Comparison of Prices and Affordability of Cancer Medicines in 16 Countries in Europe and Latin America

Moye-Holz, Daniela; Vogler, Sabine

doi:10.1007/s40258-021-00670-4

Cited by 31 publications

(30 citation statements)

References 69 publications

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“…In terms of affordability, our results show that, in accordance with Moye-Holz and Vogler 2021, antineoplastic and immunomodulating agents, which include oncologics, are the most expensive substances even if they are regulated through a reference price [17]. Affordability in general is a growing concern of health systems worldwide, as access to medicines creates social value but creates policy challenges due to the high costs involved as well [18].…”

Section: Discussionsupporting

confidence: 71%

“…Only a small co-payment between 5 and 10€ has to be payed to collect the prescribed medicine from the pharmacy. Since Germany is a reference country for other European countries, with different coverage schemes for pharmaceuticals, high prices for pharmaceuticals do have a direct impact, potentially making pharmaceuticals unaffordable in other countries [ 17 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Prior research has also found that the affordability of pharmaceuticals varies through indication areas [12][13][14][15][16]. Moye-Holz and Vogler investigated the price setting of cancer drugs in 16 European and Latin American countries and showed that high-income countries report lower PPP-adjusted prices for cancer medicines than middle-income countries and therefore were more affordable [17]. argues that many prices for pharmaceuticals, especially for rare diseases, exceed value for money thresholds and affordability in North America and are not justified by research and development costs at all [18].…”

Section: Introductionmentioning

confidence: 99%

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Indication-wide drug pricing: Insights from the pharma market

Siegmeier¹,

Büssgen²

2022

J of Pharm Policy and Pract

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Background Pharmaceutical spending has been increasing rapidly for years and is higher than ever before. To control the rising costs, countries are implementing regulatory frameworks such as (internal) reference pricing, price cuts or generics substitution. Internal reference pricing establishes a reference price within a country which serves as the maximum level of reimbursement for a group of pharmaceuticals. Price setting in the German market is especially relevant for many European countries, which use Germany as a reference country for their own price setting. Methods We evaluate pharmaceutical price dynamics for not reference priced pharmaceuticals (NRPs) as well as for reference priced pharmaceuticals (RPs) in Germany—referring to the internal reference price system. 64,862 medication packs have been extracted from the German pharmaceutical pricing register Lauer-Taxe. For each pack, we extracted detailed data on the company, manufacturer rebates, pharmacy retail prices, reference prices, co-payments, import quotas, and discount agreements. We then investigated price setting and dynamics of NRPs vs. RPs for all 14 indication areas by ATC code level 1. Results The average manufacturer price per pack was 604.84€ for NRPs and 112.11€ for RPs. Similar differences were found for the wholesale price and the pharmacy retail price. The reference price was—as expected—0.00€ for NRPs, and 154.40€ for RPs. NRP packs were imported in 42.38%, while RP packs were imported only in 24.62%. Highest average pharmacy retail prices could be found in the therapeutic areas ‘antineoplastic and immunomodulating agents’ (1711.47€), ‘systemic hormonal preparations’ (1331.95€), and ‘blood and blood forming organs’ (1260.58€). We detected high fluctuations in pharmacy retail prices per indication, as well as for reference prices per indication. The indications with the highest number of reference price regulated medical packs are ‘cardiovascular system’, ‘musculo-skeletal system’, and ‘nervous system’. Highest co-payments were found in the indications ‘antineoplastic and immunomodulating agents’, ‘blood and blood forming organs’, and ‘antiinfectives for systemic use’. Conclusion Price setting and price dynamics vary substantially between NRP and RP medication packs. Further, we saw major differences across all indication areas as well as when comparing medication packs launched by top 20 pharma companies vs. the rest.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Indication-wide drug pricing: Insights from the pharma market

Siegmeier¹,

Büssgen²

2022

J of Pharm Policy and Pract

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“…For example, in the GIDEON study, fewer patients with HCC from Latin America received TACE before sorafenib initiation versus the global cohort [75,76]. Also, Latin American countries have some differences in sorafenib cost, but almost all (except for Brazil) pay higher prices than high-income European countries [77]. There are some opportunities to cope with these issues: cost-effectiveness analyses and health technology assessment, collective negotiation, and the use of generics and biosimilars through the flexibility of patent laws [78].…”

Section: Socioeconomic Differences Healthcare Access and Treatments A...mentioning

confidence: 99%

Liver Diseases in Latin America: Current Status, Unmet Needs, and Opportunities for Improvement

Díaz

Ayares

Arnold

et al. 2022

Curr Treat Options Gastro

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Purpose of review To assess the current challenges regarding liver diseases, including the burden of disease, access to care, screening, and treatment needs in Latin America. Recent findings Latin America is a region with a rich multicultural heritage and important socioeconomic differences. The burden of liver diseases is high and mainly determined by a high level of alcohol intake and the surge of risk factors associated with NAFLD (i.e., sedentary lifestyles, broader access to highly processed foods, obesity, and type 2 diabetes mellitus). Hepatotropic viruses also play a role in the development of chronic liver diseases, although their comparative frequency has been decreasing over the last decades. There are important disparities in access to screening and treatment for liver diseases in Latin America, which are reflected in low accessLiver (E Tapper, Section Editor) to critical treatments such as direct-acting antiviral agents and drugs to treat hepatocellular carcinoma. Also, important barriers to liver transplantation are present in multiple countries, including a low deceased donors' rate and a lack of availability in several countries (especially in Central America). Our region also has disadvantages in research and education in liver diseases, which limits regional academic development and improvement in quality of care of liver diseases. Summary In order to tackle an increasing health burden due to liver diseases, Latin America urgently needs tailored interventions aiming to control the main risk factors for these disorders through the establishment of effective public health policies. Also, development of liver transplantation programs and improvement of medical education and research capabilities as well as extensive collaboration between all stakeholders are keys to address the liver disease agenda in the region. AbbreviationsACLF Acute-on-chronic liver failure ALD Alcohol-associated liver disease ALF Acute liver failure AUD Alcohol use disorder DALYs Disability-adjusted life-years DILI Drug-induced liver injury GDP Gross domestic product HBV Hepatitis B virus HCV Hepatitis C virus HDV Hepatitis delta virus HCC Hepatocellular carcinoma LT Liver transplantation MAFLD Metabolic dysfunction-associated fatty liver disease NAFLD Non-alcoholic fatty liver disease NASH Non-alcoholic steatohepatitis PHP Public health policies PNPLA3 Patatin-like phospholipase domain-containing 3 US United States USD United States Dollars WHO World Health Organization * Updated to 2019 + Updated to 2020 Country Population in 2019 GDP + Gini index* Life expectancy from birth (years)* Deceased donors' rate* DDLT rate* LDLT rate* Argentina 44,938,712

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“…For drugs approved by the US Food and Drug Administration (FDA) in 2018, the average price per patient per course was USD 150,384 [ 2 ] and is expected to increase even further with the introduction of more advanced treatment options (such as chimeric antigen receptor (CAR)-engineered T cell (CAR-T cell) therapy). The financial toxicity of expensive cancer drugs and concerns about affordability and sustainability have been raised in many developed and developing countries [ 3 , 4 , 5 , 6 ], while patients have spoken out in favor of quick access to cancer drugs [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

For Whom the Price Escalates: High Price and Uncertain Value of Cancer Drugs

Shin

Kwon

Bae

2022

IJERPH

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The price of cancer drugs has skyrocketed, yet it is not clear whether their value is commensurate with their price. More cancer drugs are approved under expedited review, which considers less rigorous clinical evidence, yet only 20% of them show an overall survival gain in the confirmatory trial. Moreover, clinical data are often generated based on small, single-arm studies with surrogate outcomes, challenging economic evaluation. With their high price and uncertain (marginal) clinical value, cancer drugs are frequently rejected by health technology assessment (HTA) bodies. Therefore, agencies, including the UK’s National Institute for Health and Care Excellence (NICE), have adopted cancer drug funds (CDF) or risk-sharing schemes to provide extra access for expensive cancer drugs which fail to meet NICE’s cost effectiveness threshold. With rising pricing and fewer new cancer medications with novel mechanisms of action, it is unclear if newly marketed cancer therapies address unmet clinical needs or whether we are paying too much. Transparency, equity, innovativeness, and sustainability are all harmed by a “special” approach for cancer medications. If early access is allowed, confirmatory trials within a certain time frame and economic evaluation should be conducted, and label changes or disinvestment should be carried out based on those evaluations.

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Comparison of Prices and Affordability of Cancer Medicines in 16 Countries in Europe and Latin America

Cited by 31 publications

References 69 publications

Indication-wide drug pricing: Insights from the pharma market

Indication-wide drug pricing: Insights from the pharma market

Liver Diseases in Latin America: Current Status, Unmet Needs, and Opportunities for Improvement

For Whom the Price Escalates: High Price and Uncertain Value of Cancer Drugs

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