This predefined regional analysis of ESMO's 2023 global survey covered 20 Asia-Pacific countries and compared WHO essential cancer medicines with high-benefit medicines under ESMO-MCBS. The findings show that marketing availability does not equal reliable access: reimbursement and patient out-of-pocket burden remain major bottlenecks. Access was generally stronger in high-income economies, while middle- and lower-income groups faced large gaps, particularly for high-benefit medicines. The evidence is expert-reported and cross-sectional, and income-group aggregates must not be presented as Thailand-specific estimates.
Key findings
- For WHO-EML cancer medicines, medicine–country observations rated Always accessible were 100% in high-income, 80.3% in upper-middle-income, and 46.5% in the combined lower-income group. Full out-of-pocket cost occurred in 0%, 1.5%, and 50.4%, respectively.
- For high-benefit ESMO-MCBS medicines, Always accessible rates fell to 96.8%, 31.1%, and 26.7%, while full-cost observations were 19.6%, 88.6%, and 95.2%. These are proportions of medicine–country observations, not percentages of patients.
- Process analysis identified reimbursement after approval as a major bottleneck. First-line pembrolizumab reimbursement for NSCLC in New Zealand lagged Australia by seven years. HTA mapping across nine countries described Thailand and Australia as relying mainly on ICER approaches, with accelerated pathways in several countries including Thailand taking roughly 4–24 weeks.
Why this matters globally
Separating availability, accessibility, and affordability makes the study more policy-relevant than simply counting marketing approvals. Contrasting WHO essential medicines with high-benefit ESMO-MCBS medicines identifies where reimbursement and financial protection lag behind innovation and provides a regional agenda for action. Because the data are expert-reported and descriptive, the results are best treated as a gap map and hypothesis generator, not a country ranking or causal proof that any policy improves access.
Thai researcher contribution
Naiyarat Prasongsook of the Department of Oncology, Phramongkutklao Hospital, is author 5 of 20, and Lucksamon Thamlikitkul of the Division of Medical Oncology, Faculty of Medicine Siriraj Hospital, Mahidol University, is author 19 of 20. Both are co-authors and neither is identified as corresponding author on the publisher page. The article provides no individual CRediT statement, so no specific responsibility for data collection, analysis, or recommendations should be inferred. Thailand is included in both the 20-country access dataset and the nine-country HTA mapping.
Limitations to consider
Expert reporting introduces potential reporting bias and variation in category interpretation. Medicine–country observations miss within-country, urban–rural, and public–private variation. The cross-sectional, descriptive design and absence of formal hypothesis testing preclude causal inference. Public HTA information may lag evolving practice, and national availability does not mean equitable access in every locality. Crucially, the main text does not report Thailand-specific access and out-of-pocket percentages; income-group aggregates must not be substituted for Thai estimates.