Table 3.
Access to the 20 most frequently selected essential medicines identified by 948 oncologists, stratified by World Bank economic classification
| Overall number of responses* | Universally available† | Substantial OOP expenses‡ | Risk of catastrophic expenditure§ | Not available | |
|---|---|---|---|---|---|
| Top 20 medications in low-income and lower-middle-income countries | |||||
| Doxorubicin | 102 | 37 (36%) | 33 (32%) | 27 (27%) | 5 (5%) |
| Cisplatin | 77 | 42 (48%) | 25 (28%) | 18 (21%) | 3 (3%) |
| Cyclophosphamide | 88 | 37 (42%) | 27 (31%) | 20 (23%) | 4 (5%) |
| Carboplatin | 86 | 26 (33%) | 27 (34%) | 26 (33%) | 0 |
| Capecitabine | 74 | 18 (24%) | 27 (37%) | 26 (35%) | 3 (4%) |
| Paclitaxel | 73 | 18 (25%) | 31 (43%) | 21 (29%) | 3 (4%) |
| Docetaxel | 55 | 13 (24%) | 21 (38%) | 19 (35%) | 2 (4%) |
| Tamoxifen | 47 | 17 (36%) | 18 (38%) | 9 (19%) | 3 (6%) |
| 5-fluorouracil | 47 | 21 (45%) | 10 (21%) | 12 (26%) | 4 (8%) |
| Imatinib | 42 | 15 (36%) | 21 (50%) | 6 (14%) | 0 |
| Gemcitabine | 42 | 8 (19%) | 16 (38%) | 16 (38%) | 2 (5%) |
| Trastuzumab | 41 | 6 (15%) | 6 (15%) | 28 (68%) | 1 (2%) |
| Dexamethasone | 41 | 22 (54%) | 12 (29%) | 6 (15%) | 1 (2%) |
| Methotrexate | 37 | 16 (43%) | 12 (32%) | 6 (16%) | 3 (8%) |
| Vincristine | 39 | 19 (49%) | 7 (18%) | 9 (23%) | 4 (10%) |
| Oxaliplatin | 35 | 8 (23%) | 12 (34%) | 14 (40%) | 1 (3%) |
| Etoposide | 34 | 13 (38%) | 9 (27%) | 9 (27%) | 3 (9%) |
| Rituximab | 35 | 3 (9%) | 9 (26%) | 22 (63%) | 1 (3%) |
| Bortezomib | 28 | 6 (21%) | 12 (43%) | 7 (25%) | 3 (11%) |
| Gefitinib | 24 | 8 (33%) | 12 (50%) | 3 (13%) | 1 (4%) |
| Top 20 medications in upper-middle-income countries | |||||
| Doxorubicin | 88 | 77 (88%) | 5 (6%) | 2 (2%) | 4 (4%) |
| Pembrolizumab | 80 | 10 (13%) | 22 (28%) | 32 (40%) | 16 (20%) |
| Trastuzumab | 79 | 50 (63%) | 18 (23%) | 7 (9%) | 4 (6%) |
| Cisplatin | 74 | 65 (88%) | 6 (8%) | 2 (3%) | 1 (1%) |
| Carboplatin | 66 | 55 (83%) | 6 (9%) | 2 (3%) | 3 (5%) |
| Paclitaxel | 64 | 55 (86%) | 6 (9%) | 2 (3%) | 1 (2%) |
| Tamoxifen | 63 | 54 (86%) | 7 (11%) | 0 | 2 (4%) |
| Capecitabine | 61 | 45 (74%) | 12 (20%) | 1 (2%) | 3 (5%) |
| 5-fluorouracil | 56 | 50 (89%) | 6 (11%) | 0 | 0 |
| Docetaxel | 51 | 39 (77%) | 7 (14%) | 2 (4%) | 3 (6%) |
| Cyclophosphamide | 48 | 43 (90%) | 3 (6%) | 1 (2%) | 1 (2%) |
| Oxaliplatin | 45 | 38 (84%) | 6 (13%) | 0 | 1 (2%) |
| Abiraterone | 40 | 17 (43%) | 11 (28%) | 8 (20%) | 3 (8%) |
| Anastrozole | 30 | 24 (80%) | 4 (13%) | 0 | 2 (6%) |
| Osimertinib | 27 | 6 (22%) | 9 (33%) | 11 (41%) | 1 (4%) |
| Imatinib | 27 | 18 (67%) | 8 (30%) | 1 (4%) | 0 |
| Goserelin | 24 | 17 (71%) | 6 (25%) | 1 (4%) | 0 |
| Gemcitabine | 24 | 16 (67%) | 5 (21%) | 2 (8%) | 0 |
| Dexamethasone | 23 | 20 (87%) | 2 (9%) | 1 (4%) | 0 |
| Etoposide | 24 | 18 (75%) | 4 (17%) | 0 | 1 (4%) |
| Top 20 medications in high-income countries | |||||
| Pembrolizumab | 299 | 206 (69%) | 62 (21%) | 26 (9%) | 5 (2%) |
| Doxorubicin | 291 | 255 (88%) | 32 (11%) | 4 (1%) | 0 |
| Cisplatin | 285 | 258 (91%) | 24 (8%) | 2 (1%) | 1 |
| 5-fluorouracil | 267 | 242 (91%) | 25 (9%) | 0 | 0 |
| Paclitaxel | 268 | 234 (87%) | 31 (12%) | 3 (1%) | 0 |
| Trastuzumab | 263 | 226 (86%) | 30 (11%) | 5 (2%) | 2 (1%) |
| Carboplatin | 221 | 196 (89%) | 23 (10%) | 2 (1%) | 0 |
| Tamoxifen | 224 | 197 (88%) | 24 (11%) | 3 (1%) | 0 |
| Capecitabine | 178 | 142 (89%) | 35 (20%) | 1 (1%) | 0 |
| Oxaliplatin | 180 | 159 (88%) | 19 (11%) | 2 (1%) | 0 |
| Docetaxel | 175 | 150 (86%) | 23 (13%) | 2 (1%) | 0 |
| Dexamethasone | 173 | 162 (94%) | 8 (5%) | 2 (1%) | 1 (1%) |
| Cyclophosphamide | 172 | 151 (88%) | 19 (11%) | 2 (1%) | 0 |
| Nivolumab | 160 | 118 (74%) | 26 (16%) | 13 (8%) | 3 (2%) |
| Rituximab | 138 | 107 (78%) | 27 (20%) | 4 (3%) | 0 |
| Osimertinib | 109 | 74 (68%) | 28 (26%) | 5 (5%) | 2 (2%) |
| Imatinib | 108 | 77 (71%) | 26 (24%) | 3 (3%) | 2 (2%) |
| Letrozole | 106 | 92 (87%) | 14 (13%) | 0 | 0 |
| Gemcitabine | 105 | 88 (84%) | 16 (15%) | 1 (1%) | 0 |
| Etoposide | 105 | 99 (94%) | 5 (5%) | 0 | 1 (1%) |
Data are n or n (%). OOP=out of pocket.
Responses do not equal the number of respondents who selected the drug, since many respondents made their drug selections and exited the survey; the number of respondents is provided in this column.
Available for all patients with no substantial out-of-pocket expenses for more than 90% of patients (ie, universal health-care coverage).
Available for all patients with substantial out-of-pocket expenses for some patients, based on the health insurance schemes (mixed model, not universal health-care coverage).
Not universal health-care coverage, substantial risk of catastrophic health expenditure. Catastrophic expenditure defined as expenditure that absorbs more than 40% of total consumption net of an allowance for food expenditures.