Actual costs of cancer drugs in 15 European countries

The financial sustainability of cancer services as part of national health systems is a major challenge;1 oncology consumes up to 30% of total hospital expenditure and the amount spent on expensive cancer drugs is rising fast.2 In view of the pipeline of new drugs, these costs are likely to continue to grow.3 Apart from the risk of unequal access between European countries, burdening health systems with fast-growing costs for these drugs means that the sustainability of cancer care could be compromised. One element increasingly under scrutiny is the pricing policy of pharmaceutical companies. Both in the recent American Society of Clinical Oncology (ASCO) meeting and in various publications,4, 5 and 6 attention has been drawn to the lack of transparency on the pricing of various drugs. Different models to judge the appropriateness of prescribing drugs have been proposed; the European Society for Medical Oncology (ESMO) and ASCO models try to balance cost and effectiveness. However, a wholehearted decision to include cost effectiveness as a criterion does not yet seem possible. An overview of actual prices in European countries does, to our knowledge, not exist, and anecdotal evidence has suggested that differences in price levels might be high. We surveyed the prices for several cancer drugs in European countries through the membership of the European Organization of Cancer Institutes (OECI) and Cancer Core Europe.7 A word-based survey was emailed to all full members of the OECI (n=51), both European Union (EU) members and non-EU members, and to the non-OECI member of Cancer Core Europe. The survey was sent to the board of the centre; for most centres the leading pharmacist responded, together with an oncologist. We asked centres to provide list or official and actual prices, corrected for VAT differences, and asked for information about central or government coordinated purchasing. The actual price was defined as the net price—ie, as price per one dose (eg, one 100 mg vial or one capsule of 12·5 mg) to allow for a comparison in case of different pack sizes. Any type of discount was taken into account because we asked the centres to provide us with the price they actually pay. We received a response from 21 centres from 15 countries. Most responses were received in June and July 2015. For some countries we received more than one response and from these we present an average.