Vast Differences Globally in Cancer Drug Retail Prices

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A pilot study revealed large differences in median retail prices for 23 cancer drugs in 7 different countries, with the highest retail prices identified in the United States and the lowest, in India and South Africa. Notably, after the monthly drug price is expressed as a percentage of domestic product per capita at purchasing power parity (GDPcapPPP), cancer drugs appear to be less affordable in low-income countries, despite the lower retail prices. The study was presented by Goldstein et al at the 2016 ASCO Annual Meeting in Chicago.1

Daniel A. Goldstein, MD

Daniel A. Goldstein, MD

“This study provides a glimpse into prices and affordability of cancer drugs around the world and sets the stage for further research,” said lead study author Daniel A. Goldstein, MD, a senior physician in medical oncology at Rabin Medical Center in Petach Tkvah, Israel. “However, the implications of our findings are limited because we were not able to take discounts and rebates into account, which would better predict drug ­affordability.”

About the Study

According to the authors, this is one of the largest analyses of differences in cancer drug prices among countries worldwide. Prior research in this field has been sporadic and based on reports on single drugs in only a few countries or regions.

The researchers calculated monthly drug doses for 15 generic and 8 patented cancer drugs used to treat a wide range of cancer types and stages. Retail drug prices in Australia, China, India, South Africa, the United Kingdom, Israel, and the United States were obtained predominantly from government websites.

GDPcapPPP is a measure of national wealth that takes into consideration the cost of living. The GDPcapPPP data for each country were obtained from the International Monetary Fund, and researchers used it to estimate the affordability of drugs.

Key Findings

The median monthly retail price ranged from $1,515 in India to $8,694 in the United States for patented drugs. For generic drugs, the median monthly retail price was the highest in the United States ($654) and lowest in South Africa ($120) and India ($159).

International Perspective on Cost of Care

  • In terms of consumers’ ability to pay, cancer drugs appeared to be most affordable in Australia. The countries with the lowest ability to pay were China and India.
  • In the United States, the cost of generics was 14% of the domestic product per capita at purchasing power parity (GDPcapPPP), and the cost of patented cancer drugs was 192% of the GDPcapPPP.

In terms of ability to pay, cancer drugs appeared to be most affordable in Australia, with monthly drug prices of 3% of the GDPcapPPP for generics and 71% of the GDPcapPPP for patented drugs. The countries with the lowest ability to pay were China and India. In China, the monthly price of generics was 48% of the GDPcapPPP and 288% for patented drugs. In India, the cost of generics was 33% of the GDPcapPPP and of 313% of the GDPcapPPP for patented drugs. In the United States, the cost of generics was 14% of the GDPcapPPP and 192% of the GDPcapPPP for patented cancer drugs. 

Study Limitations

The study did not take into account the health insurance systems in different countries. Depending on who is purchasing the medication in a given country, the government, insurance company, or patient may suffer the brunt of the burden of financial toxicity.

Dr. Goldstein concluded: “Despite having the highest GDP per capital, drugs are less affordable in the United States compared to other developed countries. Despite lower prices in low-income countries, drugs are less affordable [in low-income countries] than in other countries…. This study raises significant questions, and they are ethical economic, political, and regulatory.” ■

Disclosure: Dr. Goldstein reported no potential conflicts of interest. For full disclosures of the study authors, visit


1. Goldstein DA, Clark J, Tu Y, et al: Global differences in cancer drug prices: A comparative analysis. 2016 ASCO Annual Meeting. Abstract LBA6500. Presented June 6, 2016.