- Design
- Retrospective observational study of sales data
- Population
- 41 essential cancer medicines in 71 countries, 2002–2023
- Primary outcome
- Uptake by diagnostic requirement and country income
- Effect
- Genomic-test-dependent medicines ~65% lower uptake (coefficient −0.453)
An observational study in The Lancet Oncology (25 September) tracked uptake of 41 cancer medicines added to the WHO Essential Medicines List between 2002 and 2023, across 71 countries grouped by income, using commercial sales data.
Medicines requiring complex genomic testing had about 65% lower uptake than those needing no diagnostic test. At listing, 44% of lower-income countries used genomic-test-dependent medicines, against 80% for those needing only immunohistochemistry. Volumes were lower in lower-income countries across every group.
For oncologists in middle-income settings, the message is practical: a drug's place on an essential list does not mean patients can get the test that makes them eligible.
- Genomic-test-dependent medicines had about 65% lower uptake
- Fewer than half of lower-income countries used them at listing
- Immunohistochemistry-dependent medicines were far more widely used
- Plan testing pathways alongside drug access when adopting precision oncology
Why it matters
Essential-medicine listing alone may not reach patients when a costly test stands in the way.
Don't overread it
Sales data show associations, not why uptake was lower.
The statistics, in plain English
A regression coefficient of −0.453 on a log scale translates to roughly 65% lower volumes; the 95% CI (−0.562 to −0.344) shows the association is consistent.
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