Weak economic evidence for WHO’s essential cancer medicines for Africa

Introduction The WHO Model Lists of Essential Medicines (MLEM and MLEMc) guide national medicine selection, particularly in low-income and lower middle-income countries (LMICs). Concerns exist about the adequacy and transferability of economic evidence supporting recent cancer medicine additions. Methods We systematically examined modifications to cancer medicines on the WHO MLEM(c) between 2017 and 2023 and assessed their adoption into National Essential Medicines Lists (NEMLs) and NEMLs for children (NEMLcs) of African LMICs (2019–2024). Economic evidence was classified as cost or cost-effectiveness data and transferability to African LMIC contexts was evaluated. Results Of 160 modifications, 11% included cost data and 9% cost-effectiveness evidence. All identified cost-effectiveness studies showed low transferability to African LMIC settings. Among 46 African LMICs, 23 NEMLs and 6 NEMLcs were available. Median adoption of new cancer medicines was 23% for NEMLs and 13% for NEMLcs. Conclusion Recent WHO MLEM(c) modifications to cancer medicines are rarely supported by robust, context-specific economic evidence yet several have been adopted in African LMICs. Stronger requirements for economic evaluations are essential to ensure the affordability, sustainability and policy relevance of WHO essential medicine recommendations.