ESMO International Consortium Study on the availability, out-of-pocket costs and accessibility of antineoplastic medicines in countries outside of Europe

Abstract

Background: The availability and affordability of safe, effective, high-quality, affordable anticancer therapies are a core requirement for effective national cancer control plans.

Method: Online survey based on a previously validated approach. The aims of the study were to evaluate (i) the availability on national formulary of licensed antineoplastic medicines across the globe, (ii) patient out-of-pocket costs for the medications, (iii) the actual availability of the medication for a patient with a valid prescription, (iv) information relating to possible factors adversely impacting the availability of antineoplastic agents and (v) the impact of the country's level of economic development on these parameters. A total of 304 field reporters from 97 countries were invited to participate. The preliminary set of data was posted on the ESMO website for open peer review and amendments have been incorporated into the final report.

Results: Surveys were submitted by 135 reporters from 63 countries and additional peer-review data were submitted by 54 reporters from 19 countries. There are substantial differences in the formulary availability, out-of-pocket costs and actual availability for many anticancer medicines. The most substantial issues are in lower-middle- and low-income countries. Even among medications on the WHO Model List of Essential Medicines (EML) the discrepancies are profound and these relate to high out-of-pocket costs (in low-middle-income countries 32.0% of EML medicines are available only at full cost and 5.2% are not available at all, and for low-income countries, the corresponding figures are even worse at 57.7% and 8.3%, respectively).

Conclusions: There is wide global variation in formulary availability, out-of-pocket expenditures and actual availability for most licensed anticancer medicines. Low- and low-middle-income countries have significant lack of availability and high out-of-pocket expenditures for cancer medicines on the WHO EML, with much less availability of new, more expensive targeted agents compared with high-income countries.

Keywords: ESMO; WHO Model List of Essential Medicines; anticancer medicines; antineoplastic medicines; public health; public policy.

Figure 1.

Medication on the WHO Model List of Essential Medicines: formulary availability and out-of-pocket costs. Anast, Anastrozole; Bleo, Bleomycin; Capecit, Capecitabine; CarboP, Caboplatinum; CisP, CisPlatinum; Cyclo, Cyclophosphamide; DTIC, Decarbazine; Docet., Docitaxel; Dox, doxorubicin; Epir, Epirubicin; Etop, Etoposide; Ifos, Ifosfamide; Irino, Irinotecan; MTX, methotrexate; Oxalipl, Oxaliplatinum; Paclit, Paclitaxel; Tam, Tamoxifen; VBL, Vinblastine; VCR, Vincristine; Trastuz, Trastuzumab.

Figure 2.

Medication on the WHO Model List of Essential Medicines: Actual availability (accessibility with valid prescription). Anast, Anastrozole; Bleo, Bleomycin; Capecit, Capecitabine; CarboP, Caboplatinum; CisP, CisPlatinum; Cyclo, Cyclophosphamide; DTIC, Decarbazine; Docet., Docitaxel; Dox, doxorubicin; Epir, Epirubicin; Etop, Etoposide; Ifos, Ifosfamide; Irino, Irinotecan; MTX, methotrexate; Oxalipl, Oxaliplatinum; Praclit, Paclitaxel; Tam, Tamoxifen; VBL, Vinblastine; VCR, Vincristine; Trastuz, Trastuzumab.

Figure 3.

Medication on the WHO Model List of Essential Medicines: Dominant Barrier to Accessibility. Anast, Anestrozole; Bleo, Bleomycin; Capecit, Capecitabine; CarboP, Caboplatinum; CisP, CisPlatinum; Cyclo, Cyclophosphamide; DTIC, Decarbazine; Docet., Docitaxel; Dox, doxorubicin; Epir, Epirubicin; Etop, Etoposide; Ifos, Ifosfamide; Irino, Irinotecan; MTX, methotrexate; Oxalipl, Oxaliplatinum; Paclit, Paclitaxel; Tam, Tamoxifen; VBL, Vinblastine; VCR, Vincristine; Trastuz, Trastuzumab.

Figure 4.

Recently approved medications not on the WHO Model List of Essential Medicines, with ESMO-MCBS score >2: Formulary availability and out-of-pocket costs. MBC, Metastatic breast cancer; CRC, Colorectal cancer; RCC, Renal cell cancer; Melan, Melanoma; Prost, Prostate; Lapat, Lapatinib; Pertuz, Pertuzumab; Erlot, Eroltinib; Gefit, Gefitinib; Aftatin, Atafinib; Cetux, Cetuxumab; Panitum, Panitumumab; Suni, Sunitinib; Pazop, Pazopinib; Axitin, Axitinib; Soraf, Sorafinib; Everol, Everolimus; Ipilim, Ipilimumab; Vemuraf, Vermrafenib; Abirat, Abiraterone; Enzalut, Enzalutamide.

Figure 5.

Recently approved medications not on the WHO Model List of Essential Medicines, with ESMO-MCBS score >2: Actual availability (accessibility with valid prescription). MBC, Metastatic breast cancer; CRC, Colorectal cancer; RCC, Renal cell cancer; Melan, Melanoma; Prost, Prostate; Lapat, Lapatinib; Pertuz, Pertuzumab; Erlot, Eroltinib; Gefit, Gefitinib; Aftatin, Atafinib; Cetux, Cetuxumab; Panitum, Panitumumab; Suni, Sunitinib; Pazop, Pazopinib; Axitin, Axitinib; Soraf, Sorafinib; Everol, Everolimus; Ipilim, Ipilimumab; Vemuraf, Vermrafenib; Abirat, Abiraterone; Enzalut, Enzalutamide.

Figure 6.

Recently approved medications not on the WHO Model List of Essential Medicines, with ESMO-MCBS score >2: Dominant Barrier to Accessibility. MBC, Metastatic breast cancer; CRC, Colorectal cancer; RCC, Renal cell cancer; Melan, Melanoma; Prost, Prostate; Lapat, Lapatinib; Pertuz, Pertuzumab; Erlot, Eroltinib; Gefit, Gefitinib; Aftatin, Atafinib; Cetux, Cetuxumab; Panitum, Panitumumab; Suni, Sunitinib; Pazop, Pazopinib; Axitin, Axitinib; Soraf, Sorafinib; Everol, Everolimus; Ipilim, Ipilimumab; Vemuraf, Vermrafenib; Abirat, Abiraterone; Enzalut, Enzalutamide.