptions followed by Hodgkin’s lymphoma and germ cell tumor. Evaluation of Median Price Ratio showed that anticancer drugs are priced within the acceptable range as recommended by World Health Organization. Despite anticancer drugs being priced fairly, many Malawians cannot afford a chemotherapy prescription. Conclusion Although the average number of drugs per encounter surpassed the WHO recommended standard, the utilization of anticancer drugs was largely found to be rational. However, many Malawians on minimum government wage cannot afford to pay for a chemotherapy prescription despite fair anticancer drug prices. Deliberate efforts and strategies should be put in place to make anticancer prescription affordable to Malawians on minimum wage