Access to and affordability of anticancer medicines in Kazakhstan, Azerbaijan and Uzbekistan: a comparative evidence review
Evidence review of cancer burden (GLOBOCAN 2024), oncology medicine financing and verified price and access data in Kazakhstan, Azerbaijan and Uzbekistan.
Abstract
This narrative review compares the cancer burden, the financing of anticancer medicines and the verified evidence on their availability and affordability in Kazakhstan, Azerbaijan and Uzbekistan. According to IARC GLOBOCAN 2024 estimates, the three countries together had about 83,600 new cancer cases and 47,700 cancer deaths in 2024 [1,2]. All three finance oncology medicines largely through dedicated state mechanisms, but published evidence on prices and out-of-pocket costs is thin. The strongest country-level signals are reimbursement delays for novel cancer medicines in Kazakhstan [6] and markedly higher outpatient prices combined with very low consumption of hormonal cancer therapies in Uzbekistan [10]. Comparable medicine-by-medicine price data for the region could not be found.
Background
Cancer medicines are among the most expensive items in public pharmaceutical budgets. A global survey of 948 oncologists in 82 countries found that universal availability of the 20 most-prioritised cancer medicines ranged from 9–54% in low- and lower-middle-income countries and 13–90% in upper-middle-income countries, against 68–94% in high-income countries, and that the risk of catastrophic expenditure was highest in lower-income settings [12]. The ESMO 2023 global update, covering 126 countries, reported that in lower-middle- and low-income countries 40% of traditional chemotherapy agents on the WHO Model List of Essential Medicines (EML) were available only at full cost to patients [13]. Against this background, this brief asks what is known, specifically and verifiably, about Kazakhstan, Azerbaijan and Uzbekistan.
Method
A narrative review of official statistics, legal texts and peer-reviewed literature was conducted on 14–15 October 2026. Sources included the IARC Global Cancer Observatory (GLOBOCAN 2024 country fact sheets, published in September 2026 and replacing the GLOBOCAN 2022 round), the WHO EML (24th list, 2025), reports of the European Observatory on Health Systems and Policies, official legal databases (adilet.zan.kz, lex.uz) and Europe PMC/PubMed searches combining the country names with terms for cancer medicines, access, price and reimbursement. Only figures traceable to a primary source were retained; news sources are labelled as such. No new price data were collected.
Findings: Kazakhstan
GLOBOCAN 2024 estimates 29,851 new cancer cases and 16,355 cancer deaths for a population of about 20.6 million; the most frequent sites are breast (4,489 cases; 15.0%), colorectum (3,598; 12.1%), stomach (2,951; 9.9%), lung (2,798; 9.4%) and prostate (1,706; 5.7%), while lung, stomach and colorectal cancers cause most deaths [2]. Government Decree No. 672 of 16 October 2020 on the Guaranteed Volume of Free Medical Care (GOBMP) covers diagnosis and treatment of socially significant diseases, a list that includes malignant neoplasms, as well as medicine provision in hospitals under institutional formularies and in outpatient care under an approved list for free or subsidised supply; cancer screening is also part of GOBMP [3]. The European Observatory notes that cancer treatment is publicly funded even for people not insured under compulsory social health insurance (OSMS) [4]. SK-Pharmacia, created by Government Decree No. 134 of 11 February 2009, operates the Single Distributor system that consolidates state purchases of medicines under GOBMP [5]. An ISPOR 2024 abstract by Kazakh HTA researchers found that of 129 novel cancer medicines (ATC L01/L02) registered in 2013–2023, 31 (24%) reached full availability after an average of 35.4 months and 73 (56%) only limited availability through the Kazakh National Formulary after 25.5 months [6]. National outpatient data for 2022 (2.2 million patients) showed that the costliest 5% of users accounted for nearly three-quarters of publicly funded outpatient drug costs, with cancer and diabetes the main cost drivers among adults [7]. In 2024 a public foundation reported that local executive bodies were not ready to supply six targeted cancer medicines added to GOBMP by Ministry of Health Order No. 176 of 28 December 2023 (news report) [8].
Findings: Azerbaijan
GLOBOCAN 2024 estimates 15,251 new cases and 8,883 deaths for a population of about 10.3 million; the leading sites are breast (1,659; 10.9%), stomach (1,459; 9.6%), lung (1,243; 8.2%), colorectum (876; 5.7%) and prostate (767; 5.0%), with stomach, lung and liver cancers the leading causes of cancer death [2]. All legal residents are covered by mandatory health insurance, managed by the State Agency for Mandatory Health Insurance (established 2016), while TƏBİB (formed 2018) is the main public provider. Outpatient medicines are covered only within vertical state programmes, including oncology; other outpatient medicines are paid out of pocket, and two-thirds of health spending was out of pocket in 2021 [9]. In community pharmacies, consumption-weighted prices of hormonal cancer therapies (ATC L02) rose by 11% in 2019–2021; their outpatient consumption was seven times lower than in Georgia despite near-identical cancer prevalence, which the authors partly attribute to oncology medicines being dispensed through hospital pharmacies [10]. Verified price data for hospital oncology medicines in Azerbaijan could not be found.
Findings: Uzbekistan
GLOBOCAN 2024 estimates 38,465 new cases and 22,509 deaths for a population of about 36.4 million; the leading sites are breast (4,793; 12.5%), colorectum (3,586; 9.3%), cervix uteri (3,147; 8.2%), prostate (3,042; 7.9%) and stomach (2,662; 6.9%), and stomach, breast and lung cancers cause most deaths [2]. The state health insurance package covers socially significant conditions including cancer, but according to WHO it largely excludes outpatient pharmaceuticals for significant parts of the population; out-of-pocket payments made up about 60% of health expenditure and 18% of households faced catastrophic health spending in 2018; an outpatient reimbursement pilot started in 2021, and since 2020 price limits for all medicines have been set using external reference pricing [10]. Presidential Resolution PP-5130 of 27 May 2021 allocated additional budget funds to oncology care (60 billion soums in 2021 and at least 125 billion soums from 2022), approved centralised procurement of medical equipment and consumables, and required the Ministry of Health to review and annually update the list of medicines used for haematological and oncological diseases [11]. In 2019–2021, community-pharmacy prices of hormonal cancer therapies rose by 47% and were 231% above those in Azerbaijan and 140% above those in Georgia, while consumption was 91% lower than in Azerbaijan although cancer prevalence was only 12% lower [10].
Findings: cross-country evidence and the WHO EML
The 24th WHO EML (2025) lists among targeted cancer medicines imatinib (chronic myeloid leukaemia, gastrointestinal stromal tumour, Ph+ acute lymphoblastic leukaemia), dasatinib and nilotinib (imatinib-resistant CML), and rituximab and trastuzumab with the annotation 'including quality-assured biosimilars'; filgrastim, pegfilgrastim and pembrolizumab carry the same annotation, while bevacizumab appears only in the ophthalmology section [14]. The 2025 update added pembrolizumab for metastatic cervical, colorectal and non-small cell lung cancer and kept the rule that only cancer medicines shown to prolong life by at least 4–6 months are listed [15]. The two global studies cited above report results by income group; verified country-level figures for Kazakhstan, Azerbaijan and Uzbekistan could not be extracted [12,13]. No WHO/HAI-method survey of cancer medicine prices in these countries was identified.
Discussion
The three systems share a common model in which oncology medicines are financed through dedicated state channels: GOBMP and the Single Distributor in Kazakhstan, a vertical oncology programme in Azerbaijan, and earmarked oncology budget lines in Uzbekistan. Under such models, high prices tend to appear less as direct patient charges and more as budget constraints: delayed or restricted listing (Kazakhstan [6]), funding gaps for newly added medicines [8] and low outpatient consumption (Uzbekistan [10]). For medicines outside these programmes, particularly in Azerbaijan and Uzbekistan, out-of-pocket exposure remains material [9,10]. The evidence therefore supports a cautious conclusion: affordability constrains the breadth and speed of access, but the size of the price gap for specific medicines cannot be quantified from verified public data.
Limitations
GLOBOCAN models incidence in all three countries from national mortality data because no country-specific incidence source was available [2]. The Kazakh access study is a conference abstract, not a full peer-reviewed article [6]. The price analysis for Azerbaijan and Uzbekistan covers only hormonal therapies sold in community pharmacies in 2019–2021 and excludes hospital oncology medicines [10]. Legal texts were read in their current consolidated editions; implementation may differ from the text. One finding rests on a news report [8].
Conclusion
Verified evidence shows a substantial cancer burden in all three countries, state financing channels dedicated to oncology and documented signs of constrained access: reimbursement delays in Kazakhstan, out-of-pocket spending outside state programmes in Azerbaijan, and high prices with low use of some cancer medicines in Uzbekistan. Systematic, medicine-level price and availability studies (for example using the WHO/HAI method) are needed before stronger claims can be made. At CSC, we follow the needs of institutions in the region for cost-effective, GDP-compliant supply.
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