Drug utilization pattern and cost analysis of anticancer drugs among cancer patients attending a tertiary cancer hospital in Nepal: A cross-sectional study

Cancer imposes a rising and largely out-of-pocket-financed burden in Nepal, yet patient-level data on how anticancer drugs are prescribed and what chemotherapy actually costs patients remain limited. This study described the drug utilization pattern and cost of anticancer drug therapy among cancer patients treated at a tertiary cancer hospital in Nepal. A descriptive, cross-sectional, record-based study was conducted at Bhaktapur Cancer Hospital, Bhaktapur, Nepal. Medical records of cancer patients aged above 18 years attending the day-care chemotherapy ward were reviewed using a structured proforma. Sociodemographic characteristics, diagnosis, regimen and cycle data, and WHO/INRUD prescribing indicators were recorded, along with the actual cost, maximum retail price, and Nepal Health Insurance Board reimbursement rate for anticancer drug therapy. Data were analyzed descriptively and, given the skewed distribution of cost, on a log-transformed cost variable using Pearson correlation, independent-samples t tests, and multiple linear regression in SPSS version 16. A total of 151 chemotherapy patients were analyzed (mean age 53.81 {+/-} 12.51 years; 67.5% female). Breast cancer (26.5%) was the most common diagnosis. Patients received a mean of 10.56 {+/-} 2.19 total drugs, of which 1.72 {+/-} 0.67 were anticancer agents; 99.85% of drugs were prescribed generically, and 63.2-67.7% were on the national essential medicines list. Mean actual cost of anticancer therapy per patient was NPR 15,245.28 {+/-} 15,672.33, substantially below the mean maximum retail price (NPR 38,803.22). In bivariate analysis, log-transformed cost was significantly higher among male patients (p =.038) and among patients not fully compliant with the essential medicines list (p =.028), but no patient, disease, or prescribing variable -- including sex -- independently predicted log-transformed cost in a multiple regression model that was not statistically significant overall (R{superscript 2} =.113, p =.323). Anticancer prescribing at this hospital was characterized by near-universal generic use but only partial alignment with the national essential medicines list, and chemotherapy cost varied widely across patients without being reliably explained by the patient or prescribing factors examined. These findings support continued WHO/INRUD-style prescribing surveillance and closer attention to essential-medicines-list adherence and drug pricing in this setting.