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

Abstract

IntroductionLow-income and middle-income countries (LMICs) face the largest burden of mortality from childhood cancers with limited access to curative therapies. Few comparative analyses across all income groups and world regions have examined the availability and acquisition costs of essential medicines for treating cancers in children.MethodsA cross-sectional survey involved countries in five income groups—low-income (LIC), lower-middle-income (LMC), upper-middle-income (UMC), two high-income country groups (HIC1, HIC2). Physicians and pharmacists reported institutional use, availability, stock outs and prices (brand and generic products) of 34 essential medicines. Price comparisons used US$, applying foreign exchange rates (XR) and purchasing power parity (PPP) adjustments. Medicine costs for treating acute lymphoblastic leukaemia (ALL), Burkitt lymphoma (BL) and Wilms tumour (WT) were calculated (child 29 kg, body surface area 1 m2). Comparisons were conducted using non-parametric Kruskal-Wallis tests.ResultsFifty-eight respondents (50 countries) provided information on medicine use, availability and stock outs, with usable price data from 42 facilities (37 countries). The extent of use of International Society of Paediatric Oncology core and ancillary medicines varied across income groups (p<0.0001 and p=0.0002 respectively). LMC and LIC facilities used fewer medicines than UMC and HIC facilities. UMC and LMC facilities were more likely to report medicines not available or stockouts.Medicine prices varied widely within and between income bands; generic products were not always cheaper than brand equivalents. PPP adjustment showed relatively higher prices in UMC and LMC facilities for some medicines. Medicine costs were highest in HICs for ALL (p=0.0075 XR; p=0.0178 PPP-adjusted analyses) and WT (p =<0.0001 XR; p=0.0007 PPP-adjusted). Medicine costs for BL were not significantly different.ConclusionProblems with the availability of essential medicines, dependable supply chains, confidential medicine prices and wide variability in treatment costs contribute to persistent challenges in the care of children with treatable cancers, especially in LMICs.

Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019

“…While YLDs contribute less to global DALYs, the percentage of DALYs estimated to be caused by YLDs increased with increasing SDI quintiles, ranging from 1.4% (95% UI, 1.1%-1.8%) in the low SDI quintile to 5.7% (95% UI, 4.2%-7.1%) in the high SDI quintile. This greater comparative contribution of YLDs in higher SDI settings is consistent with likely improved survival, given generally more available access to cancer screening, diagnosis, and treatment as SDI increases. Consequently, the contribution of YLDs to health loss due to cancer would be expected to be increasingly relevant to global health planning as cancer survival improves globally, and the support needs of survivors of cancer should be considered as part of comprehensive cancer control planning efforts …”

Global, regional and national availability of essential medicines for children, 2009–2020: a systematic review and meta-analysis

“…Methodologically, 15 (68.2%) studies used standardized WHO/HAI methodology, [ 14 , 16 – 18 , 20 , 22 – 26 , 30 – 34 ] 2 (9.1%) studies used adapted WHO/HAI method, [ 13 , 29 ] and the remaining 5 (22.7%) studies used other methods. [ 15 , 19 , 21 , 27 , 28 ] The mean number of essential medicines investigated was 31 (range: 5 to 121).…”

“…Most studies (21, 95.5%) were rated as low risk of bias, [ 13 – 27 , 29 – 34 ] whereas one study (4.5%) was graded as medium risk. [ 28 ] 11 studies achieved 9 points and 9 studies scored 8 points.…”

“…The bias was mainly from the following items: five studies (22.8%) were considered as unwell-represented samples. [ 14 , 15 , 24 , 27 , 30 ] Four studies (18.2%) were considered as insufficient coverage of the identified sample. [ 15 , 19 , 23 , 24 ] It is unclear that if the sample size was adequate in nineteen studies (86.4%), 13–19, 21–[ 24 , 26 – 31 , 33 ]–[ 34 ] and coverage of the identified sample was sufficient in eleven studies (50.0%).…”

Sustainable Development Goal indicator for measuring availability and affordability of medicines for children: a proof-of-concept study

“…At present, there is no methodology for measuring accessibility of essential medicines specifically for children, but a number of studies have reported on the availability or price of medicines, or both 7–35. The methodologies for measuring these two important dimensions of access varied greatly between studies, as did the medicines surveyed, covering different age groups of children (eg, children under 5, children under 12 or all children and adolescents), priority diseases (anticancer medicines, cardiovascular medicines or a range of diseases) and number of surveyed medicines.…”