Pricing, availability, and affordability of cancer medicines in 5 middle-income countries in South America.

Abstract

e23154 Background: Whereas cancer rates are increasing globally, access to antineoplastic drugs is limited and expensive, especially in low and middle-income countries. Even the drugs from the WHO Essential Medicine List (EML) are still scarce and unaffordable in some countries. New targeted therapies, while improving survival, are often too expensive, with costs exceeding a significant portion of annual wages. In South America, fragmented healthcare systems and geographic barriers further hinder access to care. This study aims to explore and describe the pricing, availability, and affordability of FDA-approved and WHO-listed cancer drugs in five South American countries (Peru, Colombia, Brazil, Argentina, and Paraguay). Methods: We gathered publicly available data from Peru, Colombia, Brazil, Argentina, and Paraguay. Drug prices were converted to USD using Purchasing Power Parities (PPP) and reported per defined daily dose (DDD). Availability was assessed by the number of pharmacies stocking each drug, with data available only for Peru. Affordability was evaluated by determining how many days a minimum wage worker would need to work to afford one DDD of each drug. We compared these variables between drugs listed in the WHO EML and those newly FDA-approved drugs not included in the EML list (non-EML drugs). Results: Forty-one medications were included: 18 WHO EML and 23 non-EML drugs. Median prices were 230.42 USD/DDD and 761.25 USD/DDD for WHO EML and non-EML drugs respectively. In Peru, > 99% of cancer drugs were exclusively sold in privately owned pharmacies; only 13 non-EML drugs were available. Median affordability was 10.36 days and 27.44 days for the WHO EML and non-EML drugs each. WHO EML drugs were most affordable for breast cancer (0.26 days) and least affordable for melanoma (37.68 days), whereas non-EML drugs were most affordable for prostate cancer (15.5 days) and least affordable for lung cancer (31.76 days). Conclusions: Cancer drug prices are variable in South America; newer therapies are often not included in the WHO EML, are more expensive and unaffordable, requiring more than 25 days of minimum wage work to afford 1 DDD of most non-EML drugs. Limited access is also an issue, as evidenced by Peru’s drug availability. Further research into health policies is needed to improve cancer treatment access in South America.