The World Health Organization’s recent additions of cancer medicines to its essential medicines list lack robust economic evidence for African countries, despite widespread adoption across the continent, according to new research published in BMJ Global Health.
Limited Economic Evidence for WHO Cancer Medicine Recommendations
Percentage of WHO cancer medicine modifications with economic data, 2017-2023
Source: BMJ Global Health, 2024 | Georgian Medical Journal News
Systematic Analysis Reveals Evidence Gaps
Researchers systematically examined 160 modifications to cancer medicines on the WHO Model Lists of Essential Medicines between 2017 and 2023, according to the BMJ Global Health study. The analysis, conducted across 46 African low-income and lower middle-income countries, found significant gaps in economic justification for these recommendations.
The study assessed both the availability of economic evidence and its transferability to African contexts. According to the WHO’s essential medicines program, these lists guide national medicine selection policies, particularly in resource-constrained settings where economic considerations are paramount.
Of the economic evidence that did exist, all identified cost-effectiveness studies showed low transferability to African LMIC settings, according to the BMJ Global Health study, raising questions about the practical utility of existing research for policy-making in these contexts. For more analysis on health policy implications, recent coverage has highlighted similar evidence gaps.
Low Adoption Rates Across African Countries
Despite the WHO recommendations, adoption of new cancer medicines into National Essential Medicines Lists remained limited across African countries. The BMJ Global Health research team analyzed 23 national lists and 6 pediatric lists available from 2019 to 2024.
Median adoption reached only 23% for adult national lists and 13% for pediatric lists, according to the study findings, suggesting that countries may be exercising caution in the face of limited economic evidence. This pattern aligns with findings from other global health initiatives where resource constraints influence policy implementation.
Implications for Global Health Policy
The findings raise broader questions about the WHO’s evidence requirements for essential medicine recommendations. The BMJ Global Health study suggests that current processes appear to prioritize clinical efficacy over economic considerations, potentially limiting the practical value of recommendations for resource-constrained settings.
According to research published in health economics journals, robust economic evaluation is crucial for sustainable healthcare policy in low-income settings. The BMJ Global Health study authors argue for stronger requirements for context-specific economic evaluations in WHO decision-making processes.
This evidence gap is particularly concerning given the rising burden of cancer in African countries, where treatment costs can represent catastrophic expenditure for patients and healthcare systems. The WHO estimates that cancer incidence in Africa will double by 2040, making affordable access to effective treatments increasingly critical.
Recent WHO cancer medicine modifications are rarely supported by robust, context-specific economic evidence, yet several have been adopted in African LMICs
— Study authors, BMJ Global Health (2024)
Key takeaways
- Only 11% of WHO cancer medicine recommendations included cost data, with 9% having cost-effectiveness evidence (BMJ Global Health study)
- All existing cost-effectiveness studies showed low transferability to African LMIC contexts (BMJ Global Health study)
- Median adoption rates remained low at 23% for national lists and 13% for pediatric lists (BMJ Global Health study)
Frequently asked questions
What are WHO essential medicines lists?
The WHO Model Lists of Essential Medicines guide national medicine selection policies, particularly in low-income countries. These lists identify the most effective, safe and cost-effective medicines for priority conditions.
Why is economic evidence important for African countries?
African healthcare systems operate under severe budget constraints, making cost-effectiveness crucial for sustainable policy decisions. Without local economic data, countries cannot adequately assess whether recommended treatments are affordable or represent good value for money.
How could WHO improve its recommendation process?
The BMJ Global Health study authors suggest implementing stronger requirements for economic evaluations that are relevant to LMIC contexts. This would include cost-effectiveness studies conducted in similar healthcare settings with comparable resource constraints.
The BMJ Global Health research highlights the need for WHO to strengthen its economic evidence requirements to ensure recommendations are both clinically sound and economically viable for the countries most reliant on these guidance documents. As cancer rates continue rising across Africa, bridging this evidence gap becomes increasingly urgent for effective health system planning.
Source: Weak economic evidence for WHO’s essential cancer medicines for Africa
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Medically reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD. Spotted an error? Contact the editorial team.
