Medicine availability and affordability for paediatric cancers, China.

Objective: To investigate access to essential anticancer medicines for children throughout China.

Methods: We obtained cross-sectional drug use data for 2021 from 55 tertiary children's hospitals in seven geographical regions (one third of public children's hospitals in mainland China). Affordability was assessed by comparing the single-day copayment for each medicine with the same generic name and route of administration (i.e. product) or for a treatment course with daily disposable income per capita in each region. The median availability and affordability of all 33 anticancer medicines in the 2021 WHO Model list of essential medicines for children were calculated and compared by region and medicine type.

Findings: Although all medicines had been approved in China, 14 (42.4%) were available in under 50% of hospitals and six (18.2%) products had a median single-day copayment exceeding daily disposable income. Median availability was higher among the 19 medicines with approval for paediatric indications than among the 14 without (80.0% versus 48.2%, respectively; P < 0.001). Overall, 42.4% (14/33) of medicines had both good availability and affordability; the lowest proportion was in north-west China (30.3%, 10/33). A Chinese resident needed to work for 5.3 days to afford 4 weeks' induction therapy for acute lymphoblastic leukaemia, the most common childhood cancer.

Conclusion: Access to essential anticancer medicines for children remained suboptimal in China and varied across regions. Fewer than half the medicines studied had both good availability and affordability. Actions are warranted to address potential shortages and decrease the financial burden on families.