Can we achieve affordable cancer medicine prices? Developing a pathway for change

Abstract

Cancer patients face high financial burden in many lowand middle-income countries but also in high-income countries such as the US [1]. Large price variations have been identified between countries, even of similar income [2–4]. Globally, cancer medicines are largely unaffordable, also and in particular if they have to be paid by the patients: For instance, a course of standard treatment for early-stage HER2 positive breast cancer would cost about ten years of average annual wages in India and South Africa and 1.7 years in the US [5]. Such ‘financial toxicity’ [6] has been observed against the backdrop of limited (therapeutic) value in terms of clinical parameters and patient-reported outcomes. Several studies explored the relationship between prices of cancer medicines and their therapeutic benefits, based on the value frameworks of the American Society of Clinical Oncology and the European Society for Medical Oncology, for instance, and could not identify any significant association for several cancer medicines [7–12]. The World Health Organization (WHO) classified several cancer medicines as ‘essential medicines’ [13], i.e. those that satisfy the priority health-care needs of the population. As such, they should be made available at a price the individual and the community can afford [14]. To implement the 2030 Sustainable Development Goals (SDG) agenda, governments have committed to ‘achieve universal health coverage, including financial risk protection [. . .] and access to safe, quality and affordable essential medicines and vaccines for all’ (SDG target 3.8) [15]. Progress toward universal health coverage by introducing social health insurance, expanding the scope of safe and cost-effective medicines in the benefits package scheme, and reducing copayments would help ease the financial burden for patients. Even in high-income countries with solidarity-based health systems (i.e. those with a large share of public funding, based on a national health service or social health insurance), there is lack in access to cancer medication since public payers cannot afford the high prices. Bent Høie, Minister of Health and Care Services of Norway, one of the richest countries of the world, reported that in 2019 Norway ‘had to reject 22% of new medicines and treatments due to very high prices. This means we were not able to offer these medicines to patients who need them’ [16].