There is huge variation in the price of cancer drugs in high-income countries, with some countries charged more than double the price others are expected to pay, the results of an international survey reveal.
The research, which was published online December 3 by Lancet Oncology, shows that the differences in the prices of novel cancer drugs between European countries and Australia and New Zealand range from more than 25% to almost 400%.
The study involved a review of drug pricing in 18 high-income countries with comparable pharmacological systems, report the authors, led by Sabine Vogler, PhD, of the WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies in Vienna, Austria.
These included 16 European countries (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland, and the United Kingdom) and Australia and New Zealand.
The investigators then selected 31 nongeneric cancer drugs that had been authorized for oncology indications in all of the chosen countries. Price data for all the 16 European countries were provided by the Pharma Price Information service of the Austrian Public Health Institute. For Australia and New Zealand, drug price data were obtained from their pharmaceutical schedules.
The results indicated that none of the drugs included in the survey had an average unit price lower than €10. Four drugs had a unit price of between €250 and €500, two drugs had a price of between €500 and €1000 per unit, and seven drugs had a unit price of more than €1000.
The priciest drugs included plerixafor (Mozobil, Genzyme), which is indicated for hematopoietic stem-cell transplantation in patients with lymphoma or multiple myeloma, and had an average unit price of €5824.25.
The differences in the prices of the drugs between the highest and lowest priced countries was between 28% and 50% for 10 drugs, between 50% and 100% for 16 drugs, and between 100% and 200% for three drugs.
The difference in the prices between the highest- and lowest-priced countries was 388% for gemcitabine (€209.33 per vial in New Zealand and €42.91 in Australia) and 223% for interferon alfa-2b (€338.51 in Germany and €104.65 in Greece).
Overall, the UK and countries such as Greece, Portugal, and Spain paid the lowest average unit manufacturer price for cancer drugs, while Germany, Sweden, and Switzerland paid the highest prices.
The researchers note that it is difficult to obtain information on the actual prices paid for drugs rather than their list price. Their data did not include confidential discounts, which are increasingly common in countries such as Australia, Italy, the Netherlands, and the UK.
Dr Vogler explained in a release: "Although these agreements ensure patient access to new drugs, other countries risk overpaying when setting drug prices through the common practice of external price referencing, or international price comparison, because they can only use the official undiscounted prices as a benchmark. There needs to be far more transparency."
She added: "We hope that our findings will provide concrete evidence for policymakers to take action to address high prices and ensure more transparency in cancer drug pricing so that costs and access to new drugs does not depend on where a patient lives."
Measures to tackle the high prices of and variations in cancer drug prices could include cooperation between countries, Dr. Vogel told Medscape Medical News.
She said that joint procurement between countries "could be one option," although a specific procurement agency might not be necessary.
"A disclosure of confidential discounts used for many of the medicines would be another option," she added.
In an accompanying Comment, Wim H van Harten, MD, PhD, The Netherlands Cancer Institute, Amsterdam, Netherlands, presented the results of a survey emailed to all 51 members of the Organisation of European Cancer Institutes (OECI) and the one non-OECI Cancer Care Europe to determine the actual costs of cancer drugs in Europe.
They asked centers to provide the actual price they paid for several cancer drugs, and so took into account any type of discount that was obtained.
Twenty-one centers from 15 countries responded to the survey. The results showed that the actual prices paid by hospitals differed between countries by up to 58%.
For example, they found that the difference between the official price and the actual price for one 50-mg vial of ipilimumab was substantial in Spain, at €4086.54 and €2338.83, respectively, while the two prices were identical in France, at €3535.50.
"This calls for joint action by countries and medical societies with the pharmaceutical industry, since fast and equitable access to promising new drugs is important to improving treatment results," Dr van Harten writes.
Speaking to Medscape Medical News, Dr van Harten said that the figures suggest that "there seems to be space for reduction" in drug prices and that, based on their data, the reductions "might be considerable."
To achieve that, he believes that a mix of measures is required. "The more countries combine their purchasing power, the better the results; but timely access to new promising drugs is crucial for cancer patients."
One such solution might be a Europe-wide cancer drug purchasing body. "If such an agency could be initiated, it should also have the objective to negotiate speedily," Dr van Harten said.
He emphasized that oncologists also need to be transparent about their actual prescription policies. Furthermore, transparency is required from pharmaceutical companies over their cost structures and pricing policy, as well as from government purchasing agencies on their approach and results, and their additional funding of drugs.
"Even if prices are reduced by 50% there will still be need of extra funding," Dr van Harten pointed out, adding: "If cost-effectiveness calculations are based on list prices, they may produce unnecessary unfavorable results, as the costs in practice in other countries may be much lower."
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