Associate Professor University of Southern California Los Angeles, United States
Background: Despite a growing burden of childhood cancer globally and disparities in childhood cancer mortality rates between high income and LMICs, there is limited information on trends and disparities in access to essential medicines indicated for the treatment of childhood cancers between high income low and middle income countries (LMICs).
Objectives: 1. To investigate trends and disparities in the use of oral childhood cancer medicines in high income and LMICs by geographic region between 2015-2020. 2. To explore the association between changes in the availability of oral childhood cancer medicines and childhood cancer mortality rates between 2015-2019 at the country-level.
Methods: We analyzed quarterly sales data from IQVIA's MIDAS for oral childhood cancer medicines between January 1st 2015 to October 31st 2020. We included a total of 25 oral childhood cancer medicines indicated for the treatment of common childhood cancers (i.e., leukemia, lymphoma, brain and nervous system cancers). For each specific medicine, we also determine whether it is included on the current WHO essential medicines list (EML). We used data from the Global Burden of Disease (GBD-2019) to obtain population estimates for total deaths among children less than 20 years with childhood cancers. Average quarterly sales trends of cancer medicines were expressed as standard units (SUs) or tablets per 100,000 children aged < 20 years per day.
Results: Although the use of childhood cancer medicines increased significantly in LMICs between 2015 and 2019 (from 122 to 172 tablets per 100,000;p < 0.01), LMICs accounted for only ¼ of childhood cancer medicines in 2019. Although the use of childhood cancer medicines increased only 4.7%, use was nearly 20-times greater in high income countries ( 3,104 tablets per 100,000 ) in 2019. Use also varied substantially between and within regions of LMICs; Turkey (1,798 per-capita) and Romania (2,408 per-capita) with the highest rates and West Africa and Thailand the lowest rates (2.5 and 7.4 per-capita, respectively). In 2019, High Income Countries with the lowest number of deaths from childhood cancer had the largest volume of childhood cancer medicines. We also observed the increases in the availability of oral childhood cancer medicines is associated with lower childhood cancer death rates in LMIC countries (ρ=-0.62; p< 0.001).
Conclusions: Although access to oral cancer medicines has steadily increased in LMICs since 2015, there is still widespread inequitable access to these essential medicines when compared to High income countries. Efforts to increase access to childhood cancer medicines are warranted and should extend beyond their inclusion on national EMLs.
