- Design
- Retrospective observational study using IQVIA MIDAS sales data, 2002 to 2023
- Population
- 41 essential cancer medicines across 71 countries and two regions (lower, middle and high GDP groups)
- Primary outcome
- Number of countries with uptake and standard-unit uptake by diagnostic requirement
- Effect
- Medicines requiring complex genomic diagnostics had 65% lower uptake (coefficient -0.453, 95% CI -0.562 to -0.344)
This retrospective analysis looked at 41 cancer medicines added to the WHO Model List of Essential Medicines between 2002 and 2023 and tracked uptake in 71 countries and two regions using IQVIA sales data. Medicines were grouped by whether they need immunohistochemistry (6 medicines), complex genomic diagnostics (7) or neither (28). Countries were split into lower, middle and high GDP groups.
At the time of listing, 80% of lower-GDP countries used medicines requiring immunohistochemistry, 44% those requiring complex genomics and 64% those with no diagnostic requirement. In middle-GDP countries the figures were 96%, 71% and 88%, and in high-GDP countries 100%, 79% and 96%. Volumes were much lower in lower-GDP countries across all groups. Across all income groups, medicines needing complex genomic diagnostics had on average 65% lower uptake (regression coefficient -0.453, 95% CI -0.562 to -0.344).
The authors state these are associations and not causes. Sales data measure uptake, not appropriate use or access by patients. The finding suggests that listing a drug as essential does not by itself deliver it to patients when the test required is costly or unavailable.
- Know which tests your centre can do reliably (immunohistochemistry, targeted panels) and which need referral.
- Plan sample handling and send-out routes so tissue is not lost to inadequate fixation or storage.
- Prioritise molecular testing where a positive result changes treatment and the drug is accessible.
- Discuss costs of both the test and the drug with patients early.
Why it matters
It shows that diagnostics, not only drug prices, can be a barrier to access.
Don't overread it
The authors describe associations rather than causes; sales data measure volume of uptake, not whether patients received appropriate treatment.
The statistics, in plain English
The regression coefficient (-0.453) is on a transformed scale, and the authors report it as about 65% lower average uptake for drugs needing complex genomic tests. This is an association across drugs and countries, and does not account for price, disease prevalence or reimbursement.
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