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Access to cancer medicines and trials vary across Europe

Monday September 21st 2020

Access to cancer medicines varies widely across Europe both for new drugs in development and for currently approved drugs, a conference has heard.

Research found that countries in Western Europe run a higher number of clinical trials for novel cancer treatments than those in Eastern and Central European and there were significant differences in access to new treatments in development for cancer patients.

The research has been presented to the conference of the European Society of Medical Oncology this weekend.

Study co-author Dr Teresa Amaral, from University Hospital Tubingen, Germany, told the conference: “Our study gives us proof of what we previously suspected: that there is a huge asymmetry in the number of clinical trials for cancer treatments in different countries.

“Having access to clinical trials confers several benefits to cancer patients. It means they can potentially access novel therapies earlier during the trial phase rather than having to wait for licensing and reimbursement. Also, all trial participants benefit from the regular follow-up and monitoring involved in taking part in a clinical study.”

The researchers analysed the Clinicaltrials.gov database for interventional clinical trials in adults with tumours between 2009 and 2019.

They examined the number of trials in 34 European countries and found that Albania had the lowest number of active clinical trials for cancer at 0.14 clinical trials per 100 000 population, while Belgium had the highest number at 11.06 per 100 000.

They also established that the number of oncology clinical trials in European countries increased by 33% between 2010 and 2018, with a 61% increase in early phase trials compared with a 7% increase in late-phase trials.

Professor Thomas Cerny, professor of medical oncology at the University of Berne, Switzerland and member of the ESMO Principles of Clinical Trials and Systemic Therapy Faculty, said: “A higher number of phase I trials is a sign of more active research going on in a particular country, with the appropriate infrastructure and necessary incentives to conduct clinical trials.

"And the only way to develop new cancer drugs is to be able to put patients into clinical trials. The difference in the number of clinical trials per head of population, with more trials in wealthier countries, means access to clinical trials and innovative drugs is just not possible for cancer patients living in many less wealthy countries.”

A health economics analysis also reported at ESMO 2020 showed that wealthier European countries spent ten times as much as poorer countries on cancer medicines in 2018.

Lead author Dr Nils Wilking, from the Karolinska Institutet, Stockholm, Sweden, told delegates that estimated cancer-specific health expenditure for 31 countries – the EU-27 plus Iceland, Norway, Switzerland and the UK – using national figures for 2018, showed the top spenders on cancer medicines were Austria, Germany and Switzerland, with 90 to 108 Euro spending per capita; the lowest spenders were the Czech Republic, Latvia and Poland at 13 to 16 Euros per capita. The biggest differences in spending between countries were for immuno-oncology drugs.

Prof Wilking said: “There are two main factors accounting for the differences in spending on cancer medicines: one is shortage of money and the other is drugs not being approved for use by some healthcare systems.

“We need a model in which we incentivise innovation of valuable medicines through outcome-based payment models and consider a disease area and what a society is able to pay for treatment.”

Tags: Cancer | Europe | Pharmaceuticals

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