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Evaluating access to essential medicines for treating childhood cancers: a medicines availability, price and affordability study in New Delhi, India
  1. Neha Faruqui1,2,
  2. Alexandra Martiniuk1,2,
  3. Abhishek Sharma3,4,
  4. Chanchal Sharma5,
  5. Bhumika Rathore6,
  6. Ramandeep Singh Arora6,7,
  7. Rohina Joshi1,2
  1. 1School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  2. 2The George Institute for Global Health, Sydney, New South Wales, Australia
  3. 3Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
  4. 4Precision Health Economics, Boston, Massachusetts, USA
  5. 5Independent researcher, New Delhi, India
  6. 6Cankids NGO, New Delhi, India
  7. 7Max Super Speciality Hospital, New Delhi, India
  1. Correspondence to Neha Faruqui; neha.faruqui{at}


Introduction Limited access to essential medicines (EMs) for treating chronic diseases is a major challenge in low-income and middle-income countries. Although India is the largest manufacturer of generic medicines, there is a paucity of information on availability, price and affordability of anti-neoplastic EMs, which this study evaluates.

Methods Using a modified WHO/Health Action International methodology, data were collected on availability and price of 33 strength-specific anti-neoplastic EMs and 4 non-cancer EMs. Seven ‘survey anchor’ hospitals (4 public and 3 private) and 32 private-sector retail pharmacies were surveyed. Median price ratios (MPRs) were calculated by comparing consumer prices with international reference prices (IRPs).

Results On average, across survey anchor areas (hospital and private-sector retail pharmacies combined), the mean availability of anti-neoplastic EMs and non-cancer medicines was 70% and 100%, respectively. Mean availability of anti-neoplastic EMs was 38% in private-sector retail pharmacies, 43% in public hospital pharmacies and 71% in private hospital pharmacies. Median MPR of lowest-priced generic versions was 0.71 in retail pharmacies. The estimated cost of chemotherapy medicines needed for treating a 30 kg child with standard-risk leukaemia was INR 27 850 (US$442) and INR 17 500 (US$278) for Hodgkin’s lymphoma, requiring 88 and 55 days’ wages, respectively, for the lowest paid government worker.

Conclusion Most anti-neoplastic EMs are found in survey anchor areas, however, mean availability was less than non-cancer medicines; not meeting the WHO target of 80%. Medicine prices were relatively low in New Delhi compared with IRPs. However, the cost of chemotherapy medicines seems unaffordable in the local context.

  • essential medicines
  • medicines access
  • childhood cancer
  • generic medicines
  • pharmacies
  • India

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  • Handling editor Sanni Yaya

  • Contributors NF and RJ conceived the study idea. NF, RJ, RSA, AS and AM developed the research methodology with inputs from BR. NF, RSA, AS and CS planned the field survey. NF and CS conducted the data collection. NF, RSA, AS and RJ conducted the data analyses and interpretation of the results with contribution by AM and BR. NF drafted the first manuscript. NF, RJ, RSA, AS and AM revised and edited the subsequent versions of the manuscript to its final stages and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The views expressed in this article are of the authors and not necessarily of the institutions that they represent.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval for the study was obtained from The Institutional Ethics Committee for Health Related Research, Delhi, India.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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