BACKGROUND: The global burden of disease from cancer is rapidly increasing, especially in low- and middle-income countries (LMICs). The World Health Organization (WHO) publishes an Essential Medicines List (EML), which includes 48 medications in its “Antineoplastic and Immunosuppressives” category. The effectiveness of this list in promoting access and affordability of cancer medications in international settings should be assessed.
METHODS: Medications listed on national formularies from 116 countries (mostly LMICs) were compared against cancer medications listed on the EML. Concordance between the two lists was compared with per capita gross domestic product (GDP) at purchasing power parity, per capita health expenditures, the human development index, the combined prevalence of overweight and obesity, and smoking prevalence. Purchase prices for cancer medications on the EML were collected and compared to one another, as well as across countries, regions, GDP, cancer incidence, formulation, generic status, medication category, and year of purchase.
RESULTS: Fewer than half of cancer medications on the EML were present on most LMIC national formularies, with no country exhibiting full concordance. Concordance was positively associated with all indicators of economic development. Concordance was also positively associated with prevalence of overweight and obesity. Statistical tests found significant disparities in prices paid for essential cancer medication across countries, regions, individual medications, generic status, and medication categories.
CONCLUSION: Concordance was low in nearly all LMICs. Countries with greater economic development exhibited greater concordance. Cancer medications, on average, were much more expensive than medications in other categories, and several cancer medications exhibited median prices over $100 per package. On its own, the EML does not sufficiently ensure access and affordability of cancer drugs in international settings. Given that the expected prevalence of this already-pervasive disease will rapidly rise in the future, the authors propose expanding the mandate of the International Agency for Research on Cancer (IARC) such that it can facilitate the affordable procurement of chemotherapy by LMICs.