Access to affordable, safe, effective and quality medicines is key to achieving Universal Health Coverage (UHC), as highlighted in the 2023 Sustainable Development Goals, where the aspiration is to leave no one behind. The reality, however, is different, and is a sober one, where countries face a range of obstacles to achieving this.
“The availability of anti-cancer medicines directly affects the daily practice of doctors and consequently their ability to care for patients with cancer,” notes Nathan Cherny, Shaare Zedek Medical Center, Jerusalem, Israel, member of the ESMO Cancer Medicines Committee, chair of the ESMO-MCBS Working Group and project lead for the ESMO studies on availability and accessibility of antineoplastic medicines (ANMS).
The studies --carried out at regular intervals-- aim to update the data available to ESMO regarding availability of cancer medicines globally by collecting data on formulary availability of licensed anti-neoplastic medicines, patient ‘out-of-pocket’ cost for the medication, availability of medication for patients with a valid prescription, and the impact of the country’s level of economic development on these parameters.
“Depending on whether one wants to look at the half-full or half-empty glass, the unnoticeable differences with respect to data previously collected and published in 2017 can be interpreted either positively or negatively,” underlines Cherny.
Indeed, the latest survey, which covered 127 countries, reveals dramatic disparities in terms of cost – thus availability and accessibility – of anticancer medicines between high- and upper-middle-income countries versus low- and lower-middle income countries.
“What is worse is that the disparities affect both the inexpensive, frequently off-patent generic medicines, which are available only at full cost as an out-of-pocket expense for patients as well as the expensive, innovative medicines – either targeted or immuno-therapies, leaving large parts of the world population uncovered,” notes Dario Trapani, Chair of the ESMO Cancer Medicines Committee and member of the ESMO-MCBS Working Group.
The comparison of the data collected in 2022-2023 with the results of the 2017 study was done with greater attention to those anti-cancer medications included in the 2021 WHO Model List of Essential Medicines, i.e., a compilation of medications that WHO deems necessary for a basic healthcare system to function effectively.
“These medicines are considered essential, because they address the most important healthcare needs and are considered cost-effective, safe, and readily available,” notes Cherny. “However, the situation pictured in these graphs makes us ‘see red’,” he continues.
“Given that approximately one in five people will develop cancer during their lifetime, ESMO calls for countries to guarantee UHC benefit packages to their entire population, including not only medicines but a core set of comprehensive, safe, affordable, effective, and high-quality services for prevention, screening, diagnosis, treatment according to guidelines, palliative care, and rehabilitative services for cancer,” says ESMO Director for Public Policy Jean-Yves Blay, General Director of the Centre Léon Bérard, the Comprehensive Cancer Centre of Lyon, France. “The packages must be well funded and delivered by a well-trained and well-resourced health workforce, and the provision of these services should not result in financial hardship for patients or lead to catastrophic and generational impoverishment.”
“With the ESMO ANMS Studies, our Society has substantially improved our understanding of the realities on the ground,” notes ESMO President, Andrés Cervantes. “The results are a stark reminder that cancer care remains inaccessible to most patients, making the role of our Society even more important, informing policymakers worldwide providing them with the evidence they need to make informed decisions.”
Universal Health Coverage Day is the annual appointment of the global movement for #healthforall, marking the anniversary of the 2012 UN General Assembly’s historic endorsement of the resolution urging countries to accelerate progress towards universal health coverage.
- The overall results of the latest ESMO Study on the availability, out-of-pocket costs and accessibility of antineoplastic medicines were presented in a dedicated session on Saturday 21 October 2023 during the ESMO Congress 2023 in Madrid
- The full paper “ESMO International Consortium Study on the availability, out-of-pocket costs and accessibility of antineoplastic medicines in countries outside of Europe” with the latest results and the discussion following on from comparing data with those collected 5 years earlier is expected to be published early 2024