BackgroundAccessibility to essential cancer medications in low- and middle-income countries is threatened by insufficient availability and affordability. The objective of this study is to characterize variation in transactional prices for essential cancer medications across geographies, medication type, and time.MethodsDrug purchase prices for 19 national and international buyers (representing 29 total countries) between 2010 and 2014 were obtained from Management Sciences for Health. Median values for drug pricing were computed, to address outliers in the data. For comparing purchase prices across geographic units, medications, and over time; Mann-Whitney U tests were used to compare two groups, Kruskal Wallis H tests were used to compare more than two groups, and linear regression was used to compare across continuous independent variables.ResultsDuring the five-year data period examined, the median price paid for a package of essential cancer medication was $12.63. No significant differences in prices were found based on country-level wealth, country-level disease burden, drug formulation, or year when medication was purchased. Statistical tests found significant differences in prices paid across countries, regions, individual medications, and medication categories. Specifically, countries in the Africa region appeared to pay more for a package of essential cancer medication than countries in the Latin America region, and cancer medications tended to be more expensive than anti-infective medications and cardiovascular medications.ConclusionsThough preliminary, our study found evidence of variation in prices paid by health systems to acquire essential cancer medications. Primarily, variations in pricing based on geographic location and cancer medication type (including when comparing to essential medicines that treat cardiovascular and infectious diseases) indicate that these factors may impact availability, affordability and access to essential cancer drugs. These factors should be taken into consideration when countries assess formulary decisions, negotiate drug procurement terms, and when formulating health and cancer policy.

Many children in the CWS, especially younger children (ages 2-5), did not have a reported dental visit in the past year. Cost was a barrier, and caregiver status was associated with the likelihood of obtaining dental care. Health and social service providers should refer these children for dental care.

No abstract

Asynchronous online tutorials that award continuing education units without cost and provide knowledge about computers and nursing informatics were made available to registered nurses in Southern California. Four hundred seventy-three nurses enrolled; 52% (246) completed tutorials. Nonsignificant differences in the number of tutorials completed were found across characteristics of participants, meaning that nurses were similarly disposed to participate regardless of age, educational preparation, experience, practice setting, or ethnicity. They tended to overestimate their computer capabilities at the time of enrollment and abandoned the tutorials when they encountered technical problems. Nurses need live workshops teaching computer basics, Internet skills, and how to enroll in and run asynchronous programs. Marketing of online programs should be multifaceted, including live and electronic strategies.

No abstract