{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T16:22:08Z","timestamp":1776270128205,"version":"3.50.1"},"reference-count":60,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2020,11,10]],"date-time":"2020-11-10T00:00:00Z","timestamp":1604966400000},"content-version":"unspecified","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2020,8,28]]},"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Low-income and middle-income countries (LMICs) face the largest burden of mortality from childhood cancers with limited access to curative therapies. Few comparative analyses across all income groups and world regions have examined the availability and acquisition costs of essential medicines for treating cancers in children.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A cross-sectional survey involved countries in five income groups\u2014low-income (LIC), lower-middle-income (LMC), upper-middle-income (UMC), two high-income country groups (HIC1, HIC2). Physicians and pharmacists reported institutional use, availability, stock outs and prices (brand and generic products) of 34 essential medicines. Price comparisons used US$, applying foreign exchange rates (XR) and purchasing power parity (PPP) adjustments. Medicine costs for treating acute lymphoblastic leukaemia (ALL), Burkitt lymphoma (BL) and Wilms tumour (WT) were calculated (child 29\u2009kg, body surface area 1\u2009m<jats:sup>2<\/jats:sup>). Comparisons were conducted using non-parametric Kruskal-Wallis tests.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Fifty-eight respondents (50 countries) provided information on medicine use, availability and stock outs, with usable price data from 42 facilities (37 countries). The extent of use of International Society of Paediatric Oncology core and ancillary medicines varied across income groups (p&lt;0.0001\u2009and p=0.0002 respectively). LMC and LIC facilities used fewer medicines than UMC and HIC facilities. UMC and LMC facilities were more likely to report medicines not available or stockouts.<\/jats:p>\n                  <jats:p>Medicine prices varied widely within and between income bands; generic products were not always cheaper than brand equivalents. PPP adjustment showed relatively higher prices in UMC and LMC facilities for some medicines. Medicine costs were highest in HICs for ALL (p=0.0075\u2009XR; p=0.0178 PPP-adjusted analyses) and WT (p =&lt;0.0001\u2009XR; p=0.0007 PPP-adjusted). Medicine costs for BL were not significantly different.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Problems with the availability of essential medicines, dependable supply chains, confidential medicine prices and wide variability in treatment costs contribute to persistent challenges in the care of children with treatable cancers, especially in LMICs.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2020-003282","type":"journal-article","created":{"date-parts":[[2023,2,20]],"date-time":"2023-02-20T05:50:20Z","timestamp":1676872220000},"page":"e003282","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Shortages and price variability of essential cytotoxic medicines for treating children with cancers"],"prefix":"10.1136","volume":"5","author":[{"given":"Yehoda M","family":"Martei","sequence":"first","affiliation":[{"name":"Hematology \u2013 Oncology Division, University of Pennsylvania, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kotoji","family":"Iwamoto","sequence":"additional","affiliation":[{"name":"Health Technology and Pharmaceuticals Programme, World Health Organization Regional Office for Europe, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronald D","family":"Barr","sequence":"additional","affiliation":[{"name":"Pediatric Haematology\/Oncology, McMaster University and McMaster Children's Hospital, Hamilton, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John T","family":"Wiernkowski","sequence":"additional","affiliation":[{"name":"Pediatric Haematology\/Oncology, McMaster University and McMaster Children's Hospital, Hamilton, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4330-2829","authenticated-orcid":false,"given":"Jane","family":"Robertson","sequence":"additional","affiliation":[{"name":"Health Technology and Pharmaceuticals Programme, World Health Organization Regional Office for Europe, Copenhagen, Denmark"},{"name":"Clinical Pharmacology, University of Newcastle, Waratah, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,11,10]]},"reference":[{"key":"2025073012560424000_5.11.e003282.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(13)70008-1"},{"key":"2025073012560424000_5.11.e003282.2","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1002\/pbc.24858","article-title":"Beyond the bench and the bedside: economic and health systems dimensions of global childhood cancer outcomes","volume":"61","author":"Denburg","year":"2014","journal-title":"Pediatr Blood Cancer"},{"key":"2025073012560424000_5.11.e003282.3","doi-asserted-by":"crossref","first-page":"e185","DOI":"10.1016\/S1470-2045(20)30022-X","article-title":"Sustainable care for children with cancer: a Lancet oncology Commission","volume":"21","author":"Atun","year":"2020","journal-title":"Lancet Oncol"},{"key":"2025073012560424000_5.11.e003282.4","unstructured":"Johnson LM . 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