Availability and affordability of essential anticancer medicines in a resource-constrained province of Iran: A WHO/HAI-based public health assessment.

BACKGROUND: Access to essential anticancer medicines in low- and middle-income countries is shaped not only by physical availability but also by affordability. Evidence from subnational settings in Iran remains limited. This study assessed the point-in-time availability and wage-based affordability of selected essential anticancer medicines in Lorestan Province, western Iran. METHODS: In a cross-sectional survey 20 essential anticancer medicines were assessed in 13 public hospital pharmacies and 70 private community pharmacies using an adapted WHO/HAI approach. Availability was measured as stock on the survey day, and affordability as the number of daily minimum wages needed for a standard 30-day course. RESULTS: Public-sector generic availability was high overall (mean 81% ± 24%), while public-sector originator availability was lower (33% ± 28%). Private pharmacies showed almost no stock for either generics (0.3% ± 1.1%) or originators (0.5% ± 2.2%). Eighteen of 20 medicines were unavailable in private pharmacies. Only three generics-letrozole, bortezomib, and exemestane-were affordable (≤1 wage-day), along with two originators-letrozole and bortezomib. Most treatments required several to hundreds of wage-days, with the highest burdens seen for capecitabine, nilotinib, rituximab, and trastuzumab. CONCLUSIONS: Availability in public hospitals did not translate into affordability, and private-sector access was extremely poor. Policy responses should combine stronger supply monitoring, procurement reform, and targeted financial protection to improve equitable access to oncology medicines.