Europe: drug access still unequal

Four years on from the original study, an update to the Karolinska Report has found that European patients still face unequal access to cancer treatment, depending on where they live. These inequalities and gaps in survival are particularly noticeable when comparing Eastern Europe with Northern and Western Europe. The report by Dr Nils Wilking, a clinical oncologist at the Karolinska Institutet, and Dr Bengt Jönsson, Professor of Health Economics at the Stockholm School of Economics, which is based on findings from the 27 EU countries (excluding Cyprus and Malta), Iceland, Norway and Switzerland, updates and improves on two earlier reports by the same authors in 2005 and 2007. The most recent report was supported by an unrestricted grant from the European Federation of Pharmaceutical Industries and Associations.

The report reveals that whereas cancer incidence is increasing, cancer mortality is decreasing, indicating the positive impact of screening programmes and improvements in treatments. "New treatments have made it possible to target diseases more effectively. For cancer patients, these newer therapies mean an improved quality of life, with less time spent in hospital and the chance to return to their day-to-day activities earlier," stated Wilking.

However the report highlights wide gaps in Europe in relative survival rates. For example, in Sweden 60.3 per cent of men and 61.7 per cent of women diagnosed with cancer survive compared to only 37.7 per cent of men and 49.3 per cent of women in the Czech Republic. EUROCARE 4 data also shows that for a similar incidence, cancer patients in Sweden have greater chances of survival than those in the UK. Healthcare systems in Europe are spending more on cancer, but this expenditure remains lower than the relative burden of cancer in comparison to other diseases.

Patients in Austria, France and Switzerland have the broadest access to newer cancer treatments while Poland, the Czech Republic and the UK continue to lag behind. Jönsson emphasised: "The inequalities, highlighted in our original report in 2005, still remain. For patients and society this is a real concern, as expectations are that all patients in Europe should have equal opportunity to access these treatments, particularly when evidence shows that access to cancer treatment is linked to an improvement in outcome".

The report authors urged policy-makers to take action and proposed new policies to improve treatment access for patients in Europe:

• adapt healthcare budgets generally and hospital budgets specifically to incorporate the introduction of new cancer drugs;
• introduce separate funding for cancer drugs, with or without requirements of an additional gathering of data;
• expedite (regulatory and economic) review times for innovative cancer drugs; and
• promote a European collaborative approach to collecting available scientific information for Health Technology Assessments (HTAs).

The number of cancer drugs has increased substantially over the last ten to 15 years, and it is likely that a further increase in the number of agents will be seen over the next five years. It is expected that the number of cancer drugs approved during 2007 and 2012 will be 50. With this influx of new technology and growing patient awareness of treatment options, already stretched healthcare budgets will come under increasing pressure to deliver. How HTAs play a part in this will be a major point of discussion.

Matthew Dennis - Editor, Cancer Drug News