title: Access to Cytotoxic Medicines by Children With Cancer: A Focus on Low and Middle Income Countries.
abstract: BACKGROUND
  The Essential Medicines Working Group of the International Society of Pediatric Oncology (SIOP) has proposed a list of antineoplastic drugs that should be available in low and middle income countries.
  
  
  METHODS
  Data were extracted on the listing of 18 essential and 8 ancillary antineoplastic medicines in the national essential medicines lists (NEMLs) or national reimbursable medicines lists (NRMLs) of 135 countries with gross national income (GNI) per capita of less than US $25,000. Correlations between numbers of medicines listed and GNI per capita, annual government health expenditure (AGHE) per capita, and the number of physicians per million people were examined.
  
  
  RESULTS
  Listing of the 18 essential antineoplastic drugs ranged from 27% (thioguanine) to 95% (methotrexate). The median number of medicines listed was 7 (0-18) in low income countries (n = 26) and 14 in lower-middle (n = 42), upper-middle (n = 44), and high income countries (n = 20). For the ancillary eight medicines, the median was one (0-8) across the 135 countries. Correlations with GNI per capita (r = 0.17, P = 0.0266) and physician density (r = 0.25, P = 0.0017) were statistically significant; not so for AGHE per capita (r = 0.00, P = 0.5000).
  
  
  CONCLUSIONS
  There was large variability within income groups in numbers of antineoplastic agents identified as essential in NEMLs and NRMLs. While not a direct measure of availability, listing is an important step, guiding procurement for the public sector. These results focus attention on deficits in NEMLs and NMRLs as a step to improving access to effective antineoplastic medicines for cancers in children in low and middle income countries.
authors.affiliation: Departments of Pediatrics, Pathology and Medicine, McMaster University, McMaster Children's Hospital, Hamilton, Ontario, Canada.
authors.forename: Ronald
authors.initials: R
authors.lastname: Barr
authors.affiliation: Clinical Pharmacology, School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Robertson
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics*; D002648:Child; D019049:Developed Countries / Q000191:economics; D003906:Developing Countries / Q000191:economics*; D018954:Drugs, Essential / Q000191:economics*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007182:Income; D008297:Male; D009369:Neoplasms / Q000188:drug therapy* / Q000191:economics*
chemical_list: D000970:Antineoplastic Agents; D018954:Drugs, Essential
keywords: cancer; children; countries; developing; medicines