India may be the largest manufacturer of generic medicines in the world, but cancer-afflicted children, who are among society’s most vulnerable groups, remain a deprived lot as far as availability and affordability of essential anti-cancer drugs are concerned.
This has been pointed out by a new study published in the British Medical Journal (BMJ) Global Health, which found that there is a lack of availability of essential anti-cancer drugs, in both public and private sector pharmacies even in the national Capital , for treating childhood cancer, so much so that it is much below the World Health Organisation’s prescribed standards.
The study titled, ‘Evaluating access to essential medicines for treating childhood cancers: a medicines availability, price and affordability study in New Delhi, India,’ was led by the George Institute for Global Health in collaboration with the University of Sydney, Cankids India, Max Super Speciality Hospital, and Boston University School of Public Health. Seven hospitals — four public and three private — and 32 private-sector retail pharmacies were surveyed.
The researchers used a modified WHO/Health Action International methodology to collect data on availability and price of 33 strength-specific anti-cancer essential medicines and four non-cancer essential medicines. Affordability was calculated for the two most common cancers in India: acute lymphoblastic leukaemia and Hodgkin’s lymphoma.
“Mean availability of essential anti-cancer medicines across all hospitals and pharmacies surveyed was less than the WHO’s target of 80%. Low availability and poor affordability of anti-cancer essential medicines highlight the need to streamline public sector and private sector medicine procurement and supply systems,” said Neha Faruqui, principal author of the study from the George Institute for Global Health.
Median prices were calculated by comparing consumer prices with international reference prices. On an average, the mean availability of essential anti-cancer medicines in the survey hospitals and retail pharmacies combined was 70%, in retail pharmacies it was 38%, in public hospital pharmacies 43% and in private hospital pharmacies it was 71%.
The study found that only three anti-cancer essential medicines were available on the Jan Aushadhi website. The prices of Jan Aushadhi prices are much lower than retail pharmacies but compared to public-sector procurement prices, a patient would pay two times and 2.9 times for anti-cancer and non-cancer medicines in the private-sector. Therefore, initiatives to improve public-sector medicines availability are needed, the researchers said.
“Availability is low in the capital city of India which can be considered the best case scenario for access to anti-cancer medicines. We don’t expect availability to be higher in other states,” said Rohina Joshi, associate professor at University of Sydney.
Medicine prices were relatively low in Delhi compared with international reference prices. However, the cost of chemotherapy medicines seems unaffordable in the local context. “When calculated using the lowest (and most-sold) generic price offered in pharmacies, the estimated cost of chemotherapy medicines needed for treating a 30 kg child with standard risk leukaemia was Rs 27,850 and Rs 17,500 for early stage Hodgkin’s lymphoma, requiring 88 and 55 days’ wages, respectively, for the lowest paid government worker,” said Ramandeep Arora, paediatric oncologist. “If the patient/family is not offered any pharmacy discount and had to buy the same medicines at maximum retail price, they require an extra 12 days’ wages for both diseases,” he said.
“Government insurance schemes and discount pharmacy initiatives should expand the inclusion of essential anti-cancer medicines, as a way towards limiting the catastrophic out-of-pocket expenditure associated with cancer treatment,” said Faruqui.
Childhood cancer comprises almost 3-5 percent of the total cancer cases in India. According to the Indian cancer society, it is estimated that about 50,000 children and adolescents ages 0 to 19 years will be diagnosed with cancer each year in India.
