Recently published as a Special Article in the flagship journal of the European Society of Medical Oncology (ESMO), Annals of Oncology, ESMO, in partnership with experts from the Union for International Cancer Control (UICC), The Institute of Cancer Policy (ICP) of King´s College London, and the European Society of Oncology Pharmacy (ESOP), conducted a survey to establish the current availability, out-of-pocket costs and accessibility of cancer medicines in 48 countries across Europe.
The study*, thanks to the intelligence gathering and collaboration of some 126 appointed field reporters, has evidenced that the accessibility, availability, and out of pocket costs of anti-cancer therapies differ immensely across Europe. The disparity is particularly profound between Eastern and Western Europe and most notable in countries with lower gross domestic product per capita. Findings also showed that the implications of such inequality most seriously impacts on patients with incurable disease where benefit and potential outcomes are dependent on access to both inexpensive and more expensive anti-cancer therapies. For cancer medicines in the curative setting, such as trastuzumab for example, the differences were markedly less.
“By demonstrating that the availability and accessibility of anti-cancer therapies is largely dependent on postcode as well as disease status and setting, it is increasingly clear that improving outcomes and the quality of life for cancer patients across Europe is not happening as equally, or as quickly, as it should”, observes Josep Tabernero, Director of VHIO and President-Elect of ESMO.
“Importantly, it´s not only down to the widely-debated issue of pricing. Results from this latest ESMO survey also identify a lack of equitable access and availability of even the most basic chemotherapeutics in some regions where supply is not meeting demand”, he continues.
Collectively this data should help guide health authorities across Europe to assess whether anti-cancer medicines are available to patients who are prescribed them. Identified shortages in established, essential, and effective therapies can then be tackled as a priority in order to improve clinical outcomes for an increasing number of patients across borders.
In terms of inequalities in access to more expensive anti-cancer medicines, the current reality is that not all novel therapies will be available and accessible to all patients. With limited resources, priorities will have to be made based on considerations such as performance, pricing and net clinical gain. ESMO’s duty, as a professional association, is to assist national institutions and individual oncologists alike in their clinical decision-making by defining the magnitude, value and efficacy of different diagnostic and treatment options as well as establishing the ´essentials´ for the optimal treatment of patients.
To deliver on these ambitions the Society is continuously expanding its intelligence gathering as well as further developing its portfolio of initiatives including its Magnitude of Clinical Benefit Scale (ESMO-MCBS), which has already been instrumental in independently grading novel cancer medicines that are proven as opposed to promising in terms of efficacy and clinical benefit. Consequently rated as high ´performers´ these medicines, to be incorporated in ESMO’s Clinical Practice Guidelines, will more likely be rapidly implemented by health authorities across Europe and thus become readily accessible to an increasing number of patients.
While ESMO´s Magnitude of Clinical Benefit of Scale does not tackle the pricing of EMA-approved anti-cancer medicines per se — it is not the role of the Society to define the right price for medicines, allocate budgets or set reimbursement mechanisms – the tool provides legislative bodies and decision makers with expanded, reliable and unbiased information on oncology treatments in order to facilitate more informed priority setting, as well as engage in, lead, and advance public policy debate surrounding the real value of cancer care.
Flanking these efforts is ESMO´s recently introduced Cancer Medicines Working Group which is dedicated to facilitating open discussion focused on the problem of medicine accessibility due to financial affordability as well as providing a more global model for more appropriately matched reimbursement based on value and regional economic parameters. The Group will engage with all stakeholders in oncology in order to formalise a series of concrete recommendations, models and tools that can be implemented and adapted according to ´local’ trends and the socio-economics of each individual country.
“These dedicated efforts, hand in hand with ESMO´s public policy program on the ground in Brussels, will aid the choice-taking that each country will need to make while firmly factoring in their respective economic and socio-political considerations. Only then will we collectively make the most appropriate treatments available and accessible for more cancer patients – regardless of their country of residence, specific location or individual circumstances”, says Fortunato Ciardiello, President of ESMO.
By continuing to provide a transparent and balanced picture from an independent perspective, ESMO is undoubtedly leading the way in triggering these must-have conversations and consequent actions. No country has unlimited resources and the key now will be to work together to prioritize and better guide informed decision making when it comes to facilitating access to approved therapies. The shaping of oncology policy towards facilitating equitable access to optimal, affordable care for patients throughout Europe and beyond quite literally begins ‘at home’. Decision makers will need to balance efficacy and reimbursement of anti-cancer therapies with regional realities.
“Knowledge is certainly power. Through its important portfolio of informative tools and resources, ESMO will continue to unmask real issues on a country by country basis and in so doing, target the problem areas that are restricting equitable access and availability of anti-cancer medicines for certain patients”, comments Ciardiello.
“While our patients all deserve optimal treatment and care, medical oncologists and cancer care providers rely on this necessary information to make more realistic, increasingly evidence-based decisions in order to make the best informed choices for their patients – with their patients”, concludes Tabernero.
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* Cherny N; Sullivan R; Torode J; Saar M; Eniu A. ESMO European Consortium Study on the availability, out-of-pocket costs and accessibility of antineoplastic medicines in Europe. Ann Oncol. 2016;27(8):1423-1443.
