Availability of WHO Essential Medicines for Cancer Treatment in Botswana

Abstract

PurposeStock outs of cancer drugs are potentially fatal but have not been systematically studied in low- and middle-income countries. The aim of this study was to determine the availability and alignment of the Botswana National Essential Medicines List (NEML) for cancer drugs with the WHO’s Essential Medicines List (EML).MethodsThe availability and cost of cancer drugs were analyzed using data from a weekly stock catalog sent by Botswana’s Central Medical Store to all pharmacy departments in government hospitals. Comparative data were extracted from the WHO EML and the “International Drug Price Indicator Guide-2014” from the Management Sciences for Health. Interviews with key informants were used to collect data on the Botswana NEML and the drug supply chain in the public sector.ResultsThe 2015 Botswana NEML for cancer had 80.5% alignment with the WHO EML. At least 40% of essential drugs were out of stock for a median duration of 30 days in 2015. Stock outs affected chemotherapy drugs included in first-line regimens for treating potentially curable diseases such as cervical, breast, and colorectal cancer and were not associated with buyer price of therapy. Analyses showed that the median price ratio for procured drugs was greater than 1 for 61% of the NEML drugs, which suggests inefficiency in procurement in the public sector.ConclusionsBotswana has one of the highest alignments of NEML to the WHO EML in the sub-Saharan African region, which is consistent with investment in the health care system evident in other clinical spheres. Better quantification of chemotherapy requirements using data from the National Cancer Registry and resource-sensitive treatment guidelines can help reduce stock outs and facilitate more effective and efficient procurement processes.

Enhancing global access to cancer medicines

“…It would also allow other cancer medicines to be considered for inclusion on the World Health Organization Model Lists of Essential Medicines. Table describes some methods to help reduce cancer medicine prices …”

“…To optimize outcomes, evidence‐based, economically wise practice must be emphasized throughout the cancer care process, from diagnosis and prescribing to dispensing and administration. Systems should be in place to identify and address problematic cancer medicine use (eg, tracking local and national cancer medicine use to forecast future use, purchase, and budgets and to prevent stock shortages that cause missed treatment) …”

“…Table 4 describes some methods to help reduce cancer medicine prices. 8,24,28,30,[42][43][44][45][46][47][48][49][50][51][52] Although a combination of these methods can continue to be used, recent publications suggest that further change is required. 28,30 Building on the work of others, we propose that an international body comprising representatives from the pricing authorities of all countries is convened.…”

“…Systems should be in place to identify and address problematic cancer medicine use (eg, tracking local and national cancer medicine use to forecast future use, purchase, and budgets and to prevent stock shortages that cause missed treatment). 28,44 Locally adapted cancer treatment guidelines that take account of available resources can help to improve affordability. For instance, the cost of diagnosing and treating a child with Hodgkin lymphoma was lower in Rwanda than in South Africa because radiotherapy and computed tomography scans were not standard components of care in Rwanda due to a lack of availability, chemotherapy costs were lower, and care was provided by generalists with support from volunteer US-based oncologists.…”

Global Collaborations for Cervical Cancer: Can the East–West Alliance Facilitate Treatment for all?

“…Adequate infrastructure and health workers are also needed to manage acute complications of treatment administration. A recent study on the availability of WHO essential medicines reported frequent unavailability of cisplatin in some countries in Africa [32]. In other high incidence countries where drugs are available and subsidised for patients below the poverty line, approvals may be needed for weekly cycles [33], leading to delays in the implementation of an effective concurrent chemoradiation schedule.…”