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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