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Mini Oral - Public policy

1588MO_PR - A comparative study on costs of cancer and access to medicines in Europe


18 Sep 2020


Mini Oral - Public policy


Bioethical Principles and GCP

Tumour Site


Nils Wilking


Annals of Oncology (2020) 31 (suppl_4): S1142-S1215. 10.1016/annonc/annonc325


N. Wilking1, G. Brådvik2, P. Lindgren3, C. Svedman2, B. Jönsson4, T. Hofmarcher5

Author affiliations

  • 1 Oncology And Pathology, Karolinska Institutet, 11335 - Stockholm/SE
  • 2 The Swedish Institute For Health Economics, The Swedish Institute for Health Economics, 22002 - Lund/SE
  • 3 Karolinska Institutet, The Swedish Institute for Health Economics, 22002 - Lund/SE
  • 4 Economics, Stockholm School of Economics, 113 83 - Stockholm/SE
  • 5 Lund University, The Swedish Institute for Health Economics, 22002 - Lund/SE


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Abstract 1588MO_PR


Costs and value of new cancer treatments are often causing headlines without being discussed in a larger context. This study estimates the cost of cancer and access to medicines in Europe in 2018 and extends a previous analysis for 1995–2014.


Cancer-specific health expenditure for 31 countries (EU-27 plus Iceland, Norway, Switzerland, and the UK) were derived from national estimates. Data on cancer drug sales were obtained from IQVIA. Productivity loss from premature mortality was estimated from data from Eurostat and the WHO. Productivity loss from morbidity and informal care costs were estimated based on previous studies.


The total cost of cancer was €199 billion in 2018. Total costs ranged from €160 per capita in Romania to €578 in Switzerland (after adjustment for price differentials). Health expenditure on cancer care were €103 billion, of which €32 billion were spent on cancer drugs. Informal care costs were €26 billion. The total productivity loss was €70 billion, composed of €50 billion from premature mortality and €20 billion from morbidity. Patient access to cancer medicines was much greater in wealthier than poorer countries in 2018, in terms of value and volume. The top spenders were Austria, Germany, and Switzerland (€92 to €108 per capita), whereas Czechia, Latvia, and Poland spent the least (€13 to €16). The largest country differences were seen in immuno-oncology medicines. Between 1995 and 2018, cancer incidence increased by 50% in Europe, but cancer mortality increased only by 20%. Health spending on cancer doubled from €52 billion to €103 billion (in 2018 prices and exchange rates), but the share of cancer care on the total health expenditure remained stable at around 4–7%. A shift from treatment in inpatient care to ambulatory care has likely saved costs. Expenditure on cancer medicines tripled from €10 billion to €32 billion between 2005 and 2018 (excluding confidential rebates). Productivity loss from premature mortality decreased over time, linked to mortality reductions in working-age patients.


There are large and persistent country differences in spending on cancer care, access to new cancer medicines and outcomes in Europe. Inequalities are mainly related to countries’ economic strength and not to the disease burden of cancer.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The Swedish Institute for Health Economics, Lund, Sweden.


European Federation of Pharmaceutical Industries and Associations (EFPIA), Brussels, Belgium (unrestricted grant).


N. Wilking: Advisory/Consultancy, This study has been supported by an unrestricted grant from EFPIA: Bayer, BMS, EFPIA, Eisai, Oasmia, Roche, Sanofi. G. Brådvik; P. Lindgren; C. Svedman: Advisory/Consultancy, IHE conducts research and evaluations for a large number of for-profit health care companies: IHE and EFPIA (unrestricted grant). B. Jönsson: Advisory/Consultancy, IHE and EFPIA (unrestricted grant): Bayer, BMS, AZ, Allergan, Celgene, Jansen, Takeda, Vifor, Pfizer, Novartis. T. Hofmarcher: Advisory/Consultancy, IHE conducts research and evaluations for a large number of for-profit health care companies: IHE and EFPIA (unrestricted grant).

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