By Marcio Barra
A new report detailing patient access to cancer drugs across Europe has shed some light on the numbers for Portugal, and how does it compare to other countries.
The report, “Comparator report on patient access to cancer drugs in Europe revisited”, conducted by the Swedish Institute for Health Economics, gives an overview on the consumption and spending on cancer drugs across European countries, divided by cancer type. The report´s data encompasses 1995 to 2014.
Highlights of the report include:
- The number of people diagnosed with cancer continue to increase in Europe, with cancer incidence totaling 7 million in 2012, up by 30% from 1995.
- Mortality rates are going down in relative terms, owing to advances in cancer treatments available today. These include multimodal therapy approaches, improved care by multidisciplinary teams, and improved diagnostic and screening methods that have facilitated early detection of tumors.
- In Europe, sales of cancer drugs were € 8.0 billion in 2005 and € 19.8 billion in 2014. The top sellers in 2014 include trastuzumab (Herceptin and Kadcyla), rituximab (Mabthera) and imatinib (Glivec), which are soon to lose or have already lost exclusivity.
- Despite the increase in incidence of cancer and of the sales of cancer drugs between 2005 and 2014, the direct health cost of cancer has remained stable, at around 6.0 % of total health expenditure over the last twenty years. A shift from in-patient to ambulatory and home care and less toxic agents have supported this trend.
- France was the biggest spender on cancer drugs in 2005 but was surpassed by Germany in 2014.
- The direct health costs of cancer may have surpassed the indirect costs of cancer in 2014.
- The direct health cost of cancer per capita was €169 in Europe. After adjusting for differences in purchasing power parity, this value was the highest in Luxembourg with €311, followed by Central and Western European countries where it exceeded €200. In Southern European countries (except Portugal, which was at €76) the direct health cost was between €160 and €100.
- During the last 20 years, 98 new chemical entities for the treatment of cancer have been approved, 95 of these following EMA’s centralized procedure. Recent years have shown an increased number of cancer drug approvals.
- Many drug agents currently in the pipeline are immuno-oncology agents, which stimulate the body´s own immune system to attack the tumor.
- Uptake of new treatments is slow. New cancer drugs launched within the last three years make up only 8% of the total average sales, with the higher share in richer countries with higher payment power. Low national income and health care spending per capita are major obstacles in the access to new drugs.
- Most anti-tumor drugs are introduced in patients with late stage- or metastatic disease, where their magnitude of effect is seldom known, and adds uncertainty to the value of the drug. The report urges the creation of better pay for performance models, assisted by upcoming diagnostic tools, to better manage the uncertainty about the drug´s value.
One limitation of the report, as pointed out by the authors, is the lack of systematically collected data on spending in cancer care to provide detailed estimates of health care spending on cancer in all European countries.
Looking at Portugal, the total health expenditure with cancer was around 3.9% in 2014 (with total health expenditure in Portugal estimated at 9.7% of the GDP, or 20,395 million €, adjusted for purchasing power parity). This rounds up to 795 million € of direct health costs with cancer in Portugal. Data from 2006 showed that total health expenditure on cancer amounted to €565.03 million in 2006, while total health costs amounted to €14,500 million (in 2005), resulting in a share of 3.9%. Direct medical care expenditures include expenditures on hospitalization, ambulatory care, chemotherapy, radiotherapy, medical consultations and drugs, but not expenditures with screening and primary prevention measures, making these values underestimated.
It is worth mentioning that Portugal shows similar DDD per case usage to that of the richer countries in some cancer sub-types, such as breast cancer, lung cancer and chronic myeloid leukemia, which indicates a high uptake and access of cancer drugs. In the case of lung cancer, Portugal has one of the highest uptakes of new drugs, such as crizotinib (Xalkori), gefitinib (Iressa) and erlotinib (Tarceva).
In multiple myeloma, Portugal has the higher DDD per case usage of myeloma drugs among the Lower GDP/capita tier countries, and is similar to the Mid GDP/capita tier, with a high usage of thalidomide and lenalidomide. Bortezomib has just been recently launched for multiple myeloma, and there are several new treatments in the pipeline for multiple myeloma, making this area one of the most research intensive at the moment.
The Portuguese magazine “Sábado” investigated the report further, and shed some light on the costs that a Portuguese state-run cancer hospital has providing care and medication to its patients. Currently, the Portuguese Institute of Oncology (IPO) of Lisbon invests, in average, 70 to 100 thousand € in a year for each cancer patient, with some cases reaching 400 thousand €s.
A significant portion of these expenses goes to medication, with the Portuguese Institute of Oncology (IPO) of Lisbon spending more than €30 million each year to cover drug costs. The magazine took the opportunity to discuss the matter with Nuno Miranda, the director of the national program for oncologic diseases of the Direção-Geral da Saúde (General Health Directorate), and hematologist at the Lisbon IPO.
“When looking at other countries (in regards to access to oncologic agents), Portugal occupies an intermediary position. Indeed, in some areas it is one of the countries with the highest use of cancer medicines”.