ESMO Global Consortium Study on the availability, out-of-pocket costs, and accessibility of cancer medicines: 2023 update

BACKGROUND: The availability and affordability of safe, effective cancer therapies are core requirements for effective cancer control. Global disparities exist in access, however, yielding unequal cancer outcomes. The goal of this study was to provide updated data regarding the formulary availability, out-of-pocket costs, and accessibility of cancer medicines in countries across the full spectrum of economic development areas.

METHODS: This study was conducted through an online survey based on a previously validated methodology. It evaluated the formulary availability, out of pocket costs, and actual accessibility of essential generic cancer medication commonly used for a wide range of cancers, including those on the 22nd WHO Model List of Essential Medicines (EML), and cancer medications used in eight high-incidence cancers. A total of 853 field reporters from 170 countries were invited to participate. The collected data were collated and peer-reviewed on the ESMO website, with final adjustments made accordingly.

RESULTS: Data were collected by 317 reporters and 231 peer reviewers across 126 countries. The study revealed that patients in most high-income countries can access cancer medications without significant out-of-pocket expenditure, including novel treatments with high ESMO-Magnitude of Clinical Benefit Scale (ESMO-MCBS) scores. Conversely, in lower-middle and low-income countries, 40% of traditional chemotherapy agents deemed essential in the WHO EML are only available at full cost to patients.

CONCLUSIONS: This dataset provides a new and updated 'Global Reference' to enhance accountability for inequalities in access and availability of cancer medicines and to identify challenges and shortcomings to drive public health policies and positively impact national cancer control planning.