The report ‘Medicines, vaccines and health products: Cancer medicines’ was published in November 2018. Data for the report was gathered using a wide-ranging literature review, as well as stakeholder consultations and expert review, and examined pricing approaches adopted by the pharmaceutical industry and authorities responsible for the pricing of medicines.

WHO investigated the impact of pricing approaches (or lack thereof) on the price, availability and affordability of cancer medicines. It examined the possible relationship between pricing approaches and:

(a)  research and development of cancer medicines, including incentives for investment in research and development on cancer and in innovation of these measures, as well as possible gaps in undertaking research and development (that is, a possible shortfall in funding or activities in certain areas of cancer research);
(b)  transparency in price and governance; and
(c)  benefits and unintended negative consequences that would deviate from the original policy intent.

WHO found that cancer drugs remain costly even in countries with strict drug pricing regulations. In fact, it found that universal coverage of cancer medicines alone, at 2018 prices, would greatly exceed a generously assumed budget of 5% of the total healthcare expenditure. This means that cancer treatment remains unaffordable for many patients worldwide, who lack adequate insurance coverage. For example, a course of standard treatment for early stage human epidermal growth factor receptor 2 positive (HER2+) breast cancer (doxorubicin, cyclophosphamide, docetaxel, trastuzumab) would cost about 10 years of average annual wages in India and South Africa and 1.7 years in the US.

Evidence on whether greater price transparency would lead to higher or lower medicine prices was inconclusive. Whereas the report found that initiatives such as value-based pricing, due to the many uncertainties associated with estimating value, ‘may lead to unaffordable prices for cancer medicines’.

Cancer is one of the world’s greatest global health challenges, with a rising burden estimated to have risen to 18.1 million new cases and 9.6 million deaths in 2018. However, the lack of access to vital cancer treatment is highlighted by the sharp differences in survival rates for high-income and lower-income countries. In high-income countries over 80% of children diagnosed with cancer will be cured of the disease. In contrast, in low- and middle-income countries cure rates as low as 10% have been observed among children diagnosed with cancer.

The report concluded that ‘overall, the analysis suggests that the costs of research and development and production may bear little or no relationship to how pharmaceutical companies set prices of cancer medicines’. In fact, WHO says that ‘pharmaceutical companies set prices according to their commercial goals, with a focus on extracting the maximum amount that a buyer is willing to pay for a medicine’. This pricing approach, according to the association, ‘often makes cancer medicines unaffordable, preventing the full benefit of the medicines from being realized’.

To tackle the rising prices of cancer drugs, WHO suggests other possible ways to enhance accessibility and affordability. These include short-term projects such as ‘managed-entry agreements’ or ‘risk-share agreements’ and medium- to long-term efforts such as promoting competition through harmonizing regulatory requirements for biosimilars.

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