WHO introduced the Model List of Essential Medicines (EML) for neoplasm in 1977, with updates every 2 years. Addressing inequities in access is crucial for ensuring that the benefits of treatment advancements are accessible. We aimed to evaluate international patterns in the consumption and expenditure of cancer medicines listed by the WHO EML.

In this multinational drug use study, we annualised consumption and expenditure data of 65 WHO essential cancer medicines between Jan 1, 2012, to Dec 31, 2022, from the MIDAS database, covering 30 high-income, seven upper-middle-income, and three lower-middle-income economies. Trends over the decade were assessed using rank-sum test, trends regression, and the Lorenz curves. Panel regression assessed associations between consumption, country income levels, disability-adjusted life-years (DALYs) by neoplasm (cancer-related DALYs), Gini index, and the universal health coverage (UHC) index. The constitutes of medicines regarding WHO-documented overall survival benefits at least 4 months were examined.

By 2022, we found no significant difference in annual consumption of WHO essential cancer medicines between high-income and middle-income economies (median 436·82 [IQR 92·66–800·14] standard units vs 609·52 [278·44–762·50] standard units; p=0·84). Differences in expenditure on EML cancer medicines between high-income and middle-income economies were evident in 2022 (high-income economies: US$33 198·82 [IQR 18 123·61–51 818·48]; middle-income: $4034·42 [2502·68–5805·27]; p=0·0007). Over the 11 years, consumption of EML cancer medicines had an average annual growth rate of 16·79% (IQR 10·62 to 24·07) for middle-income economies compared with 1·81% (0·51 to 6·37) in high-income economies and expenditure had an average annual growth rate of 8·96% (3·38 to 18·82) compared with –0·06% (–1·94 to 2·95) in high-income economies. UHC index was positively associated with consumption (adjusted coefficient: 11·35 [95% CI 6·59–16·10]; p<0·0001), whereas we found no significant effects with country income, DALYs, or the Gini index. Middle-income economies consumed more medicines with documented overall survival benefits of more than 4 months compared with high-income economies (57·1% vs 37·8%; p=0·004).

Over the past decade, the consumption gap of WHO essential cancer medicines has narrowed among different economies, especially in middle-income economies. Improved UHC might be associated with improved treatment access.