Country and regional variations in purchase prices for essential cancer medications

Abstract

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.

Enhancing global access to cancer medicines

“…Cancer medicine pricing varies considerably between countries and might not correlate with a country's purchasing power . Despite comparable gross national incomes, essential cancer medicine prices were higher in Africa than in Latin America . There was up to a 92% difference in list prices for cancer medicines between 15 European countries and up to a 58% difference in actual prices paid .…”

“…8 Despite comparable gross national incomes, essential cancer medicine prices were higher in Africa than in Latin America. 21 There was up to a 92% difference in list prices for cancer medicines between 15 European countries and up to a 58% difference in actual prices paid. 22 For 31 cancer medicines in 16 European countries, Australia, and New Zealand, the difference in list prices between the highest and lowest priced country ranged between 28% and 388%.…”

Policy and governance solutions for ensuring equitable access to cancer medicines in low- and middle-income countries

“…Similarly, our team assessed the costs paid by 16 LMIC health systems to purchase cancer medications on the EML, and we also found a noticeable disparity in prices paid for these medications (5). While health systems purchased the median package of allopurinol (the least expensive cancer medication) for only $1.56, health systems were charged $1,800 for the median price of a package of trastuzumab (the most expensive cancer medication) (5). According to the World Bank, the GNI per capita for low income countries is $1,005 or less.…”

Shortages and price variability of essential cytotoxic medicines for treating children with cancers

“… 15 Similarly, although the Management Sciences for Health Inc (MSH) provides global data on prices, the current data are outdated, with the most recent information available being 2015. 16 While there have been a number of studies and reports comparing availability and prices of cancer medicines within and between jurisdictions, 17–23 these studies have focused on list prices for 31 originator medicines in 18 HICs 17 and in 10 countries of the South East Asian, Western Pacific and East Mediterranean regions, 18 drawn on limited data pricing sources within the MSH database, 19 been restricted to a single country 20 or focused on patient out-of-pocket costs for cancer medications. 21 22 …”