Despite considerable progress in the discovery and development of new cancer drugs between 1990 and 2022, there may be disparities in both the availability and timeliness of these treatment options globally, particularly among lower-income countries, according to a recent study published by Li et al in BMJ Global Health.
Background
Previous research on country differences in the availability of new cancer drugs has typically focused on one region of the world and included only a small sample of drugs.
Study Methods and Results
In the recent study, investigators used data from Pharmaprojects, a database that tracks global pharmaceutical research and development activities across more than 150 countries, to analyze the availability of all commercially developed cancer drugs from 1990 to the end of 2022—with the goal of broadening the understanding of international disparities in the availability and timeliness of the drugs. They focused on the first launch of a new cancer drug in each county, irrespective of its therapeutic indication, as well as the date the drug first became available for treatment in that country.
The investigators then used data from the World Bank to group countries according to population size; Gross National Income (GNI), a proxy for ability and willingness to pay; Gini index, a measure of inequalities in income distribution; and the number of physicians per 1,000 individuals. To quantify the need for cancer drugs, they extracted crude cancer incidence rates for each country from the Global Cancer Observatory.
During the study period, 568 new cancer drugs were launched worldwide. The investigators incorporated a total of 4,184 drug launches or regulatory approvals for these cancer drugs in 111 countries into the analysis. They approximated the dates of about 27% (n = 1,115) of these drug launches. More than 50% of the drugs were launched in the past decade, with 20% launched between 2013 and 2017 and 35% launched between 2018 and 2022 compared with 22% launched from 2003 to 2012 and 18% launched from 1993 to 2002. By December 31, 2022, 35% of the 568 drugs had been launched in only one country, 22% had been launched in two to five countries, and 43% had been launched in more than five countries.
However, the number of new cancer drug launches varied substantially depending on the region. For instance, those with the most launches were high-income regions such as North America, Western Europe, East Asia, and Australia. Regions with the fewest drug launches included Africa, Southeast Asia, the Middle East and Central Asia, and Eastern Europe—considered low- and middle-income regions.
The investigators found that few new cancer drugs were launched in lower middle– or low-income countries and that the gap between higher- and lower-income countries widened over the course of the study period. These inequities in access to cancer therapy may help to explain poorer cancer outcomes in many lower-income countries.
At the country level, the number of new cancer drugs launched ranged from 0 to 345. Countries with the highest number of launches included the United States (n = 345), Japan (n = 224), Canada (n = 221), Australia (n = 204), the United Kingdom (n = 191), and China (n = 169).
Differences in the number of cancer drugs launched between higher- and lower-income countries also widened over time. The average number of new cancer drug launches each year increased from 0.5 in the early 1990s to 8.7 in 2022 in high-income countries, whereas the equivalent figures were 0.1 to 1.5 per year in upper middle–income countries and minimal among lower middle– and low-income countries.
Long delays in drug launches following a global launch occurred in many countries. Average delays between the first global launch and the second, third, fourth, and fifth launches shortened over time: 20, 26, 38, and 44.5 months, respectively, from 1990 to 1999; and 16, 21.5, 29, and 37 months, respectively, from 2010 to 2022. Nearly half (45%) of the cancer drugs were first launched in the United States, followed by nearly 11% in China; just over 10% in the United Kingdom, Germany, France, Italy, and Spain; and just under 9% in Japan. The investigators uncovered that a higher GNI and cancer incidence were associated with more launches and shorter launch delays.
“Fewer launches and longer launch delays of anticancer [drugs] may have contributed to the disproportionally high cancer morbidity and mortality in [low- to middle-income countries]. Previous research has shown that although overall incidence was lower in [these countries], mortality-to-incidence ratios were significantly higher, especially among women,” detailed the study authors.
Conclusions
“Without timely access to effective treatments, this disparity is expected to worsen as cancer incidence is projected to increase much faster in [lower- to middle-income] than in [high-income countries], driven by demographic changes and increasing risk factors associated with a growing economy,” the study authors emphasized.
The investigators acknowledged several limitations of their study, including that both cancer drug launches and regulatory approvals were used as proxies for availability. No information on drug prices was available, and pricing may have a role in the timing of a cancer drug launch.
“Despite considerable progress in the discovery and development of new cancer [drugs] in recent decades, many of these [treatments] remained unavailable many years after their first global launch or were only available after long delays, especially in the lower-income parts of the world,” the study authors stressed. “This disparity underscores the need for policy solutions to provide more equitable access to cancer [drugs] globally,” they concluded.
Disclosure: For full disclosures of the study authors, visit gh.bmj.com.
