Comparator Report on Cancer in Europe 2019 – Disease Burden, Costs and Access to Medicines

Hofmarcher T, Brådvik G, Svedman C, Lindgren P, Jönsson B and Wilking N

In a new report, the Swedish Institute for Health Economics (IHE) analyzes and compares the cancer situation in Europe. The report provides a comprehensive view of the development of cancer in Europe between 1995 and 2018. It highlights differences between European countries in terms of disease burden, costs, and patient access to new cancer medicines. It also describes the medical trends going forward and discusses some policy issues that will be important to address.

The report shows that the number of newly diagnosed cancer cases has increased by around 50% from 2.1 million to 3.1 million cases between 1995 and 2018 in Europe (EU28 + Iceland, Norway, Switzerland). The number of deaths from cancer has increased by around 20% from 1.2 million to 1.4 million deaths during the same period. The slower increase in the number of deaths than in the number of newly diagnosed cases is a positive sign. Continuous increases in 5-year survival rates for the most common cancer types in all countries are a reflection of this development. However, large differences in survival rates remain between countries; wealthier countries typically have higher survival rates than poorer countries.

How can the cancer situation be improved in the future?
A major challenge is population aging. Cancer is an aging-associated disease and population aging will continue to exert an upward pressure on the number of newly diagnosed cancer cases. However, around 40–45% of all cancer cases are estimated to be preventable. The increasing trend in cancer incidence needs to be met by a stronger focus on primary prevention and screening.

Cancer research has been fundamental to achieving improvements in survival, by leading to advances in screening, diagnostics, and medical treatment. Medical oncology entered a new phase in the 21st century with novel medicines targeting countless newly-identified molecular targets. The latest major development is activating the body’s own immune system to attack the tumor. Cancer research has resulted in a distinct increase in the number of approved cancer medicines and indications in recent years. Around 10 new medicines were approved by the EMA every year in 2012–2018, compared to around 4 new medicines per year in 2001–2011.

Innovations in cancer treatment can only produce benefits if they reach patients in clinical practice, which requires increases in health care spending. The health expenditure spent on cancer care doubled from €52 billion to €103 billion in Europe between 1995 and 2018 (in 2018 prices and exchange rates). Despite this growth and an increased spending on cancer medicines, the overall health spending on cancer care has remained relatively stable at around 4–7 percent of total health expenditure.

There are great differences in patient access to new cancer medicines, in particular between wealthier and poorer countries. This pattern has not changed over time. The access problem requires collaboration between policy makers, payers, regulators, HTA bodies, and manufacturers. Local solutions seem most feasible to share the risk and reward of new treatment options between payers and manufacturers and to reflect the affordability levels of different countries. Novel methods for pricing, valuation, and payment have been proposed to ensure access to recent developments such as CAR T-cell therapies and combination and multi-indication treatments. This is important in order to incentivize future innovation for the benefit of patients.

This report was commissioned and funded by EFPIA – the European Federation of Pharmaceutical Industries and Associations.

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The EFPIA view


Previously published IHE Reports on cancer in Europe
:
Jönsson B, Hofmarcher T, Lindgren P and Wilking N
Comparator report on patient access to cancer medicines in Europe revisited
Lund, Sweden: IHE Report 2016:4

Jönsson B, Persson U and Wilking N
Innovative treatments for cancer in Europe – Value, cost and access
Lund, Sweden: IHE Report 2016:2

Hofmarcher T, Jönsson B and Wilking N
Access to high-quality oncology care across Europe
Lund, Sweden: IHE Report 2014:2


IHE Report 2019:7, IHE: Lund, Sweden