{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T15:43:07Z","timestamp":1789918987156,"version":"4.0.1"},"reference-count":59,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2023,5,3]],"date-time":"2023-05-03T00:00:00Z","timestamp":1683072000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>In Ghana, prices for cancer medicines are characterized by high retail markups, forex fluctuations and high variation in prices of medicines. Most patients cannot afford the cancer medicines. There is a problem of unaffordability and limited availability of essential cancer medicines which suggests potential inequity in patient access to cancer medicines. The study objective was to assess the prices, availability, and affordability of cancer medicines in Ghana. Prices of cancer medicines are a major contributor to the cost of treatment for cancer patients and the comparison of these cost was assessed to determine the affordability.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Method<\/jats:title>\n<jats:p>The methods developed and standardized by the World Health Organization (WHO) in collaboration with the Health Action International (HAI), was adapted and used to measure prices, availability, and affordability of cancer medicines in Ghana. The availability of cancer medicines was assessed as percentage of health facilities stocked with listed medicines. The price of cancer medicines (of different brands as well as the same medicine manufactured by different pharmaceutical industries) available in the public hospitals, private hospitals, and private pharmacies was assessed, and the percentage variation in prices was calculated. Medicine prices were compared with the Management Sciences Health\u2019s International Reference Prices to obtain a Median Price Ratio (MPR). The affordability of cancer medicines was determined using the treatment cost of a course of therapy for cancer conditions in comparison with the daily wage of the unskilled Lowest-Paid Government Worker.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Overall availability of cancer medicines was very low. The availability of Lowest Priced Generic (LPG) in public hospitals, private hospitals, and private pharmacies was 46%, 22%, and 74% respectively. The availability of Originator Brand (OB) in public hospitals, private hospitals, and private pharmacies was 14%, 11%, and 23% respectively. The lowest median price [United States Dollars (USD)] for the LPG was 0.25, and the highest median price was 227.98. For the OB, the lowest median price was 0.41 and the highest median price was 1321.60. The lowest and highest adjusted MPRs of OBs and LPGs was 0.01 and 10.15 respectively. Some prices were 20.60 times more expensive. Affordability calculations showed that patients with colorectal and multiple myeloma cancer would need 2554 days wages (5286.40 USD) and 1642 days wages (3399.82 USD) respectively to afford treatment.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The availability of cancer medicines was very low, and less than the WHO target of 80%. There were considerable variations in the prices of different brands of cancer medicines, and affordability remains suboptimal, as most patients cannot afford the cancer medicines. Comprehensive policies, regulations and multifaceted interventions that provides tax incentives, health insurance, and use of generics to improve cancer medicines availability, prices, and affordability, for the masses should be developed and implemented in Ghana.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0279817","type":"journal-article","created":{"date-parts":[[2023,5,3]],"date-time":"2023-05-03T17:38:35Z","timestamp":1683135515000},"page":"e0279817","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":20,"title":["A comprehensive survey of cancer medicines prices, availability and affordability in Ghana"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1596-2670","authenticated-orcid":true,"given":"Phyllis","family":"Ocran Mattila","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard Berko","family":"Biritwum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaheer Ud-Din","family":"Babar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,5,3]]},"reference":[{"key":"pone.0279817.ref001","article-title":"Global Cancer Observatory: Cancer Today","author":"J Ferlay","year":"2020","journal-title":"Lyon: International Agency for Research on Cancer"},{"key":"pone.0279817.ref002","author":"World Health Organization","year":"2021","journal-title":"Facts Sheet"},{"key":"pone.0279817.ref003","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s40545-020-00288-2","article-title":"Ten recommendations to improve pharmacy practice in low and middle-income countries (LMICs).","volume":"14","author":"ZUD Babar","year":"2021","journal-title":"J of Pharm Policy and Pract"},{"key":"pone.0279817.ref004","article-title":",, Ng\u2019ang\u2019a A, et al.","author":"J Dent","year":"2017","journal-title":"Africa\u2019s Emerging Cancer Crisis: A Call to Action"},{"key":"pone.0279817.ref005","volume-title":"Pricing of Cancer Medicines and its Impacts: A Comprehensive Technical Report for the World Health Assembly Resolution 70.12: Operative Paragraph 2.9 on Pricing Approaches and Their Impacts on Availability and Affordability of Medicines.","author":"World Health Organization","year":"2018"},{"key":"pone.0279817.ref006","volume-title":"The State of Oncology in Africa 2015.","author":"Medical Oncology in Africa.","year":"2016"},{"issue":"11","key":"pone.0279817.ref007","doi-asserted-by":"crossref","first-page":"2633","DOI":"10.1093\/annonc\/mdx521","article-title":"ESMO International Consortium Study on the availability, out-of-pocket costs, and accessibility of antineoplastic medicines in countries outside of Europe.","volume":"28","author":"NI Cherny","year":"2017","journal-title":"Ann Oncol."},{"key":"pone.0279817.ref008","doi-asserted-by":"crossref","first-page":"735","DOI":"10.2471\/BLT.15.163998","article-title":"Essential medicines for cancer: WHO recommendations and national priorities","volume":"94","author":"J. Robertson","year":"2016","journal-title":"Bull World Health Organ"},{"key":"pone.0279817.ref009","unstructured":"Ministry of Health Facilities, Ghana. Available from: https:\/\/en.wikipedia.org\/wiki\/List_of_hospitals_in_Ghana. Accessed 25 November 2022."},{"key":"pone.0279817.ref010","unstructured":"Minimum Wage. Available from: Ghana\u2019s National Daily Minimum Wage for 2021 is GH\u00a212.53 | News Ghana. Accessed 02 August 2021."},{"key":"pone.0279817.ref011","unstructured":"Ghana National Health Insurance Scheme. Available from: http:\/\/www.nhis.gov.gh\/ Accessed 25 September 2021."},{"key":"pone.0279817.ref012","volume-title":"The State of Oncology in Africa 2015.","author":"V Vanderpuye","year":"2016"},{"key":"pone.0279817.ref013","author":"ZUD Babar","year":"2018","journal-title":"Equitable Access to High-Cost Pharmaceuticals (1st Edition)."},{"key":"pone.0279817.ref014","volume-title":"Ministry of Health","year":"2017"},{"key":"pone.0279817.ref015","volume-title":"Standard Treatment Guidelines, Seventh Edition (7th), 2017.","author":"Ghana National Drugs Programme","year":"2017"},{"key":"pone.0279817.ref016","volume-title":"Ministry of Health","author":"Ghana National Medicines Policy","year":"2017"},{"key":"pone.0279817.ref017","doi-asserted-by":"crossref","first-page":"628744","DOI":"10.3389\/fpubh.2021.628744","article-title":"Availability, Affordability, Access, and Pricing of Anti-cancer Medicines in Low- and Middle-Income Countries: A Systematic Review of Literature","volume":"9","author":"P Ocran Mattila","year":"2021","journal-title":"Front. Public Health"},{"key":"pone.0279817.ref018","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s40545-020-0203-0","article-title":"Price variation among different brands of cancer medicines available in hospital pharmacies of Nepal","volume":"13","author":"S Shrestha","year":"2020","journal-title":"Journal of Pharmaceutical Policy and Practice"},{"key":"pone.0279817.ref019","article-title":"Variation of Cost among Cancer Medicines Available in Indian Market","author":"B. P. Kolasani","year":"2016"},{"key":"pone.0279817.ref020","article-title":"Country and regional variations in purchase prices for essential cancer medication","author":"R.E. Cuomo","year":"2017"},{"key":"pone.0279817.ref021","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1186\/s12913-021-06627-6","article-title":"Assessing the prices and affordability of oncology medicines for three common cancers within the private sector of South Africa","volume":"21","author":"P.O. Mattila","year":"2021","journal-title":"BMC Health Serv Res"},{"key":"pone.0279817.ref022","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1186\/s12885-017-3888-y","article-title":"Pricing appraisal of cancer medicines in the South East Asian, Western Pacific and East Mediterranean Region","volume":"17","author":"S Salmasi","year":"2017","journal-title":"BMC Cancer"},{"key":"pone.0279817.ref023","doi-asserted-by":"crossref","first-page":"e001379","DOI":"10.1136\/bmjgh-2018-001379","article-title":"Evaluating access to essential medicines for treating childhood cancers: a medicines availability, price and affordability study in New Delhi, India.","volume":"4","author":"N. Faruqui","year":"2018","journal-title":"BMJ Glob Health"},{"key":"pone.0279817.ref024","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.jcpo.2015.10.002","article-title":"Cost of treatment for children with acute lymphoblastic leukemia in Bangladesh","author":"A. Islam","year":"2015","journal-title":"Journal of Cancer Policy"},{"key":"pone.0279817.ref025","first-page":"1423","article-title":"(ESMO) European Consortium Study on the availability, out-of-pocket costs and accessibility of antineoplastic medicines in Europe.","volume":"27","author":"NI Cherny","year":"2016"},{"key":"pone.0279817.ref026","doi-asserted-by":"crossref","first-page":"160","DOI":"10.3389\/fpubh.2019.00160","article-title":"Estimating the direct cost of Cancer in Nepal: a cross-sectional study in a tertiary Cancer hospital","volume":"7","author":"SR Khatiwoda","year":"2019","journal-title":"Front Public Health"},{"issue":"1","key":"pone.0279817.ref027","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s12885-017-3980-3","article-title":"Availability of cancer medicines in public and private sectors, and their affordability by low, middle, and high-income class patients in Pakistan","volume":"18","author":"MR Sarwar","year":"2018","journal-title":"BMC Cancer"},{"issue":"42","key":"pone.0279817.ref028","doi-asserted-by":"crossref","first-page":"71548","DOI":"10.18632\/oncotarget.17742","article-title":"A global comparison of the cost of patented cancer medicines in relation to global differences in wealth","volume":"8","author":"DA Goldstein","year":"2017","journal-title":"Oncotarget"},{"key":"pone.0279817.ref029","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1002\/pbc.25722","article-title":"Access to Cytotoxic Medicines by Children with Cancer: A Focus on Low- and Middle-Income Countries","volume":"63","author":"R Barr","year":"2016","journal-title":"Pediatric Blood Cancer 2016"},{"key":"pone.0279817.ref030","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1186\/s12885-021-08435-x","article-title":"Bangalee V, Padayachee N, Oosthuizen F. Evaluating essential medicines for treating childhood cancers: availability, price, and affordability study in Ghana","volume":"21","author":"K.B Mensah","year":"2021","journal-title":"BMC Cancer"},{"key":"pone.0279817.ref031","article-title":"Evidence from Ghana Indicates That Childhood Cancer medicines in Sub-Saharan Africa Is Very Cost Effective: A Report from the Childhood Cancer 2030 Network.","author":"L Renner","year":"2018","journal-title":"Journal of Global Oncology."},{"key":"pone.0279817.ref032","volume-title":"Measuring medicine prices, availability, affordability, and price components.","author":"World Health Organization, Health Action International","year":"2008"},{"key":"pone.0279817.ref033","unstructured":"Ghana Statistical Service. Available from: https:\/\/www.statsghana.gov.gh\/regionalpopulation.php?population=MTI5MzE3OTU5OC40NDg1&&Ashanti&regid=1. Accessed 14 July 2021"},{"key":"pone.0279817.ref034","volume-title":"Model List of Essential Medicines, 22nd List, 2021","author":"World Health Organization","year":"2021"},{"key":"pone.0279817.ref035","volume-title":"Model List of Essential Medicines for Children, 8th List, 2021","author":"World Health Organization","year":"2021"},{"key":"pone.0279817.ref036","article-title":"Goodman & Gilman\u2019s","author":"L Brunton","year":"2011","journal-title":"The Pharmacological Basis of Therapeutics. 12th Edition"},{"key":"pone.0279817.ref037","unstructured":"Currency Conversion. Available from: Convert Ghanaian Cedis (GHS) to US Dollars (USD)\u2014Exchange Rates (exchange-rates.org). Accessed 06 October 2021."},{"key":"pone.0279817.ref038","article-title":"Availability, Price and Affordability of Anticancer Medicines: Evidence from Two Cross-Sectional Surveys in the Jiangsu Province, China","author":"Y Zhu","year":"2019","journal-title":"International Journal of Environmental Research and Public Health"},{"key":"pone.0279817.ref039","author":"Management Sciences for Health","year":"2015","journal-title":"International Medical Products Price GuideOctober"},{"key":"pone.0279817.ref040","unstructured":"Consumer Price Index. Available at Ghana Statistical Services(statsghana.gov.gh). Accessed 10 October 2021."},{"key":"pone.0279817.ref041","doi-asserted-by":"crossref","first-page":"e0216122","DOI":"10.1371\/journal.pone.0216122","article-title":"Evaluation of prices, availability, and affordability of essential medicines in Lahore Division, Pakistan: a cross-sectional survey using WHO\/HAI methodology","volume":"14","author":"A. Saeed","year":"2019","journal-title":"PLoS One"},{"key":"pone.0279817.ref042","article-title":"Making medicines more accessible in China: an empirical study investigating the early progress of essential medicine system","volume":"13","author":"Y. Song","year":"2018","journal-title":"PLoS One"},{"key":"pone.0279817.ref043","doi-asserted-by":"crossref","first-page":"e82","DOI":"10.1371\/journal.pmed.0040082","article-title":"Evaluating drug prices, availability, affordability, and price components: implications for access to drugs in Malaysia","volume":"4","author":"Z. U. Babar","year":"2007","journal-title":"PLoS Med"},{"key":"pone.0279817.ref044","unstructured":"Datapharm Ltd. The electronic medicines compendium (emc). Available from: https:\/\/www.medicines.org.uk\/emc. Accessed 10 August 2021."},{"key":"pone.0279817.ref045","author":"National Comprehensive Cancer Network","year":"2020","journal-title":"clinical guidelines in practical oncology (NCCN Guidelines),"},{"key":"pone.0279817.ref046","doi-asserted-by":"crossref","first-page":"240e9","DOI":"10.1016\/S0140-6736(08)61762-6","article-title":"Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis","volume":"373","author":"A Cameron","year":"2009","journal-title":"Lancet"},{"key":"pone.0279817.ref047","volume-title":"Medium-term strategic plan 2008\u20132013","author":"World Health Organization","year":"2009"},{"key":"pone.0279817.ref048","article-title":"Follow-up to the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases.","author":"World Health Assembly","year":"2013","journal-title":"Sixty-Sixth World Health Assembly."},{"issue":"2","key":"pone.0279817.ref049","doi-asserted-by":"crossref","first-page":"e0171284","DOI":"10.1371\/journal.pone.0171284","article-title":"Baseline assessment of WHO\u2019s target for both availability and affordability of essential medicines to treat non-communicable diseases","volume":"12","author":"M. Ewen","year":"2017","journal-title":"PloS One\/"},{"issue":"8","key":"pone.0279817.ref050","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1007\/s11892-018-1019-z","article-title":"Availability and affordability of essential medicines: implications for global diabetes treatment","volume":"18","author":"D. Beran","year":"2018","journal-title":"Curr. Diabetes Rep"},{"key":"pone.0279817.ref051","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1186\/s12913-020-05167-9","article-title":"Availability, prices, and affordability of selected essential cancer medicines in a middle-income country\u2013the case of Mexico","volume":"20","author":"D. Moye-Holz","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"pone.0279817.ref052","author":"World Health Organization","year":"2020","journal-title":"WHO guideline on country pharmaceutical pricing policies, second edition."},{"key":"pone.0279817.ref053","volume-title":"Pharmaceutical Prices in the 21st Century","author":"A Gray","year":"2015"},{"key":"pone.0279817.ref054","volume-title":"Pharmaceutical Policy in Countries with Developing Healthcare Systems","author":"F Suleman","year":"2017"},{"issue":"3","key":"pone.0279817.ref055","doi-asserted-by":"crossref","first-page":"219","DOI":"10.2471\/BLT.10.084087","article-title":"Practical measurement of affordability: an application to medicines","volume":"90","author":"LM Ni\u00ebns","year":"2012","journal-title":"Bulletin of the World Health Organization"},{"key":"pone.0279817.ref056","article-title":"F Measuring the affordability of medicines: Importance and challenges","author":"L.M. Ni\u00ebns","year":"2013","journal-title":"Health Policy 112. 45\u201352"},{"key":"pone.0279817.ref057","author":"Ministry of Health, Republic of Ghana","year":"2020","journal-title":"National Health Policy: Ensuring healthy lives for all (revised edition)."},{"key":"pone.0279817.ref058","article-title":"Medicine Price Surveys, Analyses, and Comparisons.","author":"S Iyengar","year":"2019","journal-title":"Medicine Prices in Africa."},{"key":"pone.0279817.ref059","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s40545-018-0153-y","article-title":"Access to innovative cancer medicines in a middle-income country, the case of Mexico.","volume":"11","author":"D Moye-Holz","year":"2018","journal-title":"J Pharm Policy Pract."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0279817","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,3]],"date-time":"2023-05-03T17:40:04Z","timestamp":1683135604000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0279817"}},"subtitle":[],"editor":[{"given":"Chulaporn","family":"Limwattananon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,5,3]]},"references-count":59,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,5,3]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0279817","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,3]]}}}