NEW DELHI : Despite India being the largest manufacturer of generic medicines in the world, there is a lack of availability of essential anti-cancer drugs for treating childhood cancers. Findings of a new study have revealed that availability of these anti-cancer drugs in both public and private sector pharmacies in the national capital New Delhi is far below the World Health Organization’s (WHO) prescribed standards.

The study titled ‘Evaluating access to essential medicines for treating childhood cancers: a medicines availability, price and affordability study in New Delhi, India’ was led by the George Institute for Global Health in collaboration with the University of Sydney, Cankids India, Max Super Speciality Hospital, and Boston University School of Public Health.

The study published in the British Medical Journal (BMJ) Global Health -- used a modified WHO/Health Action International methodology to collect data on availability and price of 33 strength-specific anti-cancer essential medicines and four non-cancer essential medicines. Seven hospitals – four public and three private -- and 32 private-sector retail pharmacies were surveyed. Median prices were calculated by comparing consumer prices with international reference prices. On an average, the mean availability of essential anti-cancer medicines in the survey hospitals and retail pharmacies combined was 70%, in retail pharmacies it was 38%, in public hospital pharmacies 43% and in private hospital pharmacies it was 71%.

“Mean availability of essential anti-cancer medicines across all hospitals and pharmacies surveyed was less than the WHO’s target of 80%. Low availability and poor affordability of anti-cancer essential medicines highlight the need to streamline public sector and private sector medicine procurement and supply systems," said Neha Faruqui, principal author of the study from the George Institute for Global Health. “Government insurance schemes and discount pharmacy initiatives should expand the inclusion of essential anti-cancer medicines, as a way towards limiting the catastrophic out-of-pocket expenditure associated with cancer treatment," she said.

The study found that only three anti-cancer essential medicines were available on the Jan Aushadhi website. The prices of Jan Aushadhi prices are much lower than retail pharmacies but compared to public-sector procurement prices, a patient would pay two times and 2.9 times for anti-cancer and non-cancer medicines in the private-sector. Therefore, initiatives to improve public-sector medicines availability are needed, the researchers said.

“Availability is low in the capital city of India which can be considered the best case scenario for access to anti-cancer medicines. We don’t expect availability to be higher in other states," said Rohina Joshi, associate professor at University of Sydney.

Medicine prices were relatively low in Delhi compared with international reference prices. However, the cost of chemotherapy medicines seems unaffordable in the local context. “When calculated using the lowest (and most-sold) generic price offered in pharmacies, the estimated cost of chemotherapy medicines needed for treating a 30 kg child with standard risk leukaemia was 27,850 and 17,500 for early stage Hodgkin’s lymphoma, requiring 88 and 55 days’ wages, respectively, for the lowest paid government worker," said Ramandeep Arora, paediatric oncologist. “If the patient/family is not offered any pharmacy discount and had to buy the same medicines at maximum retail price, they require an extra 12 days’ wages for both diseases," he said.