![]() Since there’s no box, disc, registration card, shipping, or stocking, the software can cost a lot less Apple’s own programs certainly reflect this price advantage. There are some huge advantages to this system. (Mavericks itself is an App Store download.) You can read about the programs, check out customer reviews, and download them directly to your Mac. It’s an online catalog of software from huge software companies, tiny one-person software companies, and everything in between. So now there’s the Mac App Store ( Figure 4-1)-or, as the program is called in your Applications folder, just App Store. Once everybody saw how convenient (and profitable) that system was, it didn’t take Apple long to realize it could bring the same convenience to the Mac. This analysis does not consider that we are also fortunate in many developed countries that our health service sponsors the cost of these medicines.For years, people installed software onto their computers by buying disks: floppies, CDs, and, later, DVDs.īut starting with the iPhone, people installed software onto their phones by downloading it directly from the Internet. This is in contrast to our own country (Ireland) where 1 month's salary provides purchasing power for 6 months' supply of fulvestrant. For example, in Egypt, the cost of fulvestrant is equivalent to just over 1 month of salary. The cost of fulvestrant is more likely to be a higher proportion of monthly income in lower-income countries (Fig (Fig1). ![]() However, these crude figures do not consider the purchasing power of patients with cancer in these countries. For example, in the United States, the cost of fulvestrant exceeds $1,600 in US dollars, whereas it is < $200 in US dollars for 500 mg in Pakistan (full list of prices available). Our findings highlight the wide disparity in fulvestrant costs between different countries. Monthly salary and Big Mac prices were included in our analysis. However, our inability to access a central resource with pricing is a limitation of this analysis. There is a lack of transparent sources for pricing in each country, and the authors' felt contacting colleagues was most likely to yield accurate results. We contacted medical oncology colleagues in the listed countries to assist with estimating the cost of 500 mg of fulvestrant. The lowest available price of fulvestrant (generic or brand) was included. The countries were chosen to represent a mixed economic demographic and continental distribution. We performed an analysis of the cost of fulvestrant, the cost of Big Macs, and the relationship of these costs with monthly salaries in 13 countries. 2 How many Big Macs could I buy for the cost of 500 mg of fulvestrant? How many 500 mg of fulvestrant doses could I buy with a monthly salary? How does this vary between countries? The Big Mac Index uses the cost of a Big Mac to estimate the purchasing power parity of a currency. Their work provoked our consideration of how disparities in fulvestrant pricing may occur between different countries. Their work highlights the disparity between cost and efficacy of the 250 mg and 500 mg dosing schedules of fulvestrant in India. ![]() Patel et al 1 eloquently present compelling evidence that 250 mg of fulvestrant may be a sufficient dose in resource-limited settings.
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