- Design
- Retrospective observational analysis of IQVIA MIDAS sales, 2002–2023
- Population
- 41 WHO essential cancer medicines across 71 countries grouped by GDP
- Primary outcome
- Country-level uptake and standard-unit volumes
- Effect
- Complex-genomic drugs about 65% lower uptake (coefficient −0.453, 95% CI −0.562 to −0.344)
This retrospective analysis used IQVIA sales data from 71 countries and two regions to track uptake of the 41 cancer medicines added to the WHO Essential Medicines List between 2002 and 2023. Seven required complex genomic diagnostics, six immunohistochemistry and 28 neither.
At the time of listing, 44% of lower-income countries used medicines needing complex genomic testing, versus 80% for those needing only immunohistochemistry. Across all income groups, medicines needing complex genomic testing had about 65% lower uptake by volume than medicines needing no test (regression coefficient −0.453, 95% CI −0.562 to −0.344).
The finding is associational, but the message is clear for countries like India: listing a targeted drug as essential does not reach patients unless the diagnostic test is also affordable and available. Test access is part of drug access.
- When a targeted therapy is indicated, confirm the test pathway — sample handling, turnaround, cost — before planning treatment.
- Use lower-cost immunohistochemistry surrogates where they are validated.
- Advocate for companion diagnostics to be funded alongside the drugs they unlock.
- Consider patient-access programmes that bundle testing with therapy.
Why it matters
It shows that the diagnostic, not only the drug price, is a bottleneck for targeted therapy in lower-income settings.
Don't overread it
Sales data show associations, not why uptake was low; IQVIA also covers low-income countries poorly.
The statistics, in plain English
A log-scale regression coefficient of −0.453 corresponds to roughly 65% lower volume — a large and precise difference across countries.
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