title: Selection of oncology medicines in low- and middle-income countries.
abstract: BACKGROUND
  High cancer mortality rates in low- and middle-income countries (LMICs) have raised concerns regarding access to oncology medicines. Essential medicines are those which satisfy the primary health care needs and provide a basis for public procurement or reimbursement decisions in LMICs. We explored selection of oncology medicines in LMICs through investigating national essential medicines lists (NEMLs) for cancer treatments.
  
  
  METHODS
  Recently updated NEMLs were retrieved for 76 countries. Oncology medicines were classified based on therapeutic categories. Countries were clustered based on geographic regions, income levels and burden of cancer (mortality and morbidity). Indicators of frequency (number of medicines), diversity (number of therapeutic (sub)categories) and more importantly absence were measured and compared across countries using parametric and nonparametric tests.
  
  
  RESULTS
  The overall median number of oncology medicines on NEMLs was 16 (interquartile range = 23) chosen predominantly from subcategories of 'antineoplastic agents', with substantial variation across regions and income groups. Five countries did not select any oncology medicine and 68% did not have any 'hormones and related agents' on their NEMLs. Newer technologies like targeted therapies were infrequently incorporated. The cluster of countries suffering most from the burden of cancer selected more essential oncology medicines and diversified further.
  
  
  CONCLUSIONS
  The observed selection of oncology essential medicines can reflect insufficiencies and inequalities in access to cancer treatments at least in the public sector of LMICs. Further resources need to be allocated from governments and international organizations to tackle the problem of access to oncology medicines in these countries.
authors.affiliation: Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht.
authors.forename: Y T
authors.initials: YT
authors.lastname: Bazargani
authors.forename: A
authors.initials: A
authors.lastname: de Boer
authors.forename: J H M
authors.initials: JH
authors.lastname: Schellens
authors.forename: H G M
authors.initials: HG
authors.lastname: Leufkens
authors.forename: A K
authors.initials: AK
authors.lastname: Mantel-Teeuwisse
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D003657:Decision Making; D003906:Developing Countries; D006801:Humans; D008495:Medical Oncology; D009026:Mortality; D009369:Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D011203:Poverty
chemical_list: D000970:Antineoplastic Agents
keywords: access to medicines; essential medicines; low and middle income countries; oncology medicines; selection