Inequality and Determinants of Access to Essential Anticancer Medicines for Children in China
Author(s)
Minghuan Jiang, PhD1, Yue Ma, Master2, Jin Peng, PhD2, Yifan Wu, Master2, Mao Fu, Master2, Yao Xue Lin, PhD2.
1Department of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi'an, China, 2Department of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China.
1Department of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi'an, China, 2Department of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China.
OBJECTIVES: Cancer ranks as the leading cause of death among children and adolescents globally. We aimed to evaluate the availability of essential anticancer medicines for children in China, and quantify its inequality and social determinants.
METHODS: In total of 28 essential anticancer medicines for children were included. Drug procurement data from 30 provinces of China during the period of 2018-2023 were analyzed. Human development index (HDI) was applied to categorize different socioeconomic regions of China. HDI-related inequalities of availability were examined by concentration curve and concentration index. Linear mixed-effects model was developed to examine social determinants of availability from four dimensions recommended by the World Health Organization.
RESULTS: The annual average availability of essential anticancer medicines for children in China increased from 27.72% in 2018 to 31.38% in 2023. The annual availability in very-high HDI regions (37.87%) was significantly higher compared to that in other regions (P<0.001). Injectable medicines showed significantly higher average availability than oral medicines (36.16% vs. 15.65%), and cytotoxic medicines had greater availability compared to targeted therapies (34.29% vs. 23.29%). The concentration index decreased from 0.124 in 2018 to 0.040 in 2023, with a fluctuating downward trend from 2019 to 2023. In particular for tertiary hospitals, the concentration index decreased from 0.1316 in 2018 to 0.0425 in 2023. Drug price, the rate of children healthcare management below 7 years old, the number of public hospitals, physicians’ average inpatient bed-days, basic medical insurance fund revenue, and the proportion of total health expenditure in gross domestic product were found to be significantly associated with drug availability (P<0.05).
CONCLUSIONS: The annual availability of essential anticancer medicines for children was dramatically increasing in China, and socioeconomic-related inequalities exist with declining trend. Drug price, reliable healthcare system, and sustainable financing are pivotal factors influencing the drug availability.
METHODS: In total of 28 essential anticancer medicines for children were included. Drug procurement data from 30 provinces of China during the period of 2018-2023 were analyzed. Human development index (HDI) was applied to categorize different socioeconomic regions of China. HDI-related inequalities of availability were examined by concentration curve and concentration index. Linear mixed-effects model was developed to examine social determinants of availability from four dimensions recommended by the World Health Organization.
RESULTS: The annual average availability of essential anticancer medicines for children in China increased from 27.72% in 2018 to 31.38% in 2023. The annual availability in very-high HDI regions (37.87%) was significantly higher compared to that in other regions (P<0.001). Injectable medicines showed significantly higher average availability than oral medicines (36.16% vs. 15.65%), and cytotoxic medicines had greater availability compared to targeted therapies (34.29% vs. 23.29%). The concentration index decreased from 0.124 in 2018 to 0.040 in 2023, with a fluctuating downward trend from 2019 to 2023. In particular for tertiary hospitals, the concentration index decreased from 0.1316 in 2018 to 0.0425 in 2023. Drug price, the rate of children healthcare management below 7 years old, the number of public hospitals, physicians’ average inpatient bed-days, basic medical insurance fund revenue, and the proportion of total health expenditure in gross domestic product were found to be significantly associated with drug availability (P<0.05).
CONCLUSIONS: The annual availability of essential anticancer medicines for children was dramatically increasing in China, and socioeconomic-related inequalities exist with declining trend. Drug price, reliable healthcare system, and sustainable financing are pivotal factors influencing the drug availability.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD203
Topic Subcategory
Distributed Data & Research Networks
Disease
SDC: Pediatrics