Global Disparities in the Availability and Reimbursement of Systemic Therapies for Renal Cell Carcinoma: Results of the International ARON-AID Survey

BACKGROUND: Renal Cell Carcinoma (RCC) represents a growing global health burden, with rising incidence and mortality worldwide. Despite major therapeutic advances, access to novel systemic treatments remains uneven across countries and regions. METHODS: We conducted a cross-sectional, web-based international survey to assess the availability and reimbursement status of 20 innovative systemic therapies for RCC. Responses were collected from 144 clinicians, including medical oncologists, radiation oncologists, urologists, and nuclear medicine specialists, across 58 countries. Analyses examined associations between national income level, gross domestic product (GDP), and treatment availability. FINDINGS: 36% of the countries analysed had at least 15 of the 20 therapies available. Full reimbursement for at least 15 of the selected innovative therapies was reported in six countries (10%), while 21 countries (36%) fully reimbursed 10-14 therapies and 13 countries (23%) reimbursed 1-9 therapies. In contrast, no full reimbursement for any of the assessed therapies was reported in 18 countries (31%). Higher national income level was significantly associated with greater availability of innovative therapies (Kruskal-Wallis test, p < 0·0001). Armenia (0·709), Greece (0·685), and Israel (0·666) exhibited the highest GDP-adjusted Drug Availability Index (DAI), whereas India (5·195), Nigeria (4·612), and Morocco (3·794) demonstrated the greatest number of available therapies per US$1000 of GDP per capita. INTERPRETATION: Access to innovative systemic therapies for RCC remains highly unequal at the global level, with reimbursement posing a major barrier even where drugs are available. Internationally coordinated efforts addressing health policy, infrastructure, and equitable pricing are urgently required to ensure that advances in RCC treatment translate into improved outcomes for patients across diverse economic settings.

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Journal
The Oncologist
Published
2026-10-05
DOI
https://doi.org/10.1093/oncolo/oyag397
Primary Topic
Pharmaceutical Economics and Policy
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article
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article

Global Disparities in the Availability and Reimbursement of Systemic Therapies for Renal Cell Carcinoma: Results of the International ARON-AID Survey

Glenda Marina Falcon Pacheco, Mopa Alina Sooro, Ondřej Fiala, H. Takeshita et al.
The Oncologist
Pharmaceutical Economics and Policy
article

Global Disparities in the Availability and Reimbursement of Systemic Therapies for Renal Cell Carcinoma: Results of the International ARON-AID Survey

Glenda Marina Falcon Pacheco, Mopa Alina Sooro, Ondřej Fiala, H. Takeshita, Maite De Liz Vassen Schurmann, Anas Zayed, Cinthia Gauna, Marine Rushanyan, Tarkan Yetişyiğit, Maria Tereza Nieto Coronel, Kannan Sridharan, Denis L. Fontes Jardim, María Natalia Gandur Quiroga, A. Rodriguez-Vida, Deborah Tolulope Esan, Akihiro Yano, Jakub Kucharz, Karen Flora Odounga, Andrey Soares, Marwan G. Ghosn, Martino Pedrani, Pitchou Mukaz Mbey, Aly‐Khan A. Lalani, Danelo Du Plessis, Giandomenico Roviello, Enrique Grande, Beaud Conrad Mabika Ndjembidouma, Emmanuel Seront, Mimma Rizzo, Jindřich Kopecký, Arnoud J. Templeton, Priyamvada Maitre, Luciana de Moura Leite, Mauricio Fernández Lazzaro, Alba J. Kihn-Alarcón, Orión Erenhú Rodríguez González, Mike Wenzel, Marcelo Roberto Pereira Freitas, Amalya Sargsyan, Martin Ignacio Zapata Laguado, Silvia Neciosup Delgado, Alfonso Gómez de Liaño, Abdikarim Hussein Mohamed, Zsófia Kürönya, Alexandr Poprach, Theophilus Olaide Esan, Fernando Sabino Marques Monteiro, Sarah Scagliarini, Özge Keskin, Kazutoshi Fujita, Anca Florina Zgura, Jose Mauricio Penaloza, Karine Martins da Trindade, Frederic Ivan L. Ting, Shankar Siva, Patrizia Giannatempo, Robert Mugarura, Fabio A.B. Schutz, María José Juan-Fita, Álvaro Juárez, Patrick Maison, Erin Pierce, Laurianne Grégoria James, Vladan Mutavdzic, Ernesto Maturana, Arnaud Boris Koumba, Alina Pirshtuk, Carlo Messina, Kaisa Sunela, Ray Manneh Kopp, Timothy Schieber, Olivier Mukuku, Francesco Massari, Diana Matthews, Ben Tran, Alessandro Rizzo, Zin W Myint, Jiakun Li, Kymbat Kabdullina, Haoran Li, Esther Martínez, Deniz Tural, Kevin Lu, Astrid A M Van der Veldt, Yuksel Urun, Edriss Noorzai, Bohuslav Melichar, Alvaro Pinto, Nuno Vau, Shamik Shah, Vinicius Carrera Souza, Ibukun Adewumi Okunade, Carlos Salinas Simonetti, Glauco Silveira, Ashish Singh, Daniel Mmereki, Julio Noriega, Jiri Navratil, Robin Roberts, Se Hoon Park
article en

Abstract

BACKGROUND: Renal Cell Carcinoma (RCC) represents a growing global health burden, with rising incidence and mortality worldwide. Despite major therapeutic advances, access to novel systemic treatments remains uneven across countries and regions. METHODS: We conducted a cross-sectional, web-based international survey to assess the availability and reimbursement status of 20 innovative systemic therapies for RCC. Responses were collected from 144 clinicians, including medical oncologists, radiation oncologists, urologists, and nuclear medicine specialists, across 58 countries. Analyses examined associations between national income level, gross domestic product (GDP), and treatment availability. FINDINGS: 36% of the countries analysed had at least 15 of the 20 therapies available. Full reimbursement for at least 15 of the selected innovative therapies was reported in six countries (10%), while 21 countries (36%) fully reimbursed 10-14 therapies and 13 countries (23%) reimbursed 1-9 therapies. In contrast, no full reimbursement for any of the assessed therapies was reported in 18 countries (31%). Higher national income level was significantly associated with greater availability of innovative therapies (Kruskal-Wallis test, p < 0·0001). Armenia (0·709), Greece (0·685), and Israel (0·666) exhibited the highest GDP-adjusted Drug Availability Index (DAI), whereas India (5·195), Nigeria (4·612), and Morocco (3·794) demonstrated the greatest number of available therapies per US$1000 of GDP per capita. INTERPRETATION: Access to innovative systemic therapies for RCC remains highly unequal at the global level, with reimbursement posing a major barrier even where drugs are available. Internationally coordinated efforts addressing health policy, infrastructure, and equitable pricing are urgently required to ensure that advances in RCC treatment translate into improved outcomes for patients across diverse economic settings.

The Oncologist
Semmelweis University (HU), Goethe University Frankfurt (DE), Fox Chase Cancer Center (US), Western Cape Department of Health (ZA), Cliniques Universitaires Saint-Luc (BE), Shirak State University (AM), University of Cape Coast (GH), University of Lubumbashi (CD), Koç University (TR), University of Kragujevac (RS), Ankara University (TR), Kaohsiung Medical University (TW), China Pharmaceutical University (CN), Carol Davila University of Medicine and Pharmacy (RO), Pontificia Universidad Católica de Chile (CL), Christian Medical College, Vellore (IN), University of Basel (CH), University of the Witwatersrand (ZA), Homi Bhabha National Institute (IN), Bowen University (NG), Charles University (CZ), Masaryk University (CZ), Sichuan University (CN), Royal College of Surgeons in Ireland - Bahrain (BH), Stellenbosch University (ZA), Hospital Universitario Insular de Gran Canaria (ES), King Hussein Cancer Center (JO), Juravinski Cancer Centre (CA), Libreville Hospital (GA), Hospital Israelita Albert Einstein (BR), Peter MacCallum Cancer Centre (AU), Hospital Universitario La Paz (ES), Hotel Dieu Hospital (CA), Samsung Medical Center (KR), Markey Cancer Center (US), Tygerberg Hospital (ZA), AC Camargo Hospital (BR), Kabale University (UG), University of Kinshasa (CD), Eastern Cooperative Oncology Group (US), Universidad Bernardo O'Higgins (CL), Ospedale Antonio Cardarelli (IT), West China Hospital of Sichuan University (CN), Bowen University Teaching Hospital (NG), Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari (IT), Ente Ospedaliero Cantonale (CH), Unidad de Artritis y Reumatismo (MX), The University of Kansas Cancer Center (US), University Hospital in Motol (CZ), University of St. La Salle (PH), Fundación Instituto Valenciano de Oncología (ES), Centro Universitário do Triângulo (BR), Institut Supérieur de Technique Médicale (CD), University Hospital Olomouc (CZ), Hospital Universitario Quirónsalud Madrid (ES), Beneficência Portuguesa de São Paulo (BR), Hospital Quirónsalud Barcelona (ES), Masaryk Memorial Cancer Institute (CZ), Complejo Hospitalario de Jaén (ES), Instituto Nacional de Cancerología (CO), Azienda USL di Bologna (IT), Ospedale Regionale di Bellinzona e Valli (CH), National Institute of Oncology (HU), Hospital Civil de Guadalajara (MX), Peninsula Health (AU), Liga Nacional Contra el Cáncer (GT), Institutul Oncologic Bucuresti (RO), Instituto Nacional de Enfermedades Neoplásicas (PE), Department of Biomedicine Basel (CH), Hospital Materno-Infantil (ES), HonorHealth (US), Hospital Del Mar (ES), Istituto Tumori Bari (IT), University Hospital Frankfurt (DE), St. Claraspital (CH), University Hospital Hradec Králové (CZ), Országos Pszichiátriai és Neurológiai Intézet (HU), King Hamad University Hospital (BH), Instituto Nacional del Cáncer (CL), Azienda di Rilievo Nazionale ed Alta Specializzazione (IT), Hospital Sírio-Libanês (BR), Erasmus MC Cancer Institute (NL), Velindre Cancer Centre (GB), Hôtel-Dieu de France (LB), Hospital Jerez Puerta del Sur (ES), Clinical Centre of Kragujevac (RS), Fondazione IRCCS Istituto Nazionale dei Tumori (IT), Centro de Pesquisas Oncológicas (BR), University of Florence (IT), Arabian Gulf University (BH), Nazarbayev University (KZ), Yerevan State Medical University (AM), Palacký University Olomouc (CZ), International University of Health and Welfare (JP), Hospital Central Militar (MX), Saitama Medical University (JP), College of The Bahamas (BS), Kindai University (JP), University of Bologna (IT)
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