00:00The case of this medication and what is happening with it in Colombia
00:02It's excellent for understanding one of the deepest and most complex discussions.
00:07in our health system and which is rarely discussed.
00:11Imagine this: a medicine arrives in our country
00:14which is the latest treatment for some types of cancer.
00:17Oncologists are beginning to see results in their patients that leave them amazed.
00:22Then they started prescribing it for many more types of cancer.
00:26And they formulate it so much that a year after entering the Colombian market
00:29Sales of this drug have grown by 265%.
00:33In fact, that year saw the greatest sales growth in the entire country.
00:39It's growing so much that it's starting to rank among the top medications
00:43which are where the Colombian health system spends the most.
00:4615 billion in 2017
00:4856 billion in 2018
00:50203 billion in 2021
00:52524 billion in 2023
00:56919 billion in 2025
00:59Imagine, almost a trillion in just one year.
01:03The data is, of course, real.
01:04The health system has paid more than 2.7 trillion pesos for that drug since 2017.
01:10It's called Pembrolizumab
01:12or Kate Trudad, as he is known commercially.
01:15It was developed by the multinational MSD
01:17And as Raúl Murillo, the director of the Javeriano Oncology Center at the San Ignacio University Hospital, told us
01:23It has been revolutionary.
01:25The reason is simple.
01:26Along with other medicines, it opened the door to the era of immunotherapy
01:31which has meant a 180-degree turn for cancer patients.
01:35But is there a way to reduce its price?
01:38So that it doesn't hit the finances of a struggling health system too hard?
01:42These are precisely the questions that many people in the healthcare sector in Colombia are asking themselves.
01:48And some believe there is an alternative that the multinational MSD does not agree with.
01:53Optimize the dose.
01:55It's not an idea they pulled out of thin air.
01:57In fact, it is a practice that has already become common in other countries.
02:01and in the oncology corridors
02:03because everyone is very worried about the price of Pembrolizumab.
02:07A very brief explanation.
02:08For patients requiring Pembrolizumab
02:10They are given a regimen of 200 milligrams every 3 weeks
02:15or one of 400 milligrams every 6 weeks.
02:18And here's the crux of the matter.
02:19Why, if in other cases oncologists administer treatments according to each patient's weight,
02:25With Pembrolizumab, a single dose is administered.
02:28regardless of whether a patient weighs 60 kilograms or 100 kilograms?
02:33The question was asked in India,
02:35where in 2022 a group of specialists made a call
02:38to use a dose of 2 milligrams of Pembrolizumab per kilogram.
02:42The question is being asked in the United States and has been asked in Europe.
02:45Where in the Netherlands, for example, 40 hospitals conducted a study with 1,966 patients.
02:52Some were given the dose suggested by MSD, others were given a dose based on their weight.
02:57They found that the effectiveness did not vary and, of course, that the cost could be reduced.
03:03Hospitals like Erasmus MC in Rotterdam now use a weight-based dosage.
03:08In fact, in the latest report from the WHO Expert Committee on Essential Medicines,
03:15This group highlighted the therapeutic value of Pembrolizumab and advised countries,
03:19Regarding immunotherapy treatments, implement strategies to improve access,
03:24These include dose optimization.
03:27Today, the same question is being asked in Colombia.
03:30where some centers, such as the National Cancer Institute and the Javeriano Center for Oncology,
03:36They want to conduct a study to gather further evidence to support the idea of optimizing the Pembrolizumab dose.
03:42according to the weight of Colombians instead of the weight of US citizens
03:48And, incidentally, save the health system a good amount of money.
03:53MSD doesn't like the idea because, as they told us,
03:57the approved dosing regimens for Pembrolizumab
04:01They are based on a wide range of preclinical data and extensive clinical evidence.
04:07But for other specialists there is already enough evidence to support that decision.
04:12Even for several oncologists we spoke with,
04:15That idea should be supported by the government itself.
04:18because they fear getting into legal arguments with the pharmaceutical company.
04:22And if you want to know more about this story, which is deeper and began many months ago
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04:38Bye.
