A landmark study by onco-researchers at Tata Memorial Centre has laid bare the brutal arithmetic of modern cancer care. The findings are stark: a standard six-month course of the blockbuster immunotherapy drug Keytruda costs 7,994 percent of the average monthly income in India.
The research, conducted in Mumbai, highlights the huge gap between the promise of cutting-edge cancer therapies and their real-world affordability in low- and middle-income countries.
In South Asia, the money required to treat a single patient with pembrolizumab for six months could instead cover treatment for 18 to 22 patients using oral tyrosine kinase inhibitors such as gefitinib, an established alternative for head and neck cancers.
Pembrolizumab, developed by US pharmaceutical giant Merck & Co. and marketed as Keytruda, is among the world’s top-selling cancer drugs by value.
It is approved for head and neck cancers as well as malignancies of the lung, cervix and melanoma. Its clinical impact has been widely celebrated, often described as a breakthrough in immunotherapy.
But the numbers in India tell a sobering story.
The study estimates that the cost of the drug for an average patient is about Rs 10.1 lakh per month, adding up to over Rs 1.2 crore annually. For most households, such sums are simply unimaginable.
MODEST GAINS, MASSIVE PRICE
The researchers also point to a troubling disconnect between the “catastrophic” price tag of these so-called hero drugs and the magnitude of their clinical benefit.
While immunotherapies have transformed outcomes for some patients, in many trials they extend median overall survival by only two to three months.
The gains, though meaningful at an individual level, are often modest when weighed against the financial toll.
Importantly, the crisis is not confined to poorer nations. Although the burden is most acute in developing countries, the study found that no country examined—including high-income nations such as the United States and the United Kingdom—can consider these drugs genuinely affordable.
“The findings highlight the point that every country should review how cancer drugs should be priced and there should be a movement towards making the treatment affordable in countries of every economic status,” Dr Arjun Singh, surgical oncologist and co-author of the study told India Today.
India records nearly 15 lakh new cancer cases each year, with more than 9 lakh deaths annually.
Both figures are rising steadily. Cancer is also a leading driver of catastrophic out-of-pocket expenditure, pushing tens of thousands of families into extreme poverty every year.
For many, a diagnosis is not just a medical crisis but a financial one that can unravel years of savings within months.
As part of the analysis, researchers conducted a comparative affordability and budget-reach assessment of commonly used systemic therapies—pembrolizumab, nivolumab, cetuximab, gefitinib and erlotinib—across seven countries: the US, UK, Australia, South Africa, India, Pakistan and Bangladesh.
These nations represent a spectrum of high-, upper-middle- and lower-middle-income settings.
The drugs examined are widely used in head and neck cancers, among other malignancies. Across every setting, immunotherapy emerged as unaffordable.
In India, six months of pembrolizumab corresponded to 7,994 percent of monthly income.
The figure was 4,311 percent in Pakistan and 3,133 percent in Bangladesh. Even in wealthier nations, the cost remained above catastrophic thresholds—591 percent in the US and 903 percent in the UK.
In India, a single month of pembrolizumab can amount to more than a year’s wages for an average worker. Families are often forced into impossible trade-offs between paying for treatment and meeting basic needs such as food, housing and education.
A SYSTEM AT A BREAKING POINT
The study argues that this imbalance underscores both the inefficiency of financing high-cost therapies in resource-constrained systems and the ethical dilemma of allocating limited public funds to interventions that benefit relatively few patients.
The report concludes with a forceful policy message: incremental price reductions will not resolve the crisis. Instead, the authors call for structural reform, including the development of local generics or new branded agents manufactured at scale to fundamentally disrupt what they describe as the Western dominance of immuno-oncology markets.
Earlier reporting by India Today had highlighted similar concerns. Despite measures such as exemptions from import duties and goods and services tax, several cancer drugs remain far beyond the reach of most Indian patients.
For instance, Enhertu, developed by Daiichi Sankyo and AstraZeneca, can cost between Rs 50 lakh and Rs 1 crore per patient annually for breast and lung cancer treatment—effectively placing it out of reach for nearly everyone who might need it.
Dr Singh emphasised that while high-cost immunotherapies have undeniable clinical value, their survival benefits are frequently incremental.
The central question, the researchers argue, is whether health systems with constrained budgets should prioritise therapies that offer limited extensions of life at such prohibitive costs.
Even the world’s wealthiest nations, they warn, are approaching a breaking point where the unconstrained adoption of these drugs is becoming fiscally unsustainable.
In the end, the study forces an uncomfortable thought. Scientific progress has delivered remarkable new weapons against cancer. But without a parallel revolution in pricing and access, those advances risk remaining out of reach for the vast majority of patients who need them most.
