Browsing by Person "Ammar, Walid"

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Cost of oncology drugs in the Middle-Eastern country of Lebanon: An update (2014-2016)
(American Society of Clinical Oncology (ASCO), 2018-12) Elias, Fadia; Bou-Orm, Ibrahim; Adib, Salim M.; Gebran, Selim; Gebran, Anthony; Ammar, Walid
Purpose This study aims to evaluate trends in the increasing costs of oncology drugs procured by the Lebanese Ministry of Public Health (MOPH) between 2014 and 2016 and to assess the impact of the introduction in mid-2015 of new immunotherapy drugs for the treatment of lung cancer on the overall and specific costs of that treatment. Methods A secondary analysis of data from the MOPH Cancer Drug Scientific Committee data base was conducted using a total of 18,133 cancer files between 2014 and 2016. Results Over the 3-year period, about $140 million (USD) was spent on cancer drugs by the MOPH free cancer drug dispensing program. The expenditures increased by 27% after immunotherapy was phased in. The average cost of drugs per patient per year measured across all cancer types increased from $7,000 in 2014 to $8,400 in 2016. Trastuzumab, approved for treating human epidermal growth factor receptor 2–positive breast cancer ranked first in total expenditures for 2014-2015. By 2016, two new immunotherapy drugs had topped the list: pembrolizumab ranked first and nivolumab ranked third, representing 64% of the total cost of lung cancer treatment and approximately 19% of the total yearly budget; beneficiaries represented only 3% of all patients. Conclusion This update documents the increasing financial impact of newer cancer drugs on the procurement process in the middle-income country of Lebanon. The trend is aligned with the financial burden of cancer drugs worldwide, which calls for a collaborative global response to this crisis.
Secular trends of hip fractures in Lebanon 2006-2017: Implications for clinical practice and public health policy in the Middle East region
(ASBMR, 2019-09-10) Saad, Randa K.; Harb, Hilda; Bou-Orm, Ibrahim; Ammar, Walid; El-Hajj Fuleihan, Ghada
Country-specific hip fracture incidence rates (IRs) and longevity allow FRAX to be adapted to individual countries. Secular trends can affect tool calibration. Data on hip fracture IRs in the Middle East is scarce, and long-term secular trend studies are non-existent. Using the Ministry of Public Health hip fracture registry, we calculated age and sex-specific hip fracture IRs in Lebanon, from 2006-2017, among individuals aged ≥50 years. We used Kendall's tau-b (τb) test to determine the correlation between time and hip fracture IRs, and calculated both the annual % change in IRs and the % change in IR compared to the baseline period (2006-2008). The registry recorded 6,985 hip fractures, 74% at the femoral neck, 23% inter-trochanteric, and 3% sub-trochanteric. Men constituted 32% of the population, and were significantly younger than women (76.5 ± 11.0 years vs. 77.7 ± 10.3 years; p < 0.001). Annual overall IRs, per 100,000, ranged from 126.6 in 2014 to 213.2 in 2017 in women, and 61.4 in 2015 to 111.7 in 2017 in men. The average women to men IR ratio was 1.8 (range 1.5-2.1). IRs steadily increased with age, and IR ratios increased in parallel in both sexes, with a steeper and earlier rise (by 5 years) in women. Data showed a consistent decline in hip fracture IRs starting in 2006 in women, and in 2009 in men. There was a significant negative correlation between time (2006-2014) and hip fracture IRs in women (τb = -0.611, p = 0.022) but not in men (τb = -0.444, p = 0.095). The steady decrease in IRs reversed after 2015 in both sexes. This long-term data on secular trends in the Middle East is novel and consistent with worldwide changes in hip fracture rates. The impact of such changes on national FRAX-derived estimates is unclear, should be assessed, and may necessitate an update in the FRAX Lebanon calculator.