13 November 2025 – A new study published in JCO Global Oncology led by researchers at the National Academy of Medical Sciences (NAMS), Nepal and Bishal Gyawali Lab (BG Lab), Queen’s University highlights significant variation in the price and availability of gastrointestinal cancer drugs within Nepal’s public sector. The co-first authors of this paper are Dr. Ramila Shilpakar, Associate Professor at NAMS and Brian Shkabari, BHSc, a research associate at BG Lab with senior author Dr. Bishal Gyawali.
The study looks at a sample of 26 regimens used in the treatment of gastroesophageal, colorectal, hepatobiliary, and pancreatic cancers across 4 public cancer hospitals.
Key Findings:
- 9/26 (35%) regimens were available in all four hospitals, 14/26 (54%) regimens were available in at least one hospital.
- Aside from capecitabine monotherapy and fluorouracil plus cisplatin therapy, all of the remaining available treatments exceeded the monthly per-capita GDP of Nepal.
- Prices of the same drug varied by up to 997% (irinotecan) across all hospitals.
- Prices of the same drug varied by up to 422% (capecitabine) within the same hospital.
Lack of access to cancer medicines is caused by either an unavailability of medicines or the unaffordability of available ones. Substantial price variations of cancer treatments within and between hospitals may force patients with cancer to not only worry about their treatment decisions but also brands of drugs being used, their prices, places of purchase, and even the quality of the medications being used.
To our knowledge, this is the first study highlighting the variation in drug price across Nepal’s public sector. In this paper we advocate for specific measures at the national, institutional, and physician level to improve both price transparency and reduce financial burden for patients living with cancer.
| National Level | Institutional Level | Physician Level |
|---|---|---|
| Timely approval of important cancer drugs and establish a maximum retail price on all cancer drugs. Prioritize high-value cancer drugs Expand public health insurance scheme and cover for most essential cancer drugs, also setting forth their prices Support local manufacturing of cancer medicines Introduction of quality-assured generics and biosimilars into market Seek help of international organizations such as WHO/UICC/ATOM in bulk procurement of quality-assured drugs Offer import permissions to public hospitals on the basis of need at a profit cap of an agreed-upon percentage Enforce transparency in cancer drug prices at each institution | Provide readily accessible information to oncologists and patients about price and brand name/quality of drugs when prescribing cancer medicines. Increased communication between cancer centers regarding price to facilitate patient procurement of medicines Cap price difference between institutions for same cancer drugs to an agreed-upon minimal percentage (and aligned with national recommendation) | Clinician awareness of prices of cancer drugs Clinician education of low-value practices that can be avoided Continuous pressure to the government and public awareness |
Click here to read more. This article is published as open access, so it is free to read.
This study signifies growing impactful global oncology collaborations of BG Lab with its partners across the world. Last month, BG Lab published the perceptions of Indian oncologists regarding FDA approval status and use of different cancer care guidelines for the practice of oncology in India.
Dr. Bishal Gyawali 
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