Improving affordability and effectiveness of cancer medicines
Cancer is the second leading cause of death globally, and was responsible for 8.8 million deaths in 2015. Nearly 1 in 6 deaths worldwide is due to cancer, and approximately 70% of those deaths occur in low- and middle-income countries. Managing cancer is complicated by increasing prices and insufficient benefits for patients and public health of new medicines coming to market.
To address these challenges, countries requested further guidance from WHO in 2017*, as part of an integrated approach to cancer prevention and control. In response, WHO convened an informal advisory group in April 2018. The consultation aimed to provide expert advice on the benefits and consequences of various pricing approaches and on options for improving the availability and affordability of cancer medicines; for example, national and regional strengthening of pricing strategies and policies, and building capacity to implement actions across the pharmaceutical value chain.
In parallel, WHO convened a Cancer Medicines Working Group (CMWG) to provide expert advice on issues related to the selection of cancer medicines for the WHO Essential Medicines List (EML). The establishment of the CMWG was recommended at the 2017 meeting of the WHO Expert Committee on Selection and Use of Essential Medicines, where the potential to identify thresholds of benefits for cancer medicines was discussed. The CMWG, noting the limited clinical benefit offered by many cancer medicines entering the market over the last 20 years, agreed on the usefulness and relevance of benefit scales for cancer medicines developed with patient and clinician input, and concluded that for inclusion in the EML, cancer medicines should demonstrate a mean overall survival of at least 4-6 months.
The feasibility of the preliminary recommendations from both groups is currently under assessment. Updated recommendations will be included in the technical report on affordability and accessibility of cancer medicines to the WHO Executive Board at its 144th session, and in the future deliberations of the WHO Expert Committee on Selection and Use of Essential Medicines, respectively.
* At the Seventieth World Health Assembly in 2017, Member States adopted resolution WHA70.12, Cancer prevention and control in the context of an integrated approach. As part of this resolution, the Director-General was requested “to prepare a comprehensive technical report to the Executive Board at its 144th session that examines pricing approaches, including transparency, and their impact on availability and affordability of medicines for the prevention and treatment of cancer, including any evidence of the benefits or unintended negative consequences, as well as incentives for investment in research and development on cancer and innovation of these measures, as well as the relationship between inputs throughout the value chain and price setting, financing gaps for research and development on cancer, and options that might enhance the affordability and accessibility of these medicines”.