Assessment of a Global Patient Assistance Program Conducted in 53 Countries

The Glivec® International Patient Assistance Program (GIPAP) provides Glivec®  (imatinib) for chronic myeloid leukemia (CML) and gastrointestinal stromal tumors, at no cost to patients in low income countries.

Objectives

To assess the GIPAP performance in terms of patient enrollment and Program management and to study how institutions’ participation in GIPAP has driven change in institutional capacity to manage patients with cancer.

Methods

For each hospitals included, inclusion and quarterly follow-up data were systematically collected: country, type of institution, clinical, radiological and biological equipment for cancer management; research ability (assessed by various competences) and number of patients included, gender, age, stage of disease, issue of patients. In addition, an online qualitative survey was conducted in 79 physicians targeted in all the countries.

Results

Between 2003 and 2010, a total of 5,088 patients attended in the 47 institutions in 53 countries were included. Patients were mainly from Africa (60%), 91% were CML and 80% of the institutions were publics. One quarter of the institutions has a research ability, 42.6% presented technical competences for Philadelphia or CD 117 examination, 14.9% were able to perform bone marrow biopsy. Patients survival was significantly associated to age (Hazard Ratio (HR) 1.26 95%CI [1.07-1.49]), CML accelerated form (HR 1.92 95%CI [1.45-2.54]), and institution with research ability (HR 0.65 95%CI [0.42-0.99]. According to the fifty physicians included in the qualitative survey, GIPAP has brought significant improvements in patient management, follow up and access to care. The main future challenge were cancer financing programs and sustainability.

Conclusion

This large cancer assistance program has a significant positive impact on patient access to treatment. Such assistance programs can work as a complement to existing national public health system, and reinforces patient management in the institutions. GIPAP could be an interesting access model for other drugs for chronic diseases in low and middle-income countries.